Friday, February 22, 2008 - 12:10 posted by Blog Meister

Schools to Assume a More Active Role in Mental Health Equation

In the face of yet another horrible tragedy involving firearms and an unstable individual that left 7 Northern Illinois University students dead, many schools have publicly stated plans to plot a more proactive role in on-campus mental health issues. Conferences and school meetings across the country will soon attempt to determine the exact policies needed to deliver on these claims.

While NIU has experienced a tragedy, this individual case, in combination with the 2007 Virginia Tech tragedy, should not serve to focus criticism on the practice of prescribing medication. It should simply remind us of the crucial role that mental health services play on every single college campus. And if anything of substance arises from the inevitable focus group meetings that will attempt to design policy on this issue, some good may yet come from a heinous and absolutely unacceptable loss of innocent life.

Ideas have already sprung up from various institutions: in perhaps the most extreme example, Arizona State University floated the possibility of requiring all students to submit their mental health histories before attending classes. Though the intentions behind this proposal may be in the right place, it would probably create more problems than it would solve. ASU has not specified whether the plan would require such disclosures only from attending students or from all who apply. If such policies are adopted at this school and begin to become the norm (a very unlikely development at this point, but still one worth considering), some parties would inevitably either falsify their records or refrain from seeking treatment before applying due to concerns that any diagnoses or prescription records would hurt their chances of gaining acceptance to their schools of choice. The fact that a large percentage of students already have some sort of treatment history also implies a deluge of mostly useless paperwork; 1 in 4 citizens have experienced some form of mental illness, and the college entry process occurs at precisely the age at which these conditions usually begin in earnest.

The ASU proposal reflects on the uneasy balance that must be established between the act of protecting students and the need to prevent institutional paranoia that will end up punishing kids who pose no threat and further stigmatizing those who struggle with mental illness. Another developing idea is that of a Peer Corps, a formal organization composed solely of students who rely on each other for understanding and support relating to emotional and behavioral issues. Most young adults are far more likely to voice such personal concerns with their peers. The groups could be funded by the schools and run under strict guidelines like any other campus organization; in the case of possible emergencies, peers would have to refer others to health care professionals or call on security officials when needed to defuse any potential conflicts.

These groups would not in any way diminish the need for professional help on campus, and they would not keep students from visiting appointed counselors. On the contrary, they would help guide troubled students toward successful treatment plans and encourage them to schedule appointments with the appropriate individuals. This scenario is preferable to one in which students delay the act of seeking help due to institutional red tape or a fear of punishment, marginalization, and possible expulsion.

Most school officials understandably report that they have been scrutinizing the behavior of their students far more carefully in the months since Virginia Tech, and the NIU horror will only heighten this sense of anxious awareness. But, again, all must be sure that their concerns about the safety of their students do not compromise the educational experience of others. Mental illness on campus is a constantly shifting problem, not a simple task to be "solved." And the number one issue to be addressed is a need for increased funding and staffing. Sensitivity training for all teachers and faculty is also necessary, but we can't imagine that institutions will be better suited to confront the issue without an expanded resource base. Students should not have to wait for days or weeks to see a counselor. Time is, of course, limited, and every student with emotional concerns cannot see a therapist immediately. But reducing wait times and bureaucratic delays should be a top priority, especially if students are deemed to be potential problem cases. All involved parties will almost certainly agree with that sentiment; no one wants to explain that tragedies could have been averted if only the responsible individuals had received the proper attention when they most needed it.

Students should also try to get ahead of the curve: college applicants who've experienced any form of mental health treatment should carefully examine the resources of the schools to which they've applied and factor those components into all decisions regarding their academic futures. A stronger support net could make all the difference.

File Under: School Psychology
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Friday, February 22, 2008 - 12:09 posted by Blog Meister

Search For Easy Answers in the Wake of Violence Can Obscure Painful Truths

Northern Illinois University shooter Steven Kazmierczak was a diligent but troubled student of sociology. His worry about the interaction between society and the individual can be seen in a paper that he co-authored: "Self-injury in Correctional Settings: 'Pathology' of Prisons or of Prisoners?". This paper brings up the difficult question of whether destructive behavior in prisons is a result of the penal system rather than the individual. That is not the type of question that society wants to ask itself after a terrible tragedy; it is far easier to simplify a murder-suicide so that one manageable factor can carry all of the blame. The media scrambled to supply a simple cause for Kazmierczak's rampage. They quickly turned to the usual suspects: drugs, video games, and guns.

CNN ran the headline "Shooter was taking cocktail of 3 drugs", but it joined the majority of the media in focusing on one drug� Prozac. Kazmierczak's girlfriend set off the speculation by divulging that he stopped taking his prescribed dosage of Prozac approximately three weeks before the shooting. SSRI antidepressants are powerful drugs, and patients and doctors should be mindful of the possible side-effects and withdrawal symptoms. However, singling out Prozac is daft because it lingers in the body for longer than almost any other SSRI. If you stop taking a SSRI with a two day half-life, then the lurching transition may cause abnormal neural functioning as your brain struggles to adjust. But Prozac tapers off slowly, and symptoms are rare and usually mild.�Even if Kazmierczak's case was the rare one in which symptoms are severe, they would only be relatively harmless things like dizziness and irritability, not violence.

