The school near the GP practice where I work held an internet safety evening recently, subtitled “How to Keep Your Child Safe Online”. It was in the school hall, hosted by police officers, and explained the role of something called the “Child Exploitation and Online Protection Centre”. The blurb on the leaflet promised parents of children between five and 11 would learn more about the dangers of the internet, and in particular, social media. I’m not sure when it became normal for kids to have to cope with malicious online messages, and be savvy about paedophiles masquerading as peers. In Irresistible, Adam Alter makes the frightening case that even without these hazards, modern connectivity threatens the health of not just our children, but everyone.
A child I knew of killed herself after a humiliating post was shared widely around her school. An adolescent patient told me that he wakes three or four times each night to check his phone for messages, and struggles to concentrate in class. Last week a social worker told me that children in an “at-risk” family were being neglected – the mum lying on the sofa playing with her phone while the kids put themselves to bed. I know a six-year-old who walks with his hands held to his chest, thumbs blurred by movement, adopting his dad’s habitual posture, though he doesn’t yet have a phone.
Alter teaches marketing and psychology at New York University and wants to show us how smartphones, Netflix, and online games such as World of Warcraft are exquisitely and expensively engineered to hook us in. “As a kid I was terrified of drugs,” he writes. “I had a recurring nightmare that someone would force me to take heroin and that I’d become addicted.” It’s unsurprising he’s become a psychologist of addiction, and his intoxicant of choice is the internet. In a chapter subtitled “Never Get High on Your Own Supply” he makes the observation that neither Steve Jobs of Apple nor Evan Williams of Twitter have allowed their children to play with touch screens.
A couple of years ago a programmer called Kevin Holesh, worried that his own screen time was getting out of control, wrote an app called Moment, which tracks how long a user is interacting with a screen (it doesn’t count time on phone calls). The results were startling, even among those concerned enough to download the app: for 88% it was more than an hour a day, with the average being three hours. The typical user checked their phone 39 times in 24 hours. By comparison, in 2008, before smartphones became widespread, adults spent just 18 minutes a day on their phone.
Why does any of this matter? Surely time being informed, engaged and entertained by our phones is time well spent? Not necessarily: “life is more convenient than ever”, writes Alter, “but convenience has also weaponised temptation”. Childhood has changed. Alter quotes a young girl: “I don’t feel like a child any more… at the end of sixth grade [when all her peers got phones] I just stopped doing everything I normally did. Playing games, art recess, playing with toys, all of it, done.”
Etymologically speaking, to be addicted is to be a slave, and behavioural addiction is “a deep attachment to an experience that is harmful and difficult to do without”. Alter is good on the distinction between an addiction (the indulgence of which brings pleasure) and a compulsion (the indulgence of which merely brings relief from restless anxiety). For many of us, checking phones has become compulsive.
The middle part of Alter’s book is illuminating on the ways that designers engineer behavioural addiction. He examines goal-setting, and why users of Fitbits often exercise to the point of injury; the dangers of inconsistent but rewarding feedback (counting those “likes”); the importance of a sense of progress (such as counting followers, or advancing through a game). In a chapter emphasising gaming he examines the addictive power of escalating difficulty (remember Tetris?). There are a fascinating few pages on cliffhangers, and the power of streaming TV. As to social interaction: “a brain raised on online friendships can never fully adjust to interactions in the real world”, he writes, and refers to a 2012 paper, which suggested that a smartphone, placed idly in a room, can impoverish the relationship between two randomly assigned partners even if they don’t touch it. The paper concluded that “mobile communication devices such as phones may, by their mere presence, paradoxically hold the potential to facilitate as well as to disrupt human bonding and intimacy”, presumably because they represent the possibility of connection with absent others.
In the 1970s it was shown that pigeons would peck a bar more frenetically if the reward delivered was unpredictable. A squirrel monkey in a cage, with a wire into the pleasure centre of its brain, will ignore food and water in order to go on stimulating the wire. These neuropsychology experiments are well known, but Alter retells them to illustrate how the latest technology traps us in a lab cage of connectivity. For an addict, there’s little opportunity to escape.
Some will find this shrill and alarmist – new technology has always had its catastrophisers. It may have been that the girl who killed herself would have done so without the public shaming that followed her post; there have always been neglectful parents; my teenage patient might have struggled to concentrate without being woken by his phone. Socrates said that writing would make us all forgetful; Caxton’s printing press destroyed the economy of scribes; television was condemned for vulgarising and trivialising entertainment. Connectivity is here to stay, and Alter suggests that parents in conflict with their kids over it would do well to stay approachable, calm, informed and realistic, and remember that technology brings solutions along with problems. It’s easy to monitor usage or block certain sites, and have the likes and retweets hidden on your social media. It’s worth remembering, too, that the status quo won’t last long: tablet computers have only been around for seven years, smartphones for nine, and within 10 years both may well have gone the way of pagers.
What’s the next big thing? Probably virtual reality, currently in its infancy. Imagine how addictive news will be when you can walk alongside each foreign correspondent. Imagine how addictive games will be when they put you into the scene. Facebook paid $2bn for Oculus VR, and is investing heavily in its applications. Most of us have seen families out for a meal ignoring one another while each strokes a screen; a decade from now they may all be wearing headsets.
