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USA

Weight Watchers for teens: Helpful or harmful?

Before age 12, Becca was a normal, happy Midwestern kid. She loved dancing and swimming, did well in school and giggled with friends over Starbucks Frappuccinos. After age 12, Becca was different. She only danced and swam to burn calories, had trouble focusing in school and retreated from friends who socialized over food.

The turning point, says Becca, who asked that her last name not be used to protect her privacy, was joining Weight Watchers. She signed up for the program a few years after her doctor had told her she needed to lose weight, since she exceeded what was considered a healthy range for her age group. Never mind that she was off the charts in height, too.

"It was instilled in me that something was wrong with me and that I was wrong because of the way I looked, and so I tried to change the way I looked," says Becca, a 26-year-old social media manager in Illinois. Cue more than 10 years of yo-yo dieting, social isolation and total preoccupation with food and weight. She lost her period and energy, her hair thinned and eventually, she learned she had an eating disorder. "It's taken me a lot of years of therapy to not see food in points, and see it as food," Becca says.

Becca is one of the outraged voices taking to social media in response to Weight Watchers' announcement that it's opening up its program to teens for free, beginning this summer. The initiative is one of several born from the company's new vision to "inspire healthy habits for life" by making its programs more accessible to people across ages, genders, geographic locations, income and more. Critics, who've used the hashtag #WakeUpWeightWatchers, say putting kids on diets sends the message that their worth is weight-based, and sets them up for a lifelong unhealthy relationship with food, if it doesn't set the stage for a full-blown eating disorder. Many have stories like Becca's.

"Generally speaking, the initial concern comes from our knowledge in the eating disorder field that dieting is a very established risk factor for disordered eating and eating disorders," says Claire Mysko, the CEO of the National Eating Disorder Association. She and others point to research like a 2016 clinical report from the American Academy of Pediatrics concluding that focusing on a healthy lifestyle, not weight, can help prevent both obesity and eating disorders in teens. Dieting has also been shown to affect metabolism in a way that makes long-term weight gain likely, so Weight Watchers' efforts will only backfire – or, from a business standpoint, succeed, some say.

"We have no long-term data that shows that trying to suppress kids' weight is successful at long-term weight suppression and improves their well-being," says Rebecca Scritchfield, a registered dietitian nutritionist in the District of Columbia and author of "Body Kindness: Transform your health from the inside out – and never say diet again."

What is related to kids' well-being, she says, is growing up in a household without "fat talk" – aka comments about weight, either directed toward someone or about someone. Kids whose families eat meals together regularly, too, tend to eat more fruits and vegetables, but aren't necessarily thinner. "Some kids are just born fat and are going to stay fat and it's called genetics," Scritchfield says. The important thing, she adds, is instilling in kids the type of self-worth and self-compassion that inspires self-care, whether or not that affects their weight. "This argument is not about keeping kids from improving their lives," Scritchfield says.

On many accounts, Weight Watchers and other health professionals agree. After all, today's Weight Watchers is "very, very different" from the program of 10 or even three years ago, says Stacie Sherer, the company's senior vice president of corporate communications.

"We know that the consumer mindset around health and wellness and weight has changed," says Sherer, who admits that the name "Weight Watchers" is unfortunate since watching weight no longer best represents what the brand is about.

Worries that such a program will set kids up for a lifetime of weight loss and gain aren't well-founded, she adds, since there's also research finding weight cycling doesn't have an effect on metabolism. Even if people do lose and regain weight, rejoining a program to help lose it again shouldn't be seen as a failure, but rather as a positive step toward better health just like rejoining a gym after getting out of shape, Sherer says. "Overweight and obesity are chronic conditions – it's not something you just fix" and never think about again, she says. "It's something that requires ongoing management."

"As a health professional, I really think that the studies show that overweight and obesity is not healthy and it can lead to long-term health problems, and I think it's good for people – even teens – to try to lose the weight if they can," Kris-Etherton says. "Maybe what they need is a very sensible weight-loss approach."

Whether Weight Watchers can provide that approach to teens remains to be seen. Most experts agree that to do more good than harm, the program would need to screen for eating disorders and eating disorder risk, and be overseen by highly-trained health professionals, not simply longtime Weight Watchers members. The enrolled teens would need to be self-motivated to participate in the program, and their physicians and families would need to support their involvement. And, the focus would need to be clearly on health, not weight.

In other words, Weight Watchers would have to be so meticulous about how the program is implemented and perceived that they might be better off leaving the task to someone else, says Meredith Dillon, a registered dietitian at Children's National Health System in the District of Columbia who specializes in diabetes prevention and management, and is also an expert panelist for the U.S. News Best Diets rankings. "The way Weight Watchers is set up now," she says, "they can't be careful enough."