A sober warning about SSRI side-effects and withdrawal symptoms may be helpful, but such warnings often cross the line into dangerous panic. Here, almost every news story featured the fact of Prozac usage in their report, but few expounded on the psychopharmacological affect of Prozac withdrawal. What the public is left with are alarmist implications of "Prozac use leads to school shooting!" Hopefully, potential patients will not be swayed by this type of coverage, as it can only harm those in need of treatment. The real lesson to take away is that medication is only part of the battle against mental illness; therapy should always complement medication so that its use can be monitored and perhaps eventually made unnecessary.

The second blame game being played centers around video games. Despite a dearth of clear evidence that video games cause homicidal behavior, this is an accusation that reactionary politicians return to again and again. Sensing the beginning of yet another public outcry against games, attorney Jack Thompson jumped into the fray early with a letter to the university:

Pursuant to the Illinois Freedom of Information Act, I hereby request production of copies of all documents that reveal Steven Kazmierczak�s play of violent video games. Not limited to the use of his computer to play Counter-Strike.

The legal ramifications of this shooting may expand past video games to the right to bear arms. After the Virginia Tech shooting, legislation was introduced to restrict the access of the mentally ill to firearms. Measures such as this may save lives, but they unfairly lump all mentally ill together to brand them as dangerous. The public already holds greatly exaggerated views of the violent tendencies of schizophrenics, and blanket laws will only fuel that fear and perhaps spread it to more widespread disorders like depression. It is important to keep in mind that despite all the political posturing, it is impossible to determine what mental illnesses will lead to violence; Kazmierczak was a high-functioning patient with no indication of homicidal tendencies. Are we to prohibit anyone who has ever visited a psychiatrist from owning a gun?

If we cannot dump the blame on medication, video games, or guns, then what can we do? The hard-to-hear answer is that we have to do a better job at understanding and supporting those with mental difficulties, while accepting that we will never prevent 100% of the murders and suicides. Universities are complex environments with a variety of potentially destabilizing pressures, so only robust support systems can stop students from falling through the cracks.

File Under: School Psychology
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Friday, February 22, 2008 - 12:08 posted by Blog Meister

Teens, Parents Underestimate Weight Problems

More schools and communities are fighting against childhood obesity, but recent research illustrates one factor that may undercut efforts to help children who are obese or overweight live healthier lives. Parents of overweight children often do not see their child as overly heavy, and a study published in this month's Diabetes Care found that when parents underestimate the seriousness of a child's weight problem, the child tends to do the same.

A team of researchers from the University of North Carolina at Chapel Hill interviewed over 100 teenagers and their parents about the teens' weight, diet, and activity levels. The participants were asked to describe their child or themselves as very overweight, slightly overweight, about right, slightly thin, or very thin. All of the teenagers in this study had type 2 diabetes, a condition associated with excess weight, but parents and teens both generally perceived the teen's weight as less problematic that it actually was, and if the parent underestimated the weight problem, the teen was likely to follow suit. While 87% of the teens in the study were overweight, only 41% of parents described their child as very overweight, while only 35% of the teens saw themselves as very overweight. Many parents thought their child's weight was �about right,� and among these parents, 40% had children with a body mass index (BMI) that was at or above the 95th percentile. 55% of the teens who said their weight was �about right� had BMIs at or above the 95th percentile. Not surprisingly, parents and teens who did not recognize the severity of the teen's weight problem also tended to have poor diet and exercise habits.

In December, researchers from the University of Michigan provided other evidence that parents often fail to see their children's weight as problematic. They surveyed over 2,000 children and parents as part of the National Poll on Children�s Health conducted by C.S. Mott Children's Hospital. The poll's results showed that a quarter of children aged 6 through 11 were overweight or obese, but among the parents of these children, over 40% felt their child's weight was "about right." Only 13% of these parents felt that their child was overweight, and less than 10% felt concerned about their child's weight, which raises a central issue. If parents don't recognize the problem and don't feel concerned about it, they may not understand the necessity of helping their child modify their diet and other behaviors that may have contributed to their weight.

Overweight children and teens are likely to carry their excess weight into adulthood, and ensuring that these children and their parents recognize the severity of a weight problem may be a crucial step in helping them make healthy changes in their lives. Parents have a large influence over the behavior of their children and can provide support as their children move toward a healthier weight. And if the entire family commits to eating healthier food and engaging in more exercise, they will all feel the benefits of a healthy lifestyle.

File Under: Eating Healthy/ Eating Disorders
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Friday, February 22, 2008 - 12:07 posted by Blog Meister

Early Trauma Encourages Smoking

A 2005 study demonstrated that smokers are twice as likely to develop post-traumatic stress disorder when exposed to harrowing life events. The authors suggested that this link exists because nicotine warps the dopaminergic pathway necessary to respond adaptively to trauma. A new study coming out next month in the Journal of Adolescent Health flips the order of causation without breaking the chain by showing that trauma can raise the risk of smoking.

Researchers from Duke Medical Center looked at the effects of pre-sixth grade physical and mental trauma. 15,000 subjects between the ages of 16 and 22 were asked about adolescent incidences of violence and abuse. Those who reported such an incident were approximately twice as likely to start smoking in the year following the trauma. Many of the subjects reported being aware of a connection and stated that smoking provided a way for them to deal with their stress.