By Gavin Francis
26 February 2017
Gavin Francis’s Adventures in Human Being was winner of the Saltire prize for nonfiction last year.
• Irresistible by Adam Alter is published by Bodley Head
Adolescents with posttraumatic stress disorder (PTSD) symptoms are more likely to misidentify sad and angry faces as fearful, while teens with symptoms of conduct disorder tend to interpret sad faces as angry, finds a study by NYU's Steinhardt School of Culture, Education, and Human Development.
"Our findings suggest that exposure to stress and trauma can have acute emotional impacts that simply translate to misidentification of important affective cues," said Shabnam Javdani, assistant professor of applied psychology at NYU Steinhardt, who led the study with Naomi Sadeh of the University of Delaware. The study was published in the February issue of the journal Child and Adolescent Mental Health.
Research suggests that trauma increases the risk for the development of both PTSD and conduct disorder – a group of behavioral and emotional problems characterized by callousness or aggression towards others – in teens. These disorders, which often co-occur, have an immense impact on the well being and healthy development of adolescents; if left untreated, they increase the risk of hurting others or oneself, substance use, and mental health problems in adulthood.
Trauma has also been associated with an impaired ability to recognize facial expressions. Understanding facial expressions is critical for social functioning and communicating emotions. Earlier studies have found that youth with PTSD and conduct disorder symptoms have deficits in emotional processing that are associated with aggressive behavior and impaired social functioning. These interpersonal problems may be connected to youth misinterpreting social cues conveyed through facial expressions.
The researchers examined the effects of PTSD and conduct disorder symptoms on how youth with emotional and behavior problems process facial expressions. The study included 371 teens, ages 13-19, who were enrolled in therapeutic day schools in Chicago or Providence, R.I.
The teens completed a structured diagnostic assessment and a facial affect recognition task.
Seventeen percent of participants had at least one PTSD symptom, and 12.4 percent met the criteria for a PTSD diagnosis. Eighty-five percent of the teens studied had at least one conduct disorder symptom, and approximately 30 percent met the criteria for a diagnosis of conduct disorder. In addition, 17 percent of those studied had symptoms of both PTSD and conduct disorder.
The researchers found that youth with emotional and behavior problems generally had more difficulty accurately identifying angry faces than fearful or sad faces. However, when they looked at participants with PTSD or conduct disorder symptoms, their findings varied.
Higher levels of PTSD symptoms were associated with less accurate identification of angry faces compared with fearful and sad faces; specifically, youth with greater PTSD symptoms were more likely to mistake sad and angry emotions for fear.
"Fear is particularly relevant for understanding PTSD, as the disorder has been associated with a 'survival mode' of functioning characterized by an overactive fight-or-flight response and increased threat perception," Javdani said.
In contrast, teens with conduct disorder were more likely to misidentify sad faces, but did not have trouble recognizing angry or fearful faces. Conduct disorder symptoms were associated with mistaking sadness for anger, suggesting that youth with higher levels of conduct disorder interpret sad faces as angry and may be less effective at recognizing others' sadness, pain, and suffering.
"Difficulty interpreting displays of sadness and misidentifying sadness as anger may contribute to the impaired affective bonding, low empathy, and callous behavior observed in teens with conduct disorder," Javdani said.
The researchers point to potential treatment implications of their findings: enhancing the accuracy of recognizing facial expressions may be an important treatment goal for youth with symptoms of PTSD and conduct disorder.
Shabnam Javdani, Naomi Sadeh, Geri R. Donenberg, Erin M. Emerson, Christopher Houck, Larry K. Brown. Affect recognition among adolescents in therapeutic schools: relationships with posttraumatic stress disorder and conduct disorder symptoms. Child and Adolescent Mental Health, 2017; 22 (1): 42 DOI: 10.1111/camh.12198
21 February 2017
Children and youth who experience adversity during childhood may suffer serious psychological and psychiatric difficulties as a result. Adversity may range, for example, from chronic poverty to parents' mental health problems. A new special section published in the journal Child Development includes articles from 12 sets of experts on how interventions can be developed to maximize resilience among children experiencing adversity and improve outcomes for their families as well. The special section, "Developmental Research and Translational Science: Evidence-Based Interventions for At-Risk Youth and Families," edited by Drs. Suniya Luthar and Nancy Eisenberg, "distills robust findings to derive top priorities for interventions" intended to help those at-risk for psychological and psychiatric maladjustment.
Across the articles included in the special section, authors frequently noted that the well-being of the primary caregiver was an important focal point for intervention. The primary caregivers in most cases were mothers, and researchers noted that successful interventions needed to "ensure ongoing nurturance and support for mothers" through relational, interpersonal therapeutic approaches as well as supportive relationships in their everyday communities. A second focal issue was specific parenting behaviors: researchers found that averting harsh, insensitive behaviors in favor of nurturing, loving ones was very beneficial. Additionally, several authors provide strategies for how parents experiencing high stress levels can respond to their children's needs and demands with appropriate sensitivity rather than harshness. Third, Luthar and Eisenberg indicate that from the studies included in the special section, it is evident that interventions should foster self-regulation and coping skills among parents and their children, noting that parents often adjust their parenting strategies based on how regulated their child's behavior is or is not.