By Anna Medaris Miller,

20 February 2018

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21 FEBRUARY

Canada: Self-esteem key to treating mental health

Improving how mental health patients perceive themselves could be critical in treating them, according to a study from the University of Waterloo.

The study found that youth with psychiatric disorders currently receiving inpatient services reported lower self-concept, particularly global self-worth, compared to those receiving outpatient services.

"This was the first study that examined youth with psychiatric disorder by comparing what type of service they were receiving and whether that was associated with self-concept," said Mark Ferro, the Canada Research Chair in Youth Mental Health and an assistant professor in the Faculty of Applied Health Sciences at Waterloo. "We know that global self-worth is lower in the inpatient group and we know from other research that lower self-concept is a precursor to other more serious mental health problems."

The study examined 47 youth aged 8-17 years who were receiving inpatient and outpatient psychiatric services at McMaster's Children Hospital in Hamilton. The participants' self-concept was measured using the Self-Perception Profile for Children and Adolescents.

Self-concept might be an important aspect to consider when implementing treatment programs to improve the mental health of youth who are hospitalized.

"Because youths who are in the inpatient service have a lower self-concept, therapies within their overall treatment program aiming to improve self-worth might be worthwhile," Ferro said. "Interventions to improve an individual's self-concept or self-perception would be complementary to some of the more pressing needs within child and youth inpatient psychiatric services."

The study, which was undertaken by Ferro and Hamilton Health Sciences bursary student Chris Choi, was recently published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry

20 February 2018 

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19 FEBRUARY

USA

Vaping, e-cigs and the health of our youth

No doubt, you've heard stories about teens vaping at school or at parties, and you've seen recent headlines like "JUUL Leading To More Teens Vaping At School," "E-Cigarettes: A Shiny Alternative To Smoking," and "Vaping Is The New High School Epidemic." Well, this vaping "epidemic" is likely much closer to home than many think.

An ever-increasing number of teens and preteens are vaping, or smoking "e-cigarettes," each day, and its popularity is growing exponentially. It's believed that over a quarter of all middle school students and three quarters of high school students have tried e-cigarettes. In fact, when recently studying e-cigarette use among teens, the National Institute on Drug Abuse didn't bother asking whether they were vaping; it asked what they were vaping.

And, now, parents and school administrators are playing catch up, trying to learn more about e-cigarettes and how they can affect children's health. To provide some guidance, last week, the Scarsdale School District hosted "Vaping, E-Cigs and the Health of Our Youth," a presentation by Dr. Richard Stumacher, chief of pulmonary and critical care at Northern Westchester Hospital, and a smoking cessation expert.

"There's a lot of media, there's a lot of imagery... that are trying to grab your attention and (say) that vaping is not smoking, that vaping is not poison..." Stumacher began, as he showed the audience various advertisements. But, he finished with one alternative message that illustrated his point of view: a depiction of e-cigarettes as "the next generation cigarette for the next generation addict."

The most recent "official" or FDA opinion of vaping is that while e-cigarettes aren't without health risks, they're likely to be far less harmful than conventional cigarettes; they may help adults who smoke conventional cigarettes to quit smoking; their long-term health effects aren't clear; and, among young people, e-cigarette use increases the risk of transitioning to conventional cigarettes. In addition, there's conclusive evidence that e-cigarettes are addictive and contain a host of harmful chemicals, including nicotine.

In addressing the oft-mentioned health "benefits" of e-cigarettes over conventional cigarettes, Stumacher explained that substituting e-cigarettes for conventional cigarettes can reduce users' exposure to toxins and carcinogens, and may reduce short-term adverse health effects. However, he said, "that does not mean healthy or safe; it just means that, over the short term, it's not so bad."

Stumacher's main concern is nicotine addiction in adolescents and teens. A powerful, mood-altering substance, nicotine quickly affects the brain, causing a release of dopamine, which results in a feeling of pleasure and calm. After about 20 minutes, the feeling begins to dissipate, often leading a smoker to continue cigarette use throughout the day. "Nicotine affects the area in the brain that governs judgment and decision-making; that is the last part of the brain to develop," he said. "It disrupts growth of brain circuits that control attention, learning and susceptibility to addiction, and increases the risk of psychiatric disorders, cognitive impairment and attention deficit."

Stumacher explained that it's easier to convince teens about the dangers of smoking conventional cigarettes since there's indisputable evidence about exposure to carcinogens, and links to lung and heart disease. However, the medical community is actually divided over the effects of e-cigarettes. In short, "there are people who are pro and anti-vaping; insufficient literature and medical research; and, as of yet, no evidence of disease directly caused by vaping," he said.

So, Stumacher took the opportunity to present what is known about the risks of e-cigarette use. There are some 42 chemicals present in e-cigarettes, 19 of which that are especially harmful. And, of over 51 brands tested, 92 percent contained at least one of these harmful substances. Besides nicotine, quite a few of them, like diacetyl, are used as flavoring. "While many of the people who are pro-vaping will say that the chemicals are safe for food consumption... my perspective is that while it may be safe to go into your stomach, it may not be safe to go in your lungs," he said.