The finding that smoking seems to cause maladaptive stress behavior and that stress seems to lead to smoking suggests that both are related to the same stress and reward mechanism. It is not yet clear whether both smoking and trauma alter a healthy mechanism rather than just correlate with an impaired mechanism. For example, it could be that poor parenting raises the risk of both maladaptive stress response and addiction. Many confounding factors, such as parental education level, were accounted for, but others may remain.

The establishment of a robust link between smoking and stress may save many lives. Not only can counselors more closely monitor smokers who have been subjected to trauma, but children who have been abused can be given preemptive therapy to dissuade them from taking up smoking when safer drugs, or just a shoulder to lean on, would better stabilize them.

File Under: Adolesence
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Friday, February 22, 2008 - 11:36 posted by Blog Meister

Young Brains Process Fear Differently

Age may have some effect on how the brain processes memories of fearful experiences, according to research published in The Journal of Neuroscience. In studying the process of fear extinction in developing rats, researchers from the University of New South Wales in Sydney found that young rats, the equivalent of human children, processed memories of a fearful experience differently than older rats, the equivalent of adolescents.

The study examined the role played by the amygdala during memory extinction, the process of extinguishing a conditioned response to fear. The researchers trained rats, aged 16 days and 24 days, to associate a certain sound with a mild electric shock. When they then repeatedly created the sound without the associated shock, the rats' fearful reaction to the sound dissipated. Fear extinction does not destroy the memory of the experience, and the feared response can reoccur spontaneously. This has not been observed in young rats, however. In this study, the researchers searched for a different mechanism underlying fear extinction in young rats by testing the role of the amygdala, an area of the brain involved in memory and emotion.

The researchers repeated the process of conditioning and extinction twice. Both times, they used anesthesia to temporarily deactivate the rats' amygdalae. In the first trial, the researchers observed that deactivating the amygdala hindered the process of fear extinction in 16 day old and 23 day old rats. In the second trial, rats went through the process of conditioning and extinction and were then re-conditioned to and re-extinguished from the same stimulus. The amygdala was deactivated in only some of the rats. This time, the researchers observed that in 17 day old rats, only those with an active amygdala successfully completed extinction training, a further indication of the amygdala's involvement at this age. In 24 day old rats, however, fear extinction occurred whether or not the amygdala had been deactivated. The researchers determined that the age at which the initial extinction training occurred was important for later extinction training. Re-extinction training depended upon the amygdala for rats that initially underwent extinction training at age 17 days. For rats that did not undergo extinction training until they were aged 24 days, however, subsequent extinction trainings did not depend upon the amygdala.

For young rats, the amygdala appears to play a critical role in processing memories of fear, but the mechanism changes as the brain matures. These results provide further understanding of how the brain processes and extinguishes fearful memories, and as we continue to study these processes, we will better understand the biological factors underlying fear and how we can treat those hindered by fear.

File Under: Special Needs
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Friday, February 22, 2008 - 11:35 posted by Blog Meister

Antibodies During Pregnancy May Induce Autistic Behavior

The immune system is a zealous defender against small invaders, but it can sometimes turn against our own bodies. This possibility is especially frightening for pregnant mothers, whose immune systems may harm the fetus. We have written periodically about the building case that viruses during pregnancy can raise the risk of schizophrenia, and this month brings evidence that the immune system may contribute to another devastating mental disorder� autism.

David Amaral, research director of the UC Davis M.I.N.D. Institute, was tipped off to the danger of antibodies by the work of his colleague Judy Van de Water. Van de Water's work, which will appear next month in Neurotoxicology, demonstrated that when extracted from the mothers of autistic children, IgG is capable of damaging fetal brain proteins. IgG is the only type of antibody that can cross the placenta, making it the obvious suspect. Van de Water used a method called the "Western Blot" to figure out which IgG attack good cells. Interestingly, only 15-20% of women who gave birth to autistic children had these auto-antibodies.

Amaral collected large amounts of the dangerous IgG that Van de Water identified. When he injected these samples into pregnant monkeys, a glaring difference emerged in early childhood. All four monkeys from the experimental group displayed conspicuous stereotypies� repetitive movements like arm flapping that are common to autistics. These behaviors were especially pronounced when the monkeys faced the stress of a new environment. The group injected with normal human IgG showed no abnormal behavior.

Though his sample size was too small to allow firm conclusions, Amaral expressed confidence that larger studies will confirm the link between IgG and stereotypies. While that seems plausible, it will be much more difficult to prove that IgG is the sole cause of autism. For one thing, stereotypies are just one of three main symptom categories; social impairment was minor in the monkeys, and they did not know sign language so could not be evaluated for language impairment. Secondly, Van de Water�s experiments only showed a connection to the IgG of mothers with regressive, not early onset, autism, and not even all of these mothers had the auto-antibodies.

In an interview with us, Amaral agreed that autism is probably caused by multiple mechanisms, but he offered an intriguing way that his experiment could still be consistent with one mechanism. He explained that practical considerations limited the amount of auto-antibodies that could be extracted, requiring them to confine their injections to the last half of the second trimester. It is quite possible that this was the period of fetal development where only motor functions are vulnerable, and that social and language functions would have been impaired if injections had been sustained throughout pregnancy.