In their introduction, Luthar and Eisenberg highlight areas that need further attention in future prevention research. These include more attention to fathers and father-figures, adolescents and their parents, and interventions successful among specific ethnic minority groups. Furthermore, the studies underscore the need to strive for outcomes related to everyday competence (i.e., academic achievement, healthy choices) and altruistic behaviors like compassion as "children who are prosocial and sympathetic toward others tend to be socially competent, well regulated, low in externalizing problems, and express more positive emotion."
The special section articles also suggest that future work must focus on developing intervention programs in community settings, particularly using a "deployment focused model" where interventions are developed and tested in the very settings they are ultimately intended to support, and not just in university laboratory settings. There has been much success, for example, from interventions implemented in schools, where efforts are to promote the well-being of not just students but also of their teachers, who serve important socializing functions and are themselves at high risk for burnout.
The special section includes a practical summary table which can be used to guide the development of interventions for different populations. Interventions targeted different groups of at-risk families including, but not limited to:
Finally, in order to achieve large-scale implementation of such programs that science has shown to be beneficial, Luthar and Eisenberg recommend shifts in national funding priorities.
"We do know what helps kids and what hurts them, and how best to intervene," Luthar said. "The problem is that we have not, in parallel, directed resources toward taking these evidence-based interventions to large scale. This must change. If we are to truly help today's vulnerable children and families, there has to be greater commitment of resources to ensure that promising programs are readily accessible to those most in need, and that these programs are implemented with high quality and fidelity to treatment procedures."
Suniya S. Luthar, Nancy Eisenberg. Resilient Adaptation Among At-Risk Children: Harnessing Science Toward Maximizing Salutary Environments. Child Development, 2017; DOI: 10.1111/cdev.12737
21 February 2017
Source: Society for Research in Child Development
Do you believe that all people should tell the truth all of the time? Do you believe it’s always wrong to lie? Most people hold this belief, whether from a moral, religious or ethical point of view. Parents seem especially convinced of this immutable position for their children.
But let’s take this out of the realm of parenting and children for a moment. Have you ever told a lie? Are you lying right now when you tell me you have never lied? All people do it. Sometimes you lie to protect another person’s feelings, or to protect against potential consequences, including the effect it might have on your wallet. Some people tell lies to the IRS to avoid paying taxes. Others may have finally decided to stop being deceitful because their frequent lying harmed a relationship, hurt their reputation or bothered their conscience.
If you know all people lie, and even admit to yourself that you have told lies, why do you hope, expect and teach your children not to lie? One of the reasons parents may be so insistent their kids tell the truth is that children are often able to lie and get away with it. This can have consequences which go beyond a parent’s reprimand, from leaving children more vulnerable to risks they may encounter without proper supervision to damaging relationships.
The purpose of lying is to get what you want without getting caught. When a child lies, and gets away with it, your daughter gets to hang out at the mall even though you’ve told her not to. Or your son rides his bicycle through the forbidden woods that is his shortcut. And when children don't get caught lying, they're able to maintain the approval and respect of their parents.
What is a parent to do? How can you make your children tell the truth? You can’t!
Children want what they want, just like adults. But children also want their parents to love, accept and approve and be proud of them as well. Lying, like any behavior, is an attempt to get what we want and need.
If you’ve ever tried punishing your child for lying, you know that this often doesn’t work. Instead children become sneakier and better liars. Also, as a caveat, you shouldn’t punish young children for telling tall tales. That’s because it’s normal for your toddler or pre-school-age child to avoid telling the truth. You probably even know when your child is telling an unlikely story. Asking a young child to discern the truth from a story is asking too much. You rely on this magic when you tell your children about Santa Claus and the tooth fairy. Your child relies on this magic, too. And it’s important to encourage kids’ to use their imagination.
For older, school-age children, what you can do is influence them to become people who tell the truth. You can help your child become a person of integrity, where her word is her bond, and help ensure your child’s honor and reputation remain intact. Because your child seeks your love and approval, you are able to influence you child to tell the truth instead of lying. But this needs to be talked about and taught. It won’t happen by accident.
Teach your children about the difference between telling the truth and telling a lie. Ask them, “How do you feel inside when you know you have told me something that isn’t true? Does it feel good that you got away with it? Does it also feel bad and are you sad that you’ve stolen a piece of the trust I have in you?”
Ask your child to please tell you the truth, especially at times you think lying might be an option your child is considering. You don’t have to threaten, just make the request: “This might be a time when you are considering telling me a lie instead of the truth. I’d appreciate it if you would tell me the truth. Then together we can work out what to do next.” Remember, you can’t force your child to be truthful.
Avoid telling lies yourself. If you have real examples from your life when you were tempted to tell a lie but avoided it, bring this up as part of the family’s normal, casual conversation: “My boss asked me if I had completed the report she’s been asking me for today. I’m almost finished but wanted to lie and tell her yes, just so she’d get off my back. But then I realized that was silly. I told her the truth: ‘I’m almost done.’”
