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Extracts from the Journals relating to Children, Youth and Families - in the fields of health, substance abuse, education, psychology, science ...

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30 JULY

Does criticizing our own bodies damage our kids' body image?

Most of us have been there: We complain about our belly getting too big or our pants feeling too tight or we ask our partner, "Do I look fat in this?” In fact, it’s become so commonplace in our weight-obsessed culture that we often don’t think twice about these types of comments. But how does our body bashing affect our children’s body image and capacity for mindful eating?

A new study by Webb et al (2018) examined the impact of overhearing family “fat talk”* (which they defined as verbalizations of self-depreciating evaluations of one’s own body) on a daughter’s body appreciation and mindful eating. They posited that hearing “fat talk” from one's family may reinforce notions of a thin ideal and self-objectification (the internalization of an outside observer’s perspective in relating to one’s body), which in turn may make women less attuned to the internal workings of their own body, eat less mindfully, and rely more on environmental or other external cues to guide their eating.

Results of the study indicated that, indeed, overhearing family members participate in “fat talk” was inversely associated with mindful eating, body appreciation, and body functionality. In other words, the more that children were exposed to family “fat talk,” the less likely they were to eat mindfully or to appreciate their body either generally or in terms of how their body functions. In contrast, more frequent mindful eating was associated with higher levels of body appreciation and body functionality.

This study adds to a growing body of research supporting the harmful effects of negative body talk in the family environment, and shows us that even indirect negative body talk (i.e., conversations between parents not directed at the child) can lead to less mindful eating, more disordered eating, less body appreciation, and more body dissatisfaction in children which persists into adulthood.

So the next time you want to express something negative about your body, take a pause. Kids hear and absorb every message we send to them, even the subtle ones. If we are to set them up for a positive experience with their bodies, we must be the example. If you need support in healing your own body image, please seek out treatment with a therapist trained in body image and size inclusivity.

*Note: In the research study by Webb et al (2018), they use the term “fat talk” to describe negative body talk. For the sake of consistency in this post, I use the term as well. However, I think this is a problematic term as it implies that fat is a negative attribute and describing oneself as “fat” is describing oneself negatively. The Health At Every Size ® and Fat Acceptance movements are working hard to neutralize the word “fat” as a general descriptor, rather than a pejorative insult. The fact that negative body talk is termed “fat talk” speaks to the weight-bias that is prevalent in our culture at large, including the eating disorder community.

By Alexis Conason

25 July 2018

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27 JULY

Perfectionism in young children may indicate OCD risk

Studying young children, researchers at Washington University School of Medicine in St. Louis found that kids who possess tendencies toward perfectionism and excessive self-control are twice as likely as other children to develop obsessive-compulsive disorder (OCD) by the time they reach their teens.

Further, MRI scans taken as part of the research revealed that the perfectionists often had smaller volumes of a brain structure previously linked to OCD.

The findings were published July 18 in the journal JAMA Psychiatry.

“Having a lot of self-control and striving for perfection often are considered by parents and society as good because they can eliminate mistakes, but excessive self-control and perfectionism raise a red flag,” said Kirsten E. Gilbert, PhD, the study’s first author and an instructor in child psychiatry at Washington University. “In adolescents and adults, these characteristics are associated with OCD and other disorders, such as anorexia and social anxiety. We’ve now been able to link this to OCD risk in children.”

OCD is a chronic mental health disorder that often involves uncontrollable, recurring thoughts, or obsessions – such as a fear of germs or a need to have things in perfect order – and behaviors that a person feels the urge to repeat over and over – such as hand-washing, compulsive counting or repeatedly checking on whether doors are locked.

Gilbert said it is important to identify the disorder as early as possible because the condition often is chronic and recurs throughout life. If very young children at risk can be identified, it may be possible to intervene earlier to prevent or at least lessen the intensity of obsessions and compulsions linked to OCD.

The researchers enrolled 292 children ages 4 and 5. Over the next 12 years, 35 kids went on to develop OCD. Among children the researchers determined were exercising excessive self-control and perfectionism, an OCD diagnosis was twice as likely as among those who didn’t care as much about performing a task absolutely correctly.

All of the children in the study were recruited more than a decade ago for a related study in which researchers evaluated young children for depression. The data for the new study was culled from the previous study’s videotaped interactions of children with a researcher.

“The experimenter would hand the child a blank sheet of paper and a green marker and simply say, ‘I need you to draw me a perfect, green circle,” Gilbert explained.