These findings have important implications for treatment. It was already known that mothers who have one autistic child have a much higher chance of having another, but that elevated risk is only around 10%-20%. Now that dangerous IgG has been identified as a possible antigen, doctors could conceivably give mothers a much more specific warning. While the warning alone will be helpful, Amaral believes that techniques like plasmapheresis, a type of blood transfusion, will eventually be able to restore the womb to the status of nurturing haven.

File Under: Autism, Asperger's, PDD
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Friday, February 22, 2008 - 11:33 posted by Blog Meister

Further Evidence of Bullying's Destructive Impact

Children victimized by bullies are at risk for serious psychiatric problems and often experience anxiety, depression, and thoughts of suicide. While bullying may have a large impact on the mental health of these children, its precise role has remained cloudy. Researchers have surmised that some factors, such as genetics or the child's home environment, could increase a child's chances both of becoming a victim and developing mental disorders. In a recent study involving over 1,000 pairs of English and Welsh twins, researchers from King's College in London addressed these explanations for the correlation between bullying and mental health problems. Their findings provide further evidence of the harm bullying causes to children's mental health.

The researchers collected information from the twins' mothers and teachers when they were 7 and again when they were 10, identifying those who experienced bullying. The study defined bullying as behavior that occurred often, was difficult to stop, and could include actions such as saying hurtful things, purposefully ignoring or excluding someone, physically hurting someone, and spreading rumors. 28% of the children had been bullied between the ages of 7 and 9. In 180 twin pairs, both twins had been bullied, while in 253 twin pairs, only one twin had been bullied.

In examining the effect of bullying on mental health, the researchers focused specifically on symptoms of internalizing problems. These symptoms, which can include worrying, crying frequently, and feeling guilty, occur when negative feelings are turned inward. They indicate that a child is at risk for psychiatric conditions, especially mood and anxiety disorders. In a previous study, the researchers noted an association between bullying and internalizing problems.

Overall, pairs of twins who had been bullied displayed more internalizing symptoms at age 10 than pairs of twins who had not been bullied. These results were also true of twin pairs in which one twin had been a victim of bullying and the other had not. The researchers further investigated the association between bullying and mental health by narrowing their analysis to include only data from the identical twins within the study. Once again, twins who had been bullied experienced more internalizing symptoms than their non-bullied identical siblings. Because these twins share their genetic makeup and home environment, these results indicate that in this sample, bullying affected mental health independent of these factors. The results remained statistically significant when the researchers controlled for internalizing symptoms that the children had displayed at age 7.

This study adds more evidence to the theory that bullying has a damaging affect on mental health and can contribute to internalizing symptoms. However, the researchers stress that other circumstances, such as a poor family situation, can still be just as detrimental to a child's well-being. In many cases, bullying may be only one factor among many influencing a child's mental health. We must recognize the large impact that bullying has on children and work to not only prevent bullying, but to also help victims of bullying cope with their experiences.

File Under: Bullying/Victimization
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Friday, February 22, 2008 - 11:32 posted by Blog Meister

Toddlers Exposed to Terror Develop More Emotional, Behavioral Problems

The after-effects of the horrendous destruction visited upon the United States on September 11, 2001 have yet to be fully assessed. Despite the absolute glut of stories that have appeared in nearly every single broadcast program or publication in the world in the subsequent 6 1/2 years, most of the information regarding the country's mental fitness following the terrible event has been of a speculative nature.

Many Americans were forced to perform the unfortunate task of explaining what had happened that day to their young children, most of whom realized that something monumental had occurred but could not quite process the details and all that they implied. But thousands of children were within miles of the attacks as they occurred; many in lower Manhattan had just arrived at school when the attacks began, and most first received the news from their teachers. Victims too young to rationalize unfolding tragedies may be even more vulnerable to their emotionally crippling impact, but clinical study has yet to fully explore this subject in relation to the 9/11 attacks despite a few very in-depth analytical reports. Researchers at New York's Mount Sinai School of Medicine recently attempted to remedy this dearth of data at a time when the political news cycle reminds Americans of these tragedies nearly every day and all aspects of the attacks and their lingering aftermath warrant serious ongoing study. By interviewing the parents of preschool children who had been living in downtown Manhattan on September 11 in the 35 months following the tragedy, the researchers attempted to construct a larger portrait of underaged Americans' response to terrorism and draw larger conclusions about the youngest victims of large-scale trauma.

Various reports stated that a majority of children living in the general vicinity experienced some form of stress reaction in the period immediately following 9/11, and almost half of the area parents surveyed in the weeks immediately following the attacks reported that their children feared for their own safety or that of loved ones regardless of their distance from the actual events. Diagnostic percentages obviously cannot capture the true toll of such events - whether children display symptoms sufficient for PTSD or depression, most have been profoundly affected by what they've seen. As the Department of Health and Human Services posits on their site, "no one who sees a disaster is untouched by it." And how could a thinking person not be?