Read books and tell stories about the internal struggle to lie or tell the truth. The boy who cried wolf is probably the best known tale about this moral dilemma. However, there are many more. Ask your librarian to help you find age-appropriate stories on the subject for your child. Current events provide many examples of people in all walks of life who have been caught in a lie, or cheating. Remember the Georgia teachers who were accused of lying about students’ test results and got caught? Talking about these kinds of news stories is a great opportunity to have a family discussion about honesty, lying, cheating and telling the truth. Instead of moralizing, ask your teenager her opinion, and encourage your preteen to share his thoughts.
Honesty and trust need to be talked about, connected, respected and celebrated. Help your child understand that trust is a gift you give freely. Help your child understand that when he lies, or she is dishonest, your willingness to trust your child is damaged. One lie, one moment of dishonesty does not destroy your trust. But repeated moments of dishonesty and lying really harm the relationship you have with each other. Point out that you would expect the same in return; if you lie or cheat, you know your child will be less likely to trust you.
Help your child learn through your shared experiences that telling the truth is best because it strengthens your relationship. Ultimately, you have a great deal of influence when it comes to helping your child become the honest, trustworthy person you hoped to raise.
By Nancy Buck
8 February 2017
A new study of German school students stresses the importance of children having enough break times and chances to relax and reflect, for their motivation and well-being.
For experts in children’s well-being it may come as no surprise, but there can never be enough evidence of the fact that children need sufficient free time for themselves to find motivation for any kind of learning, especially at school.
“We need more time in which we can relax and reflect upon ourselves”, says Michaela Brohm-Badry, who is a Professor for Empiric Education Studies at the University of Trier. In her study with over 1000 pupils from both elementary and high schools in Trier she demonstrates that pupils were most motivated when they had a high level of self reflection.
“Schools should allow their pupils enough time to reflect upon themselves as well as upon the tasks they are supposed to do” is one of the conclusions of Professor Brohm-Badry’s study, and, as explains, it is important for the pupils that the school strengthens five areas of well-being:1) positive emotions such as hope, gratitude and warmth; 2) engagement in the subjects of their study; 3) positive relations that are sustaining and energising; 4) understanding of the rationale for their study: why are we doing this and what does this support in bigger picture?; and, last but not least, 5) feelings of success and achievement: that their activities have results.
‘Professor for happiness’
Professor Brohm-Badry, who has been dubbed the “Professor for Happiness” in media articles reporting on her insights for motivation, criticizes the prevalent paradigm of achievement mainly concentrated on competition and efficiency. Her work reveals the limitations of the dominant formula, wherein ‘Achievement is work divided through time’. To find motivation in the first place, and to sustain it, she says it is necessary to add “well-being”. Thus, her improved formula goes like this: ‘Achievement is work times well-being divided through time’.
Professor Brohm-Badry hopes that her research helps to improve the situation of learning at schools. She not only publishes her results on various channels but also trains teachers to reflect more on the sources of student motivation.
Another advocate for children to have more free time is the German brain researcher Gerald Hüther, well-known for his popular books on children’s brain function and its role in their development. He compares the brain with a big pharmacy cupboard, with lots of drawers in which the brain files different contents of knowledge. By doing certain activities like cycling, the brain opens certain drawers needed for this specific activity.
Pressure of achievement
In a state of first doing nothing specific, but reflecting and finding motivation – maybe to play or to tackle a task – the brain is likely to open all its drawers to find a creative combination of existing knowledge leading from a state of “focussed attention” to “perception and “awareness” – a state which is aspired and looked for by many adults who feel rather oppressed by the permanent pressure of achieving and optimising.
Hüther’s solution will please children’s play campaigners. He calls on everybody – adults and children alike – to play more and to spend more time in reflection: retracing our steps, for example, appreciating the environment, or just dwelling on our thoughts.
9 February 2017
Children have opinions. About everything. And often in today's world, the opinions of children are taking on more weight than the opinions of the adults. In the old days, it used to be that what mom and dad said went. End of conversation. Today, however most parents strive to entitle their child to an opinion and in order to show respect and compassion, and listen to it intently. The question is, is giving children an opinion or a say so in things the best way to parent? And how much weight should your child’s opinion carry.
The disappearing trend of using ‘Because I said so,’ as the final argument for all things that parents don’t want to discuss with their kids is not something extremely new. As parenting experts have emerged from the shadows of the counseling world, parents have learned that tolerance and acceptance are important roles in being a supportive parent. Hard core discipline like spanking and setting your foot down, have dissipated and made room for families to have a more cooperative relationship that often means giving children an opinion on everything. Still, there isn’t a parent today who doesn’t feel the pressure to blurt out the words, ‘because I said so,’ from time to time. Giving kids too many choices and too many chances to voice their opinions can make it hard to decide simple things like where to go to dinner. By the same token, being mom and dad should come with rights of your own, such as making a decision that cannot be rebuked by an 8 year old.