This, along with the fact that e-cigarette use is strongly associated with future cigarette use, led Stumacher to advise, "The question is not whether vaping is safe; the real question is should we allow our youth to vape, and the answer is clearly no."

He continued by explaining different vaping delivery methods and "e-juices." "What are our kids using? They're using JUUL devices, which are like the iPhones of vaping," he said. All JUUL pods (cartridges that hold vaping liquid or 'e-juice') contain nicotine; there are no 'just flavoring' versions. One JUULpod is the equivalent of approximately 200 puffs, or one pack of cigarettes.

Most teens cite availability of "appealing flavors" as the primary reason to begin vaping. Countless e-juice flavors are available, ranging from vanilla custard, blueberry, cookie milk, and peanut butter and jelly, to menthol and traditional tobacco, with varying levels of nicotine strengths. "This is clearly aimed at our children," Stumacher said. "Non-nicotine flavored vaping liquate is a gross and obvious gateway product aimed at youth to enter the nicotine addiction marketplace... It's already a $5 billion industry; there is a significant amount of money to be made in turning your child into a nicotine addict."

He then passed around samples of JUULs and showed how vaping devices can vary in size and appearance. They can look like pens or conventional cigarettes, and so-called "mods" can be changed and personalized. Many teens begin with a JUUL "starter kit," which costs about $50.00. The kits contain USB ports and easily can be charged discreetly at home or school. JUUL pods are sold typically in packs of four, at a cost of $20, making them much cheaper than a $15 pack of cigarettes.

Advice for parents

"Stopping your child (from vaping) will prevent him or her from becoming enslaved by nicotine, which is the most addictive substance known to mankind," Stumacher said. He warned that increased vaping among youth will lead to devastating health issues in the decades to come. "We're going to see a tsunami of lung cancer and emphysema, heart disease, diabetes, etc., etc."

He then changed gears and provided parents with advice. "Alright, it's really not that bad; the kids aren't bad. They just don't know; they're not informed," he said, while urging parents to be patient and begin honest discussions with their teens. "Rather than yell at them or accuse them, just have conversations – frequent, small conversations. Your children are not going to, all of a sudden, decide they're not going to vape, especially if they're vaping nicotine."

Stumacher stressed that parents need to educate themselves, and begin open dialogues with children, not lecture them. He suggested beginning with a conversation in the car: "Your kid isn't looking you in the eye and there will be an end to the talk... " as opposed to a discussion at home that may go on and on, leading your child to tune out. Other tips include setting a positive example by being tobacco-free, preparing for questions that your teen may have about the health effects of vaping, and finding the right moment to discuss the issue, perhaps when seeing someone use an e-cigarette.

Another tactic is to simply prove the power of addiction. "None of the kids who vape want to go on to smoking. They think it's disgusting," Stumacher said. "If you think (your child) is a nicotine addict, suggest he or she go longer without vaping, and see how it feels. When kids feel the symptoms of withdrawal, they may realize they're addicted (and be willing to stop)."

By Laura Halligan

14 February 2018

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16 FEBRUARY

How to ‘bridge minds’ with a child to stimulate brain development 

A three-year-old boy struggles to thread beads on a string while his older sister watches. She could ignore him or take over the task to get it done quickly. But if she observes him closely, and realizes that he is struggling to hold the string steady, she could offer to hold it for him and praise him for any beads he threads.

This approach – which includes awareness of the child’s cues, clear communication, back-and-forth reciprocity and guidance that adapts to where the child is at – would be an example of the sister “bridging minds” with her brother.

Our research team at the University of Toronto has spent the past five years working to measure and teach the specific behaviours that promote children’s language and cognitive skills. We have defined supportive interactions as those in which two minds are “bridged.” We also call this “displaying cognitive sensitivity.”

Our research shows that children who grow up with siblings who display this type of sensitivity often tend to have stronger language skills and are better able to see things from another’s perspective.

It also shows that when parents and teachers adapt their own behaviours based on what a child is thinking, they help that child to learn and grow.

Serve and return interactions

Bridging minds describes what it means to step outside of one’s own thoughts, and to recognize and be responsive to what is going on in someone else’s head.

Specifically, it’s the ability to determine what the other person knows, what interests them in a given moment, what they are capable of doing, what types of instructions or support they need, and then to respond accordingly.

This concept moves beyond early work on the topic of sensitivity, which focused on the need to be responsive to how children are feeling in order to support children’s emotional development.

Instead, it draws on more recent research from the field of neuroscience, which has highlighted that responsive serve-and-return interactions are just as critical for stimulating children’s early brain development. Indeed, building bridges is about building brain connections.