Thanks, in large part, to the power of live television and other media outlets, thousands of citizens who were nowhere near the World Trade Center or the Pentagon on that horrific day reported increased anxiety, insomnia and disturbing dreams in its wake. At least half of the American population watched more than 8 hours of 9/11 coverage on television in the days immediately following the attacks. A considerable number of city dwellers receded into their apartments accompanied by little beyond than television and paranoia (14.7% of all Manhattan residents below 110th street displayed symptoms amounting to either PTSD or major depression diagnoses in the weeks after the attacks, but these numbers do not necessarily include the more severe late-onset forms of the condition. Among citizens living below Canal Street in closer vicinity to the WTC site, prevalence rates were as high as 20%). A significant number of citizens also reported more frequently using tobacco, alcohol and illicit drugs during that period. Among all citizens: "61 percent of those living within one hundred miles of the World Trade Center exhibited substantial stress reactions, compared to 36 percent of those living more than one thousand miles away."

As the most recent study showed, the WTC attacks led to considerably higher rates of behavioral and emotional problems on their own: of the 119 children involved in the study (average age approximately 4 years), nearly 1 in 4 had witnessed "high-intensity" events related to the attack (severely injured or deceased people, desperate victims leaping from the building, the structures themselves collapsing). Those kids were 5 times as likely to report sleep problems and 3 times as likely to experience notable symptoms of depression and anxiety than those who did not directly witness the most horrific elements of the attack. But when combined with other, unrelated traumas, these numbers grew considerably larger: kids who witnessed the horrors of the WTC attack directly and also experienced some sort of independent trauma during the same period were 16 times more likely to experience attention problems and 21 times more likely to report symptoms of emotional instability, anxiety or depression than those who were not directly exposed.

How can we explain this pattern? The findings, according to researchers, fall under the allostatic load theory of stress: in summary, the burden of multiple traumas is far greater than the sum of their parts. Children reeling from, for example, the death of a grandparent, a parental separation, or a major move would therefore be far more susceptible to the influence of a terrorist attack, especially when they witness the devastation firsthand. We've addressed the issue of depression and PTSD in the wake of major tragedy, concluding that psychosocial health should be part of our national security investment; one does not need to be directly involved in a terrorist attack or field of combat to suffer from its adverse influence. And the most tragic victims of these senseless attacks are the most innocent: those too young to even begin to understand why.

File Under: Mood Issues (Depression, Anxiety, etc.)
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Friday, February 22, 2008 - 11:32 posted by Blog Meister

Genes Counter Depression Spawned by Child Abuse

In another major finding on the relationship between genetic predisposition and mental illness, researchers have identified a link between malformations of a particular stress hormone receptor and a reduced likelihood that victims of child abuse will develop severe depression later in life.

Biology plays a significant role in determining one's stress response, and an inefficient ability to counteract various stressors forms one of the foundations of clinical depression; as anxiety builds over time, it facilitates chronic conditions. Corticotropin-releasing hormone (CRH), a chemical that serves to help regulate the stress response of the body and brain, is the central player in this new equation. The variation in question occurs in CRH's receptor protein; receptors facilitate the process of hormonal transmission by effectively catching the chemical messengers and binding them to target areas. Serious stressors signal the release of "stress hormone" cortisol by the adrenal gland, and the presence of inordinate amounts of the chemical throws the brain and body into "fight or flight" mode. In affected individuals, that process is skewed - the stress hormone can't adequately attach itself to the areas of the brain to which it travels. This proves beneficial in the sense that, without this key interaction, the young brain's development cannot be as heavily influenced by the consistent overabundance of cortisol, which can condition the individual into a more-or-less constant state of anxiety that carries into adulthood.

The majority of abused children, exposed to inordinate amounts of stress and� significant threats to their well-being, develop hypersensitive response systems that leave them even more vulnerable to a litany of mental health issues headed by the gold standard: depression. But study subjects displaying this genetic abnormality only displayed approximately 50% of the symptoms experienced by control patients. This is not to say that their condition in any way mitigated the unimaginable pain of abuse, but their mature neurologies were not shaped by the experience to such a great degree; they were, essentially, more resilient to the abuse because their brains could not fully process the intense anxieties that it created. The good news: the polymorphisms occurred in approximately 1/3 of the subject pool, meaning that many individuals are naturally less susceptible to the development of chronic conditions stemming from child abuse.

The first group studied by researchers were 422 adults who were all from low-income backgrounds and a majority of whom were African-American; in order to further solidify their study, they ran the same tests on a group of 199 more affluent and largely caucasian subjects. Their results were nearly identical, implying that the polymorphism trumps ethnic heritage and socioeconomic status in predicting the course of adult mental illness. The relevance of this finding cannot be overstated, as it is not uncommon for adults who suffer from severe chronic depression to have suffered child abuse in some way (this holds particularly true among women). Depression is almost a foregone conclusion for victims of recurring child abuse. But researchers can�very conceivably use this data to develop medications that make use of the CRH factor to better counter depression in individuals who've suffered such severe traumas. They may even be able, with time, to offer a pre-emptive treatment strategy.

File Under: Bullying/Victimization
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Friday, February 22, 2008 - 11:31 posted by Blog Meister

Genetic Variation Linked to Antisocial Behavior in ADHD Kids

Behavioral problems are present in about half of ADHD cases, and children who struggle with antisocial behavior in addition to the primary symptoms of ADHD, which most often include hyperactivity, impulsiveness, or inattention, are at risk for many detrimental actions. They may grapple with substance abuse, academic failure, or criminal behavior, and these experiences can have lifelong consequences. In a new study, which was published in this month's Archives of General Psychiatry, researchers examined a common genetic variation thought to contribute to antisocial behavior in children with ADHD. Their findings demonstrate that children with a variation of the catechol O-methyltransferase gene (COMT) are more likely to engage in violent or aggressive acts and are at risk for committing crimes.