The easiest way to balance your authority with compassion for your child’s feelings and opinion is to teach your child how to discuss things. Giving your child an opinion, doesn’t mean that they should have the right to argue or debate when and how they do their homework or the rules of the house. However, they should be encouraged to talk about their feelings. For instance, if you feel like your child should do their homework right when they get home from school, because you know if they don’t it won’t get done than that should be the rule. If your child feels this is unfair, then allow them to discuss it with you and explain to them why things are the way they are. If you are extremely liberal you could at some point, give children a chance to prove themselves worthy of playing before doing homework. The point is that both parties are listening to each other and both feel valued for their input. Ultimately, however it is the parent’s job to make the rules.
Listening to your child and allowing them to give their opinion on things, doesn’t mean that they can rant and rave like uncaged lunatics. Respect is a two way street and children shouldn’t be taught that their opinion, in every singular moment, is the most important thing that needs to be said. There is a time to talk and a time to be quiet and children must learn them both. If your child is asked to do something, or to be quiet then they should. Later, the two of you can talk to one another and they should feel welcome to state their opinion and get the attention they deserve. Another thing, giving your child an opinion, doesn’t mean you have to AGREE with them. Just because they feel a certain way, in no way means that you are a bad parent if you can see all the holes in their opinion. You also shouldn’t feel compelled to argue, debate or engage in a win lose argument with your child because your opinions differ.
The importance of allowing your child to voice and give their own opinion is that it helps them to think for themselves and gives them a feeling of empowerment. If children can voice concerns and talk about things at home, freely, without anger and disdain they will likely take these skills with them into the world. Giving your child a chance to voice their opinion, allows them to feel worthy, and shows that you have respect for your child. The parent child relationship takes on all sorts of dynamics and some of them, such as respect should be mutual. If children are constantly silenced by authority in their lives, they grow up feeling as though they have nothing important to add.
Parents do need to have balance though. It is good to feel a sense of giving your child an opinion, but it shouldn’t be the most important opinion in the home. Too often, parents want their children to be constantly happy, that they give in to their children’s wants and needs. Parents feel guilty that their child is pouting and spend too much time worrying that their child’s unhappiness for a decision of theirs, will result in a lack of a good relationship. If this is you, than you are teaching your children that their opinion is the MOST important one and giving them a false sense, that life will always go their way. In other words, you are spoiling them. Children learn a lot in life from being challenged perhaps even more than they do from being empowered. By balancing the listening and ensuring that your child listens to your opinion as well, you will raise a fair and respectful child.
When none of that seems to be working, and you and your child just agree to disagree you may have to go back to the old days of, ‘because I said so!’ Chances are, your children will learn to respect that as well, and no long term harm will be done.
By Stef Daniel
New research suggests that using physical or verbal abuse to punish a child may encourage risky behavior in adolescence, leading to lower educational attainment.
From an analysis of more than 1,000 students, researchers found that children exposed to harsh parenting were more likely to engage in delinquency and other negative behaviors as teenagers, which was associated with lower educational achievement by the age of 21.
Study leader Rochelle F. Hentges, of the Department of Psychology at the University of Pittsburgh, PA, and colleagues recently reported their findings in the journal Child Development.
This is not the first study to document the negative implications of harsh parenting - generally defined as shouting, hitting, or making physical or abusive threats as a form of punishment – on the psychosocial behavior of offspring.
One study published in PLOS One in 2014, for example, associated harsh parenting with greater risk of emotional and behavioral problems in offspring, while a more recent study published in the Journal of Family Psychology linked harsh parenting with poorer learning and lower academic achievement.
For their study, Hentges and colleagues set out to pinpoint the behaviors that might lead to lower educational attainment among individuals exposed to harsh parenting in childhood.
The researchers analyzed the data of 1,060 students from the Maryland Adolescent Development in Context Study, following them from the 7th grade until the age of 21.
Through the duration of the study, the students were required to report their exposure to harsh parenting, their social interaction with peers, sexual behavior, and delinquency.
The educational attainment of each student was assessed at the age of 21, determined through the number of school years completed.
"We believe our study is the first to use children's life histories as a framework to examine how parenting affects children's educational outcomes via relationships with peers, sexual behavior, and delinquency," notes Hentges.
Compared with students exposed to more lenient parenting in the 7th grade, students who were exposed to harsh parenting were more likely to deem their peers to be more important than other responsibilities – such as adhering to their parents' rules – in the 9th grade.
As a result, the team found that these harshly parented students were more likely to partake in risky behaviors in the 11th grade. These included more frequent sexual behavior, hitting, stealing, and other delinquencies.
These behaviors, in turn, were associated with low educational attainment at the age of 21.
Hentges hypothesizes that adolescents whose needs have not been met by their parents "may seek validation from peers."
"This may include turning to peers in unhealthy ways, which may lead to increased aggression and delinquency, as well as early sexual behavior at the expense of long-term goals such as education," she adds.
Study co-author Ming-Te Wang, professor of psychology in education at the University of Pittsburgh, suggests that there are a number of interventions that might improve the educational attainment of youths who are subject to harsh parenting.
For example, these adolescents may benefit from teaching techniques that focus on hands-on learning or group activities, as well as programs that offer education and help in relation to sexual behavior, delinquency, and unhealthy relationships with peers.