Drawing a perfect circle is difficult for almost anyone, but especially for young children. After a child would complete the drawing and show the circle to the researcher, the researcher would provide negative feedback, calling the circle “too small” or “too flat” and then would tell the child to try again. After 3 ½ minutes of negative feedback, the experimenter would admit to being too harsh, would praise the child and would tell him or her that everything was fine.

Gilbert and her colleagues evaluated the children’s behavior in videos of the attempts to draw perfect circles. The researchers rated the intensity of a child’s own performance monitoring as the youngster attempted to do a better job.

“Some kids were very self-critical,” Gilbert said. “The researcher would point out flaws, but the child was critical of the effort, too. That excessive perfectionism was the strongest predictor of OCD later on.”

Senior investigator Joan L. Luby, MD, the Samuel and Mae S. Ludwig Professor of Psychiatry and director of the university’s Early Emotional Development Program, said: “In its most severe forms, OCD is a highly disabling and intractable disorder. Therefore, this first identification of tangible risk behaviors in early childhood opens exciting new opportunities for the design of preventive interventions.”

As the children got older, 152 of them had a series of three MRI brain scans over the next 10 to 12 years. The researchers found that those who behaved like perfectionists during the circle task also had smaller volumes of a brain structure called the anterior cingulate cortex, an anatomical feature in the brain that previously has been linked to OCD in adults.

Another of the study’s senior authors, Deanna M. Barch, PhD, chair of Washington University’s Department of Psychological & Brain Sciences in Arts & Sciences, and the Gregory B. Couch Professor of Psychiatry at the School of Medicine, explained that one of the primary problems underlying the obsessive thoughts and compulsive behaviors in OCD is a deficit in cognitive control, particularly involving the anterior cingulate cortex.

Most treatments for OCD involve medications and psychotherapy. If untreated, the condition can be chronic and severe.

“One of my interests, ideally, is to create therapies geared toward prevention,” Gilbert said. “We also want to look at the role of parenting because if one of these kids has a parent who’s always saying, ‘That’s not good enough!’ you can see how this problem could spiral.”

By Jim Dryden

18 July 2018

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25 JULY

Food additives a toxic mix for kids

Chemicals used to preserve, package and enhance food can harm children's health, a leading pediatricians' group says.

A growing mound of scientific evidence has linked these chemicals to changes in children's hormone systems, which can alter their normal development and increase their risk of childhood obesity, the new American Academy of Pediatrics (AAP) policy statement argues.

These chemicals affect the health of all humans, but can have a particularly strong effect in children, said lead author Dr. Leonardo Trasande, an environmental health researcher with New York University's School of Medicine.

"Pound for pound, they eat more food, so they have higher levels of exposure compared to us adults," Trasande explained. "Their organs are still developing in various ways, such that effects on that development can be permanent and lifelong."

The chemical culprits

Some chemicals that affect food safety include:

"This is a critically important report about environmental risks that have received less attention than they deserve, whether by the pediatric community or regulators," said Dr. Michael Grosso, chair of pediatrics and chief medical officer at Huntington Hospital in Huntington, N.Y.

"There is now a compelling body of evidence that the environmental chemicals that go into food processing and food containers may have significant effects on human health, including fertility, thyroid disease, certain cancers and much more," Grosso said. "Of concern is that some of these remain in the body for years."

Kristi King, senior dietitian with Texas Children's Hospital in Houston, said she has "heightened concerns regarding those additives that are thyroid disrupters."

"PFCs can alter thyroid function and metabolic changes. Perchlorate, nitrates and nitrites disrupt thyroid hormone production and inhibit iodine uptake in the body," King explained. "Iodine is extremely important in promoting growth and metabolism in children. Iodine is also essential for early brain and neurological development. Having an iodine deficiency could ultimately lead to poor growth and delayed [thinking] ability," she said.

Tighter regulation needed

The policy statement calls on politicians and bureaucrats to tighten regulations related to food additives. These measures include a more rigorous and transparent "Generally Recognized as Safe" designation process, including new requirements for toxicity testing before use in the marketplace and retesting previously approved chemicals.

And Trasande argued that citizens can have an even greater impact in this area than elected officials.

"The general public can do a lot to drive the kinds of changes that are positive for children's lives and human health," Trasande said. "The ban on BPA from baby bottles and sippy cups was not driven by some scientific statement or some regulatory good feeling. It was driven by consumer outcry. The same could be said for phthalates in toys."