The researchers analyzed data from three separate studies: the Cardiff ADHD Genetic Study, which involved 376 Welsh and English children with ADHD, the Environmental Risk Study, a cohort study involving over 2,000 British twins born between 1994 and 1995 (with an ADHD prevalence of 8%), and the Dunedin Longitudinal Study, another cohort study that involved over 1,000 New Zealander children born between 1972 and 1973 (with an ADHD prevalence of 6%). The researchers assessed the subjects of the Cardiff ADHD Genetic Study for symptoms of conduct disorder, which include fighting, setting fires, and stealing. They assessed the subjects of the Environmental Risk Study and the Dunedin Longitudinal Study for aggressive and violent behaviors similar to the symptoms of conduct disorder.

Using DNA samples, the researchers divided the subjects into groups based on variations in the COMT gene. They identified those with two alleles of the amino acid methionine (Met/Met), those with two alleles of the amino acid valine (Val/Val), and those with one allele of each (Val/Met). Among subjects from the Cardiff ADHD Genetic Study, those with two copies of the Val allele were most likely to display antisocial symptoms. This susceptibility to aggression and violence was also observed among subjects of the two cohort studies. Again, those who had been diagnosed with ADHD and also possessed two copies of the Val allele were most at risk for these behaviors. Using these two studies, the researchers found no association between this genetic variation and antisocial behavior among those not diagnosed with ADHD. These associations remained significant after the researchers controlled for the severity of ADHD symptoms and IQ score.

With data from the Dunedin Longitudinal Study, the researchers also compared the criminal behavior of those with ADHD to that of those without the condition. Overall, 20% of these subjects had been convicted of a crime. Those with ADHD who also had two copies of the Val allele were more than twice as likely to have been convicted of a crime. Again, the researchers found no association between the Val allele and criminal behavior among subjects who had not been diagnosed with ADHD, an indication that this variation in COMT does not correlate to antisocial behavior in the general population. Rather, the genetic variation may interact with other genetic factors underlying ADHD.

The interaction of genetics and environmental factors plays a large role in the development of ADHD, and there are likely many other influences involved in the antisocial behavior accompanying some cases of ADHD. The results of this study provide further evidence that identifying those at risk for aggressive or violent behavior could be possible, and in doing so we might be able to facilitate earlier treatment.

File Under: Attention Deficit Hyperactivity Disorder (ADHD)
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Friday, February 22, 2008 - 11:30 posted by Blog Meister

New Way of Detecting Fetal Alcohol Syndrome

Fetal Alcohol Syndrome, one of the leading causes of retardation, is associated with a number of glaring development problems, from facial abnormalities to aberrant behavior. Even with such signs available for diagnosis, FAS is often mistaken for a behavioral problem like ADHD, resulting in improper treatment. In addition to FAS, there are a whole range of Fetal Alcohol Spectrum Disorders that are much harder to diagnose. Fortunately, the February issue of Alcoholism: Clinical and Experimental Research features an article on a novel way to detect even subtle neural damage caused by alcohol exposure.

Dr. Sandra Jacobson examined 95 five-year-old children in Cape Town. All of these children were eventually evaluated for FAS and for prenatal alcohol exposure, but first the researchers attempted to train them in a simple eye-blinking task. A sound was accompanied over and over with a gust of air to the face, causing 86.7% of the healthy children to quickly make the Pavlovian association and thus blink every time they heard the sound. None of the FAS children learned the association, and very few of the alcohol exposed (but not FAS level) children learned to blink.

Dr. Jacobson determined that impaired Pavlovian response was unique to alcohol exposure by adjusting for IQ and by comparing alcohol exposed groups to groups with microcephaly from other causes. Microcephaly, meaning small brain, is a severe developmental problem that causes a long list of symptoms, the most important for this study being delayed motor function. If children with microcephaly learn to blink, then the blinking test really can be used as a reliable detector of the signature damage left by alcohol.

This new detection method is valuable because, while there is no way to repair the devastation of FAS, the damage can be mitigated by assuring a nurturing environment for the child. If behavioral problems are wrongly attributed to other disorders or to personality, then damaging medication or punishment might be mistakenly used. Hopefully, the extra diagnoses that result from the blink test will help dissuade expectant mothers from drinking at all. While drinking in moderation may not bring obvious FAS, it does raise the risk of more cryptic neurological problems.

File Under: Parenting
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Monday, February 04, 2008 - 14:52 posted by Blog Meister

ADHD Kids Might Make for Bigger Bullies

Bullying is a cyclical phenomenon: the child who suffers the wrath of his peers is more likely to take out his own violent urges on smaller or less capable classmates. Call it a very twisted sort of revenge. But new research implies that bullies and their victims are even more closely intertwined than we'd been led to believe. Researchers have discovered that the kids who can't sit still, pay attention, or conform to basic social standards are far more likely to both attract abuse and dish it out.