By Honor Whiteman
8 February 2017
By 2020 one in three teenagers will have access to cancer treatment in England. Think about that: only one in three. There would be an outcry. It would be scandalous, horrifying, unacceptable.
It is not true, however. Unless you delete the word “cancer” and insert “mental health”, and then it is.
In medical terms, there is a treatment gap. The number of children and young people living with a diagnosable mental illness far exceeds the number who get any help. One in 10 children suffer a diagnosable mental illness, yet just one in four of them receive treatment. By 2020 the gap may close, a little, if plans in NHS England’s Five Year Forward View for Mental Health are realised, but only a little.
Over half of lifelong mental illness and distress shows its first signs in adolescence. We have an opportunity to do something to change people’s lives for the better and dramatically reduce the number of adults living with entrenched mental health problems. This is a great prize.
In her first major speech of 2017, Theresa May stressed the importance of prevention. Green papers on social justice, family and the role of schools in monitoring mental health and wellbeing are in the pipeline. But can the treatment gap be closed by scaling up access to treatment and providing more digital options alone? Where will the workforce come from to provide the extra services and sessions required?
What if we could reduce the number of people getting ill in the first place? What are the underlying causes of rising levels of mental distress in children and can we put in place measures that increase resilience and reduce risk? If so, what are the most promising approaches?
These are some of the questions Birmingham University is setting out to explore in its new policy commission. I will be chairing the commission, working with a range of experts, and together we are calling for evidence from non-governmental organisations, academics, public agencies, thinktanks, and people with lived experience of mental health issues across the UK and internationally.
I first outlined the ambitions of the university’s mental health commission in my inaugural lecture last autumn. Our ambition is to put together a new approach that looks beyond treatment and containment towards prevention and early intervention.
There is already some good evidence of what works in mental health promotion and illness prevention. As minister for mental health I commissioned the London School of Economics to review the evidence and rates of return on investment. Among the findings was that school-based social and emotional learning programmes return £84 for every £1 invested. However, often the “saving” does not land in the budget of those who must make the investment. Siloed budgets and misaligned institutional objectives get in the way.
Last year I wrote about my visit to New York to learn about Mayor Blasio’s mental health programme: NYC Thrive. Thrive is a city-wide action plan devised from a population health perspective. It is trying to break down some of the silos. It involves schools and colleges, housing providers, the police and businesses. Prevention and early intervention are at its heart.
The West Midlands has set out its ambitions in its own Thrive strategy and the mayor of London is also working on plans.
Over the next 12 months the commission will be taking evidence, looking at the most promising ideas and setting out the actions that government and other agencies can take to make the shift to an ethos of prevention.
By Paul Burstow
8 February 2017
At nine, Tom was so worried about not being able to do his class work that he kept running out of the school gates. More than once he tried to escape out of a first-floor window, convinced his teacher was criticising him. He is not alone – research among 700 children aged 10 and 11 for the mental-health charity Place2Be suggests almost two-thirds worry "all the time". Concerns about family and friends and fear of failing at school are the top causes of anxiety, says the charity.
The school referred Tom and his mother for counselling sessions, run by the charity at the school. Tom felt he could not learn and his mother could not get a job as she was so worried about what would happen if he ran home from school and found her gone. Tom was taught breathing exercises to control his anger and reduce his anxiety – techniques he used for the rest of his school career. "It helped me get through," he said. Eight years on he applied for a place on a performing arts course and says he owes his progress to the counselling sessions.
Place2Be surveyed children in the top primary year at 20 schools across England, Scotland and Wales at the end of 2016. The entire year group in each school took part. Their top concerns were:
Family well-being - 54%
Well-being of friends - 48%
School work - 41%
40% felt their worries got in the way of school work
Almost 30% said that once they started worrying they could not stop
21% said they did not know what to do when worried
There was a gender divide, with 36% of girls worrying about being bullied, compared with 22% of boys.
More girls (28%) worried about their looks than boys (18%).
But boys (24%) were more likely to worry about being angry than girls (16%).
The most common coping strategies were talking to family members (72%) or to friends (65%), while 65% of boys calmed themselves by playing computer games compared with 39% of girls.
More than 80% of the children surveyed said the best way for adults to help was to listen sympathetically and pupils said it was important to be kind to anxious classmates. "I give them a hug and tell them not to worry and everything is OK," said one 10-year-old.
The charity's chief executive, Catherine Roche, said primary school was often characterised as innocent and happy. "But in reality we know that young children can worry about a lot of things, whether it's something going on at home, with their friends, or even about bad things happening in the world.
"It's perfectly normal to worry from time to time, but if these worries become more serious or persistent, it's important that children know where they can turn for help. Schools and families play a crucial role in ensuring that children learn to look out for each other and know how to get help if they need it."
Some names have been changed
By Judith Burns
6 February 2017
A study that tracked hundreds of children from kindergarten through high school found that chronic or increasing levels of bullying were related to lower academic achievement, a dislike of school and low confidence by students in their own academic abilities, according to new research published by the American Psychological Association.