What parents can do

The AAP policy statement said parents can limit their children's exposure to these chemicals by:

Parents also can use the recycling code on the bottom of products, as a means of determining whether the plastic packaging is safe, the statement said. You should avoid plastics with recycling codes 3 (phthalates), 6 (styrene) and 7 (bisphenols), unless the plastics are labeled as "biobased" or "greenware." That means the plastics are made from corn and don't contain bisphenols.

"It is important to have an initiative to educate families on label reading to try to identify chemical-free packaging and look for foods and beverages free from preservatives, artificial colors and artificial flavors," said Audrey Koltun, a registered dietitian nutritionist with Cohen Children's Medical Center in New Hyde Park, N.Y. "This is something I try to cover in a nutrition session.

"Elaborate and colorful food packaging with health claims can entice consumers into thinking a food is healthy or wholesome when it is not, and can have one or all of these additives," Koltun continued. "Education to families is crucial to lessen exposure to children."

The new policy statement was published online July 23 in the journal Pediatrics.

By Dennis Thompson

23 July 2018 

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23 JULY

Social media and celebrity culture 'harming young people'

Airbrushed photographs of celebrities with perfectly preened bodies staged in exotic locations are all over social media, but such flawless images have been described as damaging for the way they pressurise young people to meet unobtainable body-image standards.

Most children own a smartphone by the age of 10, and this has in turn led to increasing pressure on youngsters to look perfect in their online lives, a study has found.

The youth charity YMCA spoke to more than 1,000 young people aged between 11 and 16. They found that 62% of 15 to 16-year-olds felt that social media had ramped up expectations over their personal appearance. Photoshopped images and the sharing of only the most flattering shots shifted young people’s understanding of what a normal body looked like, the charity said.

Ideals of physical perfection were also said to be driven by celebrity culture, with 58% of 11 to 16-year-olds identifying it as the main influence.

Denise Hatton, the chief executive for YMCA England and Wales, said: “We’ve all been guilty of only posting our most flattering pictures on social media. While there’s nothing wrong with wanting to show yourself from your best angle, it’s important that we still like ourselves when we’re not looking our best, which is probably the majority of the time for most of us.”

Social media was already a concern among 11 to 12-year-olds, with 43% of those surveyed claiming individuals they saw on online influenced them.

The charity has joined Dove, the health and beauty products company, for its Be Real Campaign, which is asking people to sign up to its body image pledge. It urges social media users to stop editing their pictures and to hold brands and organisations responsible for not promoting healthy body images and diversity.

Hatton said: “Today’s beauty standard is completely unobtainable, leading us to constantly feel bad about our bodies and looks. This is particularly the case for young people and it can have serious effects on their mental and physical wellbeing. It’s time to take back control of how we feel about our bodies and celebrate our real self so that everyone can feel confident in their body this summer and beyond.”

Increasing numbers of academic studies have found that mental health problems have soared among girls over the past decade, coinciding with the period in which young people’s use of social media has exploded.

Dr Bernadka Dubicka, the chair of the child and adolescent faculty at the Royal College of Psychiatrists, said last year: “There is a growing crisis in children and young people’s mental health, and in particular a gathering crisis in mental distress and depression among girls and young women.”

Dubicka said social media such as Snapchat and Instagram “can be damaging and even destructive” to girls’ mental wellbeing. “There’s a pressure for young people to be involved 24/7 and keep up with their peer group or they will be left out and socially excluded.”

Social media use has also contributed to a increasing sleep deprivation among young people, which could both be a symptom of mental illness and also raise the risk of it developing, she added.

By Nazia Parveen

23 July 2018

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20 JULY

Early puberty in white adolescent boys increases substance use risk

White adolescent boys experiencing early puberty are at higher risk for substance use than later developing boys, a new Purdue University study finds.

"The earlier your first sip of alcohol or that you try other kinds of drugs, the more likely you are to go on to develop lifelong addiction and problems with substance use," said Kristine Marceau (mar-soh), an assistant professor in human development and family studies, whose research is focused on the biological factors related to the development of behavioral problems and substance use across the human lifespan. "A good way to prevent long-term substance use problems is to delay that onset as long as possible."

These findings are published online in Child Development. The new finding suggests that brain-related testosterone activity contributes to an increased risk of substance use more than an earlier appearance of maturity and accompanying social pressures in early pubescent white boys.

In some studies, an early start to puberty points to more "acting out" behavior, aggression and substance use. Marceau wanted to identify the biological link between early puberty and behavioral problems and whether the problems arise from social pressures of appearing older sooner, or are underlying biological changes, or perhaps both.

Early doses of testosterone can speed the development for certain areas of the brain that heighten reward-seeking behavior before