So do bullies, victims and ADHD form an unholy co-dependent triad? Researchers in Stockholm followed more than 500 fourth-graders for one year. After interviewing parents and teachers, referring problem kids to neurologists for diagnoses and asking the children themselves about bullies, researchers found that those with ADHD symptoms and positive diagnoses were more than 4 times as likely to become bullies and a shocking 10 times as likely to suffer from the same.

Does the abuse encourage ADHD? It's a dubious proposition, but a child suffering from particularly brutal abuse at the hands of a bully could very conceivably have a harder time concentrating in class. And, in turn, bully-ish behavior may be the most obvious incarnation of the impulsivity and lack of self-control so common to ADHD patients. The fact that affected students often have trouble establishing social networks, feel isolated at school and end up forming their own smaller cliques more prone to misbehavior and substance abuse also supports the "ADHD makes bullies" theory. Some of the bitterness accumulated by these future tormentors stems from the fact that other students most likely mocked their academic and behavioral difficulties in the classroom. This study thankfully counters the stereotype of a bully as a single-minded aggressor motivated only by his (or her) own desire to inflict pain. The kids who punch, trip and tease in the halls and on the playground may very well suffer far worse at home. Previous research has also noted that autistic children are more likely to bully their peers, but only if their condition also includes ADHD symptoms.

What can concerned parents do? At what age is parental intervention a good idea? And do the parents of every ADHD child need to worry that their son or daughter will be pushing, punching and taunting other kids on the playground? First, parents should consider the fact that a majority of students will encounter, at the very least, light bullying or uninvited insults from fellow students at some point in their long journey through the school system. By no means is every ADHD child guaranteed to give or receive such abuse. But if children receive early ADHD diagnoses, they warrant increased attention�behavioral abnormalities could compromise their school experiences as well as those of their classmates.

Unfortunately, the concluding recommendations of this and other studies are vague and familar: develop greater lines of communication between parents, teachers, and school officials to determine the path most beneficial to affected kids; develop a careful framework to better organize their daily lives and allow for less unstructured time that could potentially be used in, let's say, unconstructive ways; combine family therapy and medication to remedy the bullies' behavioral problems. Ritalin, sadly, cannot counter aggression (some would argue that its stated benefits are questionable at best). And a good punch in the nose is likely to inspire only the same in response. We can't protect our children from every minor slight they might suffer at the hands of their peers. So the hallways just aren't safe nowadays...but then they never really were.

File Under: Bullying/Victimization
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Monday, February 04, 2008 - 14:51 posted by Blog Meister

Depression Screening Useful in Juvenile Justice System

Many of the youths who get funneled into the juvenile justice system are released without incarceration, only to find themselves in a more serious criminal, or mental health, institution as adults. While conspicuous behavior problems are often detected and addressed, there is no systematic evaluation of these kids for emotional problems. Highlighting the feasibility and importance of such evaluations, the Journal of Studies on Alcohol and Drugs published a study this month about depression screenings.

The study, conducted by the Bradley Hasbro Children's Research Center, evaluated 208 subjects arrested between the ages of 15 and 21, 27 of whom were diagnosed with depression. Subjects with depression were much more likely to abuse substances, engage in risky sexual behavior, and attempt suicide. These hazardous behaviors were predictable even at the first arrest, and the authors of the study believe that the link should be used to give more at-risk youth special attention. The danger from drug abuse and unsafe sex adds up; many of the older youths already had HIV. The state has limited resources, but it might be possible to short-circuit many destructive patterns if government counselors are assigned to the depressed youth most likely to become trapped in them.

It was not within the scope of this study to determine whether depression causes reckless behavior, or whether it merely correlates with it. Even if it is not the cause, it would still be worthwhile to screen for depression. Depression is not only a warning sign that reckless behavior is more likely, it also a crippling mental problem that is itself a problem worth addressing because it can drain all of the joy out of a life. Lifting the terrible burden of depression should be a high priority for the juvenile justice system, and simple evaluations like those employed by the Bradley Center can go far towards achieving that goal if they are made routine for every troubled youth entering the system.

File Under: Behavior/Conduct Disorders
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Monday, February 04, 2008 - 14:50 posted by Blog Meister

Psychoanalysis Effective for Some Autistic Children

Autism Spectrum Disorder's (ASD) broad and often puzzling range of symptomatic variations allows for an extremely flexible field of potential treatments, and a considerable myriad of approaches has taken shape in response to the recent boom in ASD diagnoses. Ranging from private schools and one-on-one speech therapists to specialized diets and entire family dynamics shaped by the condition's influence, these approaches draw on an overabundance of inconclusive research and subsequent pop trends that has created a subgroup that some specialists call "therapy moms" (in a jab at the ubiquitous "soccer moms" tag). These parents are so dedicated to trying various treatments until reaching an acceptable equation that they cannot be fully present in the lives of their children; autistic kids may have trouble speaking their minds and telling others what they want, but they still need the affection of their parents to better their own development.

Some treatment approaches are, inevitably, more successful and more generally accepted than others. And while the concept of psychotherapy to benefit autistic children is not absolutely new, it has drawn greater attention following an announcement by the American Psychoanalytic Association that calls for comprehensive screenings for all children by the age of two and recommends regular psychotherapy as an essential part of a treatment regime. The idea may seem, at first glance, unconventional, but the fact that professionals who specialize in reason and emotional expression can prove helpful to a child whose major disorder creates a disconnect between experience and the act of communication makes perfect sense.