While pop culture often depicts more frequent bullying in high school, the study found that bullying was more severe and frequent in elementary school and tended to taper off for most students as they got older. However, 24 percent of the children in the study suffered chronic bullying throughout their school years, which was consistently related to lower academic achievement and less engagement in school, said lead researcher Gary Ladd, PhD, a psychology professor at Arizona State University.
"It's extremely disturbing how many children felt bullied at school," Ladd said. "For teachers and parents, it's important to know that victimization tends to decline as kids get older, but some children never stop suffering from bullying during their school years."
Most studies on bullying have tracked children for relatively short periods of time and focused on psychological effects, such as anxiety or depression. This is the first long-term study to track children for more than a decade from kindergarten through high school and analyze connections between bullying and academic achievement, Ladd said. The research, which was published online in the Journal of Educational Psychology, was part of the Pathways Project, a larger longitudinal study of children's social, psychological and academic adjustment in school that is supported by the National Institutes of Health.
The study, which began with 383 kindergarteners (190 boys, 193 girls) from public schools in Illinois, found several different trajectories for children related to bullying. Children who suffered chronic levels of bullying during their school years (24 percent of sample) had lower academic achievement, a greater dislike of school and less confidence in their academic abilities. Children who had experienced moderate bullying that increased later in their school years (18 percent) had findings similar to kids who were chronically bullied. However, children who suffered decreasing bullying (26 percent) showed fewer academic effects that were similar to youngsters who had experienced little or no bullying (32 percent), which revealed that some children could recover from bullying if it decreased. Boys were significantly more likely to suffer chronic or increasing bullying than girls.
"Some kids are able to escape victimization, and it looks like their school engagement and achievement does tend to recover," Ladd said. "That's a very hopeful message."
The researchers faced the difficult challenge of tracking children for more than a decade, from kindergarten through high school, as some families moved across the United States. The study began in school districts in Illinois, but the children were living in 24 states by the fifth year of the study. "People moved and we had to track them down all over the country," Ladd said. "We put people in cars or on planes to see these kids."
The study included annual surveys administered by researchers to the
children, teacher evaluations, and standardized reading and math test
scores. Children described their own experiences about bullying in questions
that asked whether they had been hit, picked on or verbally abused by other
kids. Some children may be more sensitive to bullying, with one child who is
shoved thinking it is bullying while another might think it is just playful,
but parents and teachers shouldn't dismiss what may seem like minor
bullying, Ladd said.
"Frequently, kids who are being victimized or abused by other kids don't want to talk about it," he said. "I worry most about sensitive kids who are not being taken seriously and who suffer in silence. They are being told that boys will be boys and girls will be girls and that this is just part of growing up."
The children from the study were followed into early adulthood, although researchers lost track of approximately one-quarter of the youngsters during the lengthy study. Approximately 77 percent of the children in the study were white, 18 percent were African-American, and 4 percent were Hispanic, biracial or had other backgrounds. Almost one-quarter of the children came from families with low annual incomes ($0- $20,000), 37 percent had low to middle incomes ($20,001-$50,000), and 39 percent had middle to high incomes (more than $50,000).
Schools should have anti-bullying programs, and parents should ask their children if they are being bullied or excluded at school, Ladd said. In the early years of the study, school administrators sometimes claimed there weren't any bullies or victims in their schools, but the researchers stopped hearing that view as bullying has received more attention nationwide, Ladd said.
"There has been a lot of consciousness raising and stories of children being bullied and committing suicide, and that has raised public concern," he said. "But more needs to be done to ensure that children aren't bullied, especially for kids who suffer in silence from chronic bullying throughout their school years."
30 January 2017
American Psychological Association
Between the unrest resulting from police brutality by white officers involving black men to protests over President Donald Trump’s travel ban affecting citizens from seven Muslim-majority nations, cultural and racial tensions are especially high in America today.
While adults are typically able to think through their stance on issues of race and culture – even as divisions remain among people of all ages – children have an even tougher time processing their views about what’s going on. Bias from the media, and even within our own communities, can have a much greater effect than previously thought, resulting in the development of embedded prejudice and racist behavior in children before they even comprehend what racism means.
Harvard University psychologist and racism expert Mahzarin Banaji found in her own research that children as young as 3 years of age are susceptible to racist behavior within a few days of being exposed to it. Children form biases early, and can quickly pick up on cues from adults as well as peers. Kids may be exposed to prejudiced attitudes at home, as well as at school. These learned biases can have a significant impact on how they perceive and treat others.
In the U.S. and around the world, such prejudices can affect how kids (as well as adults) treat others. The British Department of Education reports that approximately 20 children are suspended or expelled for serious acts of racism every day in the UK alone.
Often adolescent ethnic bullying is done under the guise of humor.
We’re all familiar with tasteless jokes based on racial or cultural stereotypes. To feel resolved of responsibility a person may say he didn’t mean anything by the joke or even note that his best friend is of a different race, or that she’s a racial minority herself. Others might simply say you’re being overly sensitive if you take issue with a bigoted wisecrack. We might even find ourselves laughing at those same jokes on occasion.
While this may appear harmless, being on the receiving end of racial humor can often have long-term adverse effects on one’s emotional psyche, self-worth and overall mental health.