Applying the science

The breakthrough of our research is that we have come up with a reliable and efficient way to measure the extent of “mind-bridging” occurring in such interactions.

This involves trained researchers using simple checklists to evaluate interactions of children with siblings, parents or early-childhood educators – based on live or video-recorded interactions of pairs or groups.

The whole process can be completed in less than 10 minutes.

Our next challenge is supporting people to use the “bridging minds” approach more often in their interactions with children. Many parents and professionals know that “early experiences matter” and “zero-to-three is a vital period for human development,” but still need more practical tools to make the most of these early years.

Our research team is currently conducting intervention studies with home-visiting nurses in Brazil and, in collaboration with colleagues at George Brown College, with early childhood educators in the Toronto area.

The goal of these studies is to help these populations build more bridges with children on a daily basis.

Maximize brain nutrition

While waiting for the results of these studies, our research team has some suggestions for how to ensure children get the most “brain nutrition” out of every interaction.

In moments of play or daily routines, parents, guardians and early learning professionals can consider:

What is this child looking at and thinking about? How can I engage them, following their lead?

Start a conversation by commenting on what they’re doing. Then, try adding on to what they are already thinking about to extend their learning.

For a child playing with blocks: “What are you building there? A tower! Oh that’s a big tower. It’s already one, two, three bricks high with three different colours. Let’s see what you will do next with the tower?”

Let children try things themselves

It’s helpful for parents and early learning professions to wonder:

What is this child capable of doing? How can I help him/her learn and succeed based on their interests?

Offer a hand to help them expand what they can do by themselves. And keep the interactions going back and forth without taking over.

Letting children try things themselves and providing positive feedback can reap real benefits.

For a child who is having trouble scooping water with a bucket: “Oh dear. It’s hard to get the water, isn’t it? I hold the bucket with both hands to make it easier for me. Want to try? Great job, you did it!”

Every interaction is an opportunity to expand what a child knows. To help build brains, parents, educators, siblings, grandparents and other caregivers can all try “bridging minds.”

15 February 2018 

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14 FEBRUARY

USA

Trans and gender non-conforming youth make up a larger demographic than previously estimated

A new study demonstrates that the population of trans and gender non-conforming youth is “orders of magnitude” larger than previously estimated.

Published this month in Pediatrics, the study analyzed a sample of nearly 81,000 Minnesota teenagers in 9th through 11th grades. Researchers collected data from the 2016 Minnesota Student Survey, which asks a range of questions about the high school students and their identities.

The University of Minnesota research team aimed to examine the health of gender non-conforming and trans teens, compared to the rest of their peers.

First, the researchers determined how many youth in that sample identified as transgender or gender non-conforming (TGNC). They found that a far higher proportion of teenagers identified as TGNC than previous studies had predicted. In fact, 2.7 percent of youth in the sample said they did not identify with typical gender labels like “boy” or “girl.”

Other research has suggested that as few as 0.7 percent of U.S. teens identify as transgender. While this isn’t a perfect comparison – gender non-conformity isn’t the same as trans identity – it offers an idea of the extent to which we’ve underestimated the size of this demographic.

Previous research has found that LGBT-identifying youth tend to suffer from higher rates of discrimination in schools. Other findings have shown that discrimination – in  schools or elsewhere – leads to poorer mental and physical health for LGBT-identifying teens. And this latest study supports those conclusions.

Taking the broadest measure as an example, 62.1 percent of TGNC youth said their general health was “poor”, “fair” or “good”, instead of “very good” or “excellent”. Only 33.1 percent of cisgender youth reported in this way. In fact, TGNC youth were far more likely to report poorer mental and physical health across the board.

Anti-LGBT commentators have often dismissed rejected calls for health interventions targeting TGNC youth, claiming that the population too small to justify the effort. But this study demonstrates quite clearly that trans and gender non-conforming youth comprise a more sizable segment of the population than previously thought.

Of course, when it comes to being compassionate, population size shouldn’t matter. Still, this is a considerably larger demographic than many realized.

As Dr. Daniel Shumer of the University of Michigan writes in an accompanying opinion piece, the population of TGNC youth is “orders of magnitude” greater than previously estimated. Crucially, Shumer says, their poor health outcomes are not a byproduct of their identity but, as the research shows, our own failure to understand the needs of TGNC youth and create interventions that can shield them from harm:

However, research that is focused on well-supported TGNC youth helps dispel the idea that simply being transgender is the cause of poor health outcomes. For example, long-term outcome data from the Netherlands demonstrate that children with gender dysphoria who were treated in a comprehensive gender center with gender-affirming treatment during adolescence and young adulthood grew to become well-functioning adults with an overall mental health status similar to that of the general Dutch population. Data from the TransYouth Project was used to establish that transgender children who have socially transitioned and are well supported in their social environments have levels of depression that are similar to those of cisgender controls, with only slightly higher levels of anxiety than the controls.