Autism advocates of all stripes continue to stress the importance of early intervention; this guiding principle also applies to a therapy approach where experts believe they can mold the behaviors and perceptions of these children as they age. Some go so far as to call autism "reversible," claiming that this early treatment can all but eliminate irregularities in the autistic brain and demeanor, but such statements cannot be qualified in any way. We've simply come to believe, in the face of building evidence, that the condition is more malleable than previously thought. The therapy theory contradicts the long-held assumption that the developing brain is effectively held hostage by the disorder and that affected patients are lifelong victims whose symptoms must be accomodated rather than improved. The recommended course of psychoanalysis for autistic children is very intensive, with kids (and, most often, their parents) meeting a therapist three to four times a week. The idea driving this approach is that the therapist can translate the patient's behaviors, emotions and desires in order to help both parent and child understand them better and further more effective methods of communication. A very imprecise science to be sure, but interpersonal contact and reinforcement is what autistic children need more than anything else (even though they often fail to respond to it in conventional ways).

Also relevant is a treatment known as applied behavioral analysis (ABA), a very carefully organized approach with more extensive evidential backing than psychotherapy. ABA is a basic training framework that may be applied to many specific treatment plans; it gradually reinforces positive behaviors through rewards, foregoing the idea of punishment because it so rarely proves effective for autistic children. Under successful ABA plans children will slowly learn, via the granting and withholding of various rewards, how best to behave to the satisfaction of their parents and therapists. Many of these behavioral issues are extremely difficult for young autistic children to fully comprehend, and ABA essentially encourages them to act in acceptable ways through reinforcement rather than reason. Children should, with time, learn to better understand what makes certain behaviors more desirable than others and put these principles into play in their daily lives.

Dietary changes and special classes alone will most likely not lead to significant improvements among autistic children; their care is a heavy long-term investment. And behavioral analysis or regular personal therapy treatments may prove extremely frustrating. But they both aim at the root of the problem in its real-world incarnation, and skeptical parents may overcome their misgivings and attempt to apply these approaches to the ongoing treatment of their own children. In a still-largely-unexplored field, any novel proposals should be considered.

File Under: Autism, Asperger's, PDD
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Monday, February 04, 2008 - 14:48 posted by Blog Meister

Study of Finnish Cohort Provides ADHD Insight

In a series of articles published in the Journal of the American Academy of Child and Adolescent Psychiatry, a team of researchers from UCLA examine ADHD in Finnish teenagers. Led by Dr. Susan Smalley, the researchers used data from a longitudinal study of a Finnish cohort to investigate a number of issues associated with ADHD, including the cognitive functioning of teens with ADHD and genetic factors that may contribute to the disorder.

The Northern Finnish birth cohort, which has been studied since 1986, includes over 9,000 subjects. The UCLA researchers examined these subjects when they were between the ages of 16 and 18. Using a standardized survey to identify those who exhibited symptoms of ADHD, they created a subgroup of 457 subjects who were further evaluated for ADHD and other psychiatric disorders. The researchers estimated the prevalence of ADHD within the cohort to be 8.5%. Surprisingly, they noted that although medication is rarely used to treat ADHD in Finland, the appearance of ADHD in the Finnish cohort, including its symptoms, prevalence, and associated conditions, resembled the appearance of ADHD in America, where medication is commonly used. The researchers explain that medications used to treat ADHD are effective in the short-term but may be less effective as a long-term solution. Previous research has already demonstrated that the effectiveness of stimulants as a treatment for ADHD may diminish over time, and more research on this topic is necessary.

To examine the cognitive functioning of subjects with ADHD, the researchers used cognitive and behavioral tests. In particular, they assessed executive function deficits (EFD) in these subjects. EFD refers to deficiencies that affect aspects of cognition and behavior, including memory, attention, and motor skills. Past studies have found that EFDs occur frequently in people with ADHD. In the Finnish cohort, however, only half of the subjects with ADHD also had EFDs. Those with cognitive deficits did not show a greater amount of hyperactivity or inattention when compared to others with ADHD, and the researchers believe that current behavioral tests used to identify cognitive deficits do not effectively separate those with cognitive deficits from those without.

The study also looked at gene variations that the researchers believe may play a role in the development of ADHD. The researchers studied 13 genes, including genes in the dopamine pathways, which previous studies have shown may be involved with ADHD. Using 188 subjects with ADHD and 166 controls, they identified two genes within the dopamine pathways that appeared to increase an individual's risk for ADHD. These genes, called DBH and DRD2, were only studied within this specific cohort, and the researchers stress that the genes probably contributed only minimally to the subjects' risk for ADHD. However, the researchers also view this discovery as further evidence of the involvement of the dopamine pathway in ADHD.

Although this study may be limited because of its focus specifically on Finnish subjects, it still provides us with further information on ADHD and the underlying factors that may contribute to it. Although many aspects of ADHD remain elusive, research will allow us a clearer glimpse into the causes and consequences of this disorder. It is important that we continue to research ADHD and adapt our understanding of it as new information becomes available.

File Under: Attention Deficit Hyperactivity Disorder (ADHD)
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