While an adult with healthy self-esteem may have an easier time brushing off racism, for children or teenagers still trying to figure out where they fit in the world, being exposed to racism can inflict long-lasting emotional and mental damage.
According to recent studies and a 2015 review published in Plos One, there is a strong correlation between racism and poor health, increased levels of stress, depression, anxiety, aggression and even high blood pressure.
A University of Melbourne study found a strong correlation between racism and mental health outcomes. Having studied 461 individual cases of racism and their links to mental health issues, lead researcher Naomi Priest reports a significant and direct link on the impact racism has on children, and the way they view their self-worth later in life.
In another study published in the International Journal of Eating Disorders by researchers Dana Sahi Iyer and Nick Haslam, 86 percent of the South Asian-American women interviewed reported experiencing racism as children through bullying and teasing. As a result, they suffered from low self-esteem, depression, poor body image, eating disorders and other feelings of self-hatred.
As parents, the most impactful thing we can do is to prepare and empower our children to react appropriately when tough situations arise. By teaching our children to address these situations calmly and assertively, we put the power back into their hands. It’s important for children who experience racism to understand it’s not their fault.
By learning to confront the situation with calm assertiveness, and openly sharing their experiences with friends, authority figures and family, not only will our kids feel empowered, but they will also learn positive, non-violent ways to deal with negative situations. This will give them the confidence to stand up for themselves and those around them to ensure a better, brighter future.
By Shimi Kang
2 February 2017
Young people in juvenile detention or jail may suffer health effects that last well into adulthood, a pair of new studies suggests.
Together, they suggest incarcerated teens will face higher rates of depression, worse physical health, and a greater risk of sexually transmitted diseases, compared to other young Americans. Experts said the studies highlight a little-recognized fact: Youth incarceration is a public health problem.
The United States has the highest rate of "youth confinement" of any developed country, according to the advocacy group Campaign for Youth Justice. In 2013, out of every 100,000 minors, 173 were in confinement nationwide.
"Juvenile incarceration is its own hidden epidemic," said Ralph DiClemente of Emory University in Atlanta. DiClemente, a professor of public health, wrote an editorial accompanying the studies, published online Jan. 23 in the journal Pediatrics.
But until now, DiClemente said, little had been known about the long-term health of young people who move through the justice system. The new findings, he said, "show us that these young people have myriad health problems and risk behaviors, and that continues into adulthood."
In one study, researchers focused on more than 1,800 young people who had spent time in Chicago juvenile detention centers. Fourteen years later, those children – now around age 30 – had much higher-than-average odds of risky sexual behavior, such as having multiple partners within a few months.
In the other study, researchers used data from a government survey tracking the health of more than 14,000 Americans – starting in middle school or high school, and continuing up to age 34. During that time, 14 percent ended up in juvenile detention or jail by age 24. Overall, the study found, incarcerated young people showed more health problems between the ages of 24 and 34, versus other Americans their age.
Close to one-quarter – 23 percent – had depression symptoms, compared with 15 percent of other study participants. More than 52 percent rated their general health as no better than "fair," compared with 41 percent.
Of course, young people who end up in jail have many other things going on in their lives that could take a toll on their health, too.
And it's difficult to weed out the effects of incarceration itself, said study leader Dr. Elizabeth Barnert. "It's a mess, and we can't say that this is causal," said Barnert, an assistant professor of pediatrics at the University of California, Los Angeles.
But her team did account for a number of other factors, including race, income and parents' education levels. And incarcerated kids still showed higher long-term risks – especially if they'd been confined for more than one year.
According to Barnert, young people may actually get certain benefits during their time in detention – namely, access to health care. But, in the long run, she said, incarceration probably has negative consequences. "Is it a direct effect of incarceration? Is it because they can't get a job afterward? Is it the psychological effects and how you view yourself afterward?" Barnert said. "We don't know."
What is clear, she and DiClemente said, is that kids and young adults in the justice system are "vulnerable." And they return to the community with largely unmet health care and social needs.
DiClemente said there is a "window of opportunity" while young people are incarcerated, when they can be screened for health problems and risky behavior. To an extent, he said, that's happening: Kids may be screened and treated for a sexually transmitted disease, for example.
"But what's not done very well is risk-behavior reduction," DiClemente said. "What happens when they go back to their communities?"
There are no easy answers, he and Barnert said. Ultimately, "system-level reform" has to become a priority – as it has in Georgia, said DiClemente.
The state is implementing the Juvenile Detention Alternatives Initiative, a project of the nonprofit Annie E. Casey Foundation. It promotes alternatives to locking kids up – such as home confinement, day and evening reporting centers and shelter care. Around 300 U.S. counties have started the program, according to the Casey Foundation. And, the group says, those places have seen "dramatic" reductions in the number of kids in detention centers – with no signs of harming public safety.
"We don't want to relegate these kids to a life where they're not going to be able to reach their full potential," DiClemente said. "This is a social issue. It's a public health issue."
Barnert pointed to the well-documented racial disparities in Americans' health and involvement with the justice system. Black men are far more likely than whites to be incarcerated at some point. And that, Barnert said, may contribute to racial disparities in health as well.
By Amy Norton
23 January 2017