Groups like GLSEN have demonstrated that, together with trans-affirmative school policies, teachers can make a real difference in students’ lives by encouraging safe  spaces.

Recognizing the reality of gender non-conformity

On a more personal note, I was once bullied in school for my identity. I frequently heard slurs like, ”queer,” “faggot” and “puff” directed at me, and I was even physically assaulted.

As an adult, I’ve spent time in therapy working through the lasting pain from these experiences. One of the surprising things I discovered was that I had internalized a lot of that shame – to the point of developing chronic anxiety. While I have supported other gender non-conforming people, sometimes being kind and accepting of ourselves proves to be the most difficult part of healing.

I’ve finally realized that I am gender non-conforming and that I am not, by narrow definition, male. And that’s okay.

At first glance, I present as a man, but my personality, my soft-spoken demeanor and my talents all tend to read as traditionally female. I’m comfortable – even celebratory – of this reality, but it has taken a lot of years of anxiety and careful work to bring peace to what was once a major source of pain.

All of this to say, no young person should ever feel such pain. Supporting gender non-conforming young people allows them to be all of who they are – and that’s vital for mental health. There’s no evidence to suggest that this exploration leads to distress or gender dysphoria, but attempts to restrict young people to narrow labels causes damage that can last a lifetime.

We owe our young people better.

By Steve Williams

8 February 2018 

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12 FEBRUARY

How OCD impairs memory and learning in children and adolescents – and what to do about it

Imagine feeling like you’re covered in germs that could kill you every time you come home from being in a public space. Before showering, you’d have to get inside without letting anything that’s touched the outside world come into contact with your house. The reality of living with obsessive compulsive disorder (OCD) can be debilitating, and quite different from what people usually mean when they refer to themselves as being “a bit OCD”.

It is particularly heartbreaking to see children and adolescents suffering from OCD, which is often chronic and tends to continue into adulthood. We have now discovered that OCD in young people actually significantly alters both memory and learning ability.

OCD, which affects 2-3% of people at some point during their life, involves ritualistic behaviour such as constantly checking on things, placing objects in a certain order or washing hands repeatedly. This helps relieve intrusive thoughts in the short term, such as an obsession with things being “just right” or an intense fear of dirt or contamination. The condition can leave some sufferers unable to eat, leave the house or in other ways go about their daily lives, often becoming isolated and depressed as a result.

It is easy to see how disruptive and embarrassing OCD symptoms can be when a child starts attending school. Habitual repetitive checking can significantly delay the amount of time it takes to complete work in school or at home. Even things that should be fun, such as playing with friends, may become stressful if you’re constantly worried about getting messy or you’re scared of touching public play equipment.

Almost 90% of children and adolescents with OCD have problems at school, home or socially – with difficulties doing homework and concentrating being the two most common problems.

Memory and learning

In our recent study, published in Psychological Medicine, we asked 36 adolescents with OCD and 36 healthy adolescent controls to complete two memory tasks to measure learning and cognitive flexibility. Adolescent OCD patients showed significant impairments in both learning and memory.

The participants were also asked to complete a task to assess “goal-directed control”, an ability which helps us be flexible in our thinking and in our solutions to problems. Habits allow us to automatically perform behaviours that do not require planning or organisation, such as changing gears while driving. However, when there is new important information or rapid changes in the environment, we rely on goal-directed control instead. Again, the adolescents with OCD showed significant impairments in such control.

This is supported by functional neuroimaging of patients with OCD demonstrating increased activity in something called the “cortico-striato-thalamo-cortical circuits” in the brain, which are thought to be involved in control.

Sadly, the problems we identified may lead to stress and anxiety in a child, which is already known to promote the habitual behaviour that is so common in OCD – creating a downward spiral. Stress is also known to impair memory. And we know that stress hormone levels increase when children enrol in school.

What’s more, having learning and memory problems in childhood could lower confidence and affect self-esteem, which in turn are associated with OCD symptoms, especially checking.

While OCD in adults is slightly different from that in children and adolecents, we have found that adults with OCD do have problems with attention.

Treatment options

We know that memory problems can affect the efficacy of psychological treatment including cognitive behavioural therapy, which is currently the best way to treat OCD. This involves changing the way you think and behave in small steps. However, if this does not sufficiently alleviate symptoms, a kind of antidepressant (SSRIs) can help.

Actually tackling the learning and memory problems can also help to improve performance in school, as well as self-confidence. We have recently shown that cognitive training using a game on an iPad can improve memory problems in schizophrenia. However, future studies are needed to determine the exact relationship between the memory problems in OCD and the symptoms.

But what can schools do practically to help students with OCD? Anna Conway Morris, a consultant psychiatrist in Cambridgeshire and coauthor of the study, has recently been working with schools to support adolescents with OCD. She found that children with OCD often write very slowly or cross things out (to get it “just right”). Their handwriting speed should therefore be measured and, if necessary, they should be given additional time for exams or school work. OCD is also associated with lower processing speed – meaning children should be given more time to answer questions orally. They often get “stuck” on tasks and may need a prompt to move to the next task.

It is important to stress that children with OCD can be high achievers if they are given support to overcome their OCD symptoms. Treatment an early stage is really important. OCD often gets better in adulthood and even those who did not do too well at school often do well at university if they are given the right support.

That means that if we can make teachers aware of these learning and memory problems, they can help OCD students realise their full learning potential. Sadly, at present, it takes on average 11 years to diagnose OCD, and treatment starts after that. Who would find that acceptable for a physical disorder such as a heart problem or cancer? As a society we need to consider good mental health as every bit as important as good physical health.

8 February 2018

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9 FEBRUARY

USA

Trans teens may not get care they need 

Transgender teens may be more likely to miss preventive health checkups and have untreated medical problems than their non-transgender peers, a U.S. study suggests.

Researchers examined survey data from 80,929 high school students in Minnesota, including 2,168 youth who identified themselves as transgender or gender non-conforming. Participants reported their gender identity and their assigned gender at birth, any chronic physical or mental health problems, any days they stayed home sick or saw the school nurse, and the timing of their last routine medical and dental checkups.

Overall, transgender adolescents were almost twice as likely as other teens to report their health as “poor, fair or good” as opposed to “very good or excellent,” the study found.

“When youth present differently than what society would expect for their birth-assigned sex, they often receive messages in society that they are behaving in a way that is ‘wrong’ or that they are ‘wrong’ in some way,” said lead study author Nic Rider, a human sexuality researcher at the University of Minnesota Medical School in Minneapolis.

“The stress and invalidation from this really impacts the health of these youth,” Rider said by email.

Just 38 percent of the transgender teens said their general health was “very good or excellent,” compared with 67 percent of the adolescents who identified as cisgender, meaning their gender identity matches the sex they were assigned at birth, the study found.

At the same time, about 25 percent of transgender youth had chronic medical issues or disabilities, and 60 percent had mental health problems. By comparison, only about 15 percent of cisgender teens had chronic physical health issues about 17 percent had psychological issues.

While more than half of the transgender teens said they had stayed home sick at least once in the previous month, only 43 percent of the cisgender participants had sick days.

About 41 percent of the transgender youth visited the school nurse at least once during the past month, compared with 26 percent of other students.

More than half of the youth got preventive health and dental checkups in the past year, but this was less likely to happen for transgender teens, researchers report in Pediatrics.

Among transgender youth, the teens whose gender expression most closely matched their assigned sex at birth had better overall health and fewer mental health issues.

One limitation of the study is that the survey questioned teens about their “biological sex” rather than their “sex assigned at birth,” which may have confused some students, the authors note. The survey also didn’t assess several factors that can influence health of non-cisgender youth, like whether they had received any medical interventions to support their gender identity such as puberty blockers or hormones, or whether they had socially transitioned to match their gender identity.

Still, there are many reasons transgender teens might wait longer than their cisgender peers to seek medical care, said Dr. Daniel Shumer, author of an accompanying editorial and a pediatric endocrinologist at the University of Michigan in Ann Arbor.

These teens may fear that they’ll be mistreated, or refused treatment, or they might experience more subtle discrimination like a clinician not using their preferred pronouns that match their gender identity, Shumer said by email. They might also be anxious about having a physical exam.

“Parents can advocate for their child by choosing primary care providers who are supportive of children with diverse gender identities and who are knowledgeable about local resources, including referral options for hormones,” Shumer added. “Remember that many physicians did not receive education about gender identity in medical school, however, all physicians have access to resources outlining how to support transgender youth.”

By Lisa Rapaport

5 February 2018

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7 FEBRUARY

The benefits of fur-weather friends in childhood development 

A recent analysis suggests that owning a pet in childhood aids in a child’s development.

Relationships with others are a key contributor to childhood development, and researchers wanted to find out whether this influence was limited to humans, or whether pets also had a role to play.

Studies have shown that children who are not able to fulfil their attachment have a tendency to develop distrust of others, low self-esteem, and a propensity of loneliness. As pets both give and receive affection, they’re thought to contribute to attachment needs in development.

A systematic review was carried out by academics from various UK and US universities including Liverpool, Bristol, Lincoln, New York and Buffalo which found beneficial correlations between children owning pets and emotional health, particularly self-esteem and loneliness.

The team identified and analysed 22 research publications that looked into social, emotional, cognitive, education, and behavioural outcomes, and concluded that pet ownership carries with it a wide range of emotional health benefits, including perspective-taking abilities and enhanced intelligence.

Overall, the work found a clear link between pet ownership and social ability; networking, play, interaction, and overall competence.

One potential reason for this is that evidence suggests children turn to their pets for reassurance and comfort when stressed, sad, and/or angry; as a result, their pets may help the children process these emotions in a healthy manner. This is far better than not being able to release them and bottling them up.

However, the analysis wasn’t all conclusive; the investigation into how pet ownership affects depression and anxiety could not point one way or the other, and the effort to investigate whether pet ownership affects behavioural development couldn’t be completed due to lack of high quality research.

The research also didn’t investigate whether one type of animal was more helpful in development of certain characteristics than others, so the age old debate of cats vs dogs will likely continue to be waged.

However interestingly, separate research suggests that the presence of a dog in a classroom helps children perform better both academically and cognitively (go team dog!).

With approximately 46% of British households including at least one companion animal, it’s worth investigating how animals are shaping the youth.

As a result, a call for further, high quality, research into a link between these is surely merited in order to elucidate the mechanisms through which this occurs.

By Ben Thomas

1 February 2018 

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5 FEBRUARY

UK

Social media 'provides important support for children in care'

Social media can bring psychological and emotional benefits to young people in care outweighing the potential risks it poses, a study has found.

Research carried out by the University of East Anglia's Centre for Research on the Child and Family found that social media provided a "window to life before being in care" and helped looked-after young people deal with the "stigma and shame" they felt about being in care.

Not only was the use of social media helpful for young people living in care to maintain healthy and appropriate birth family relationships, but it also eased transitions between placements, the report said.

Being part of an online community is also useful in tackling problems such as homelessness among young people transitioning from care – by providing access to support networks to help them find housing – as well as providing opportunities for their personal progression, the report adds.

The study, based on more than 100 visits across seven months to 10 young people aged between 14 and 18 across four residential care settings in England, highlighted the importance of digital networks in increasing self-esteem and mental well-being.

Lead researcher Dr Simon Hammond carried out in-depth observations on the sample group about how they routinely used social media in their everyday lives as well as conducting focus groups and interviews with both the young people and residential care staff.

"The young people we worked with talked about how many friends or followers they had on social media," he said. "It was the contacts outside their immediate state care environment that young people saw as their most precious commodity."

Hammond said the psychosocial support gained from using social media was particularly important in tackling feelings of depression, isolation and worthlessness frequently reported by young people in care.

"Young people in care face harder, faster and steeper transitions into adulthood with fewer resources than their peers," he said. "Placement instability often leads to young people feeling abandoned and isolated at points in their lives when they are at their most vulnerable," he added.

The study also showed that while social media gave young people in care the chance to network with organisations that could help them with opportunities for personal progression, many were not always keen to "like" or "follow" them for fear of highlighting their own care experience because, leaving them vulnerable to stigma.

Hammond said that social care professionals should adopt a "digital resilience informed approach" which recognised potential vulnerabilities while supporting young people to engage in online networks.

"This is important as our research reveals that social networks need to be viewed as an important resource for psychosocial support and that the risks shift as young people mature and progress towards independence," he said.

Andy Burrows, associate head of child safety online at the NSPCC, welcomed the findings but urged vigilance among social media providers that their sites are safe for young users.

"This valuable piece of work makes clear the benefits of social media for looked after children," he said.

"However, social networking carries risks as well as benefits and there is a responsibility on social media sites to make their platforms safe for their young users, including looked after children who can often be particularly vulnerable, so that they are free to enjoy the online world."

The research, which is due to published in the British Journal of Social Work, has been released ahead of Safer Internet Day on February 6.

By Nina Jacobs

2 February 2018 

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2 FEBRUARY

Six things you didn't know about self-injury

Even though self-harming behavior has gained a considerable amount of attention in the last two decades, it continues to be seriously misunderstood. For starters, people often think that self-injury is synonymous with cutting, but it also includes intentionally self-inflicted burns, self-hitting or bruising, extreme skin picking or scratching, even deliberately breaking a bone. Formally called nonsuicidal self-injury, or NSSI, the disorder is recognized as a distinct condition in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, rather than incorporated as a symptom of borderline personality disorder as it was previously.

Many people perceive that cutting and other forms of self-injury occur mostly among young, white females, but at least 35 percent and up to 50 percent of those who engage in self-harm are male, notes Allison Kress, a clinical psychologist in the Seattle area who specializes in working with people who self-injure. "People self-injure regardless of race and socioeconomic status," she explains. What's more, NSSI is more common than you might think: Prevalence rates among teenagers range from 15 to 30 percent, depending on the study, and a survey of 439 adults in the U.S., published in the journal Psychological Medicine, found that 6 percent had engaged in self-harm at some point in their lives.

Here are six other things that may surprise you about who engages in self-harming behavior and why:

Self-injury is not a cry for help, as many people believe.

"It's a myth that NSSI is done to get attention or to provoke some sort of reaction from other people," says Brittain Mahaffey, a clinical psychologist at the Mind-Body Clinical Research Center at the Neurosciences Institute at Stony Brook Medicine. "For folks who self-harm, it's a way for them to manage their emotional pain."

Indeed, the behavior usually occurs when someone is alone, and often the person hides the signs of self-injury because he or she feels a deep sense of shame about it. Typically, it isn’t until people decide to seek help that they reveal they’ve been engaging in self-injury.

Inflicting self-injury often makes people feel better – for a while.

People who engage in self-injury are usually "more on the emotionally sensitive end of things but don’t have the requisite skills to effectively regulate their emotions," explains Michael Hollander, an assistant professor of psychology at Harvard Medical School and McLean Hospital. "Self-injury helps with modulation of emotions. Many of these people have a hard time identifying and labeling their emotions and feelings. Others experience self-loathing and want to escape the emotional experience because it's so painful."

Often "self-injurers have poor problem-solving abilities and communication skills," says Brooke Ammerman, a doctoral candidate in clinical psychology at Temple University who has done research on NSSI. "They also have reported higher levels of self-criticism and self-hatred." One way or another, self-injury often becomes a distraction tactic, a way to numb emotional pain with physical pain or a form of self-punishment. For some people, "it satisfies a deeply held belief that they need to be punished," Hollander explains, and "it’s satisfying on two levels: justice has been done because they deserved it and it leads to emotional relief."

There are several theories as to how this plays out: One is that when tissue injury occurs, endorphins are released into the bloodstream and they have a calming effect. Another relates to the "pain offset relief" explanation – the notion that people feel relief when the pain ends and much better than before the physical pain began, Hollander says.

Like other unhealthy coping strategies, self-injury can become a habit.

Self-injurious behavior can become a pattern when people get positive reinforcement for it – if they feel better after cutting or burning themselves, for example – and this becomes their primary tool for coping with negative emotions. "They do this because it works better than anything else they've tried," Kress explains. "It puts the pain outside [the body] where it's easier to cope with." But it's a temporary fix at best, and the distressing feelings are likely to return – at which point the cycle may start again.

Self-injury is often accompanied by other mental health problems.

"Self-injury is not the primary problem – the primary problem is what's motivating the person to cut [or self-harm] in the first place," Kress says. After all, engaging in self-injury is a way of acting out feelings instead of expressing them with words, she adds.

It's true that self-harm may be a symptom of borderline personality disorder, but the behavior also can accompany depression, anxiety, panic attacks, post-traumatic stress disorder and eating disorders (especially binge eating disorder or bulimia), Mahaffey says. Adults with a history of NSSI who engaged in self-harm frequently and/or recently were found to have greater symptoms of depression, panic and anxiety, poorer emotion regulation and greater alcohol misuse, according to research published in the January 2018 issue of Psychiatry Research.

Meanwhile, a study in a 2015 issue of Comprehensive Psychiatry found that more aggressive forms of self-injury (like self-hitting) are associated with higher levels of trait aggression. Those who have a history of physical, sexual or emotional abuse are also at higher risk for self-injury, Kress adds.

People who self-harm generally are not trying to kill themselves.

The truth is, "people who self-injure know the difference between self-injury and attempted suicide," Hollander says. In most cases, self-injury is not a rehearsal for a suicide attempt. On the contrary, these self-inflicted wounds serve as a "life raft" for them, helping them cope with distress and continue on with life, Kress says. "It’s a very different mentality."

But that doesn't mean people who engage in self-injury can't become suicidal in the future, especially if the emotional problems that are triggering the injurious behavior mount, Kress says. But it isn't the NSSI that directly increases suicide risk. A study in a 2016 issue of Psychiatry Research found that people with a history of NSSI who have a strong sense of perceived burdensomeness (a feeling that others would be better off without them) and thwarted belongingness (social disconnection and loneliness) are more likely to experience suicidal ideation.

There isn't a medication that treats NSSI directly, but therapy can help.

Of course, if the person has depression, anxiety or another coexisting mental health disorder, treating the underlying disorder with medication may help ease the emotional distress so the person doesn’t feel the urge to cut or self-harm as much, Kress notes. But there isn't a drug that's designed to treat NSSI directly.

One of the most effective interventions for self-injury is dialectical behavior therapy, or DBT, which teaches distress tolerance skills and helps people learn to better regulate their emotions through individual and group therapy, Mahaffey notes. Other forms of therapy that help people identify their unhealthy, negative beliefs and behaviors and replace them with more adaptive or positive ones also can make a difference.

The important thing to remember is: "Self-injury is 100 percent treatable," Kress says. "It’s a behavior, and behaviors can be changed."

By Stacey Colino

31 January 2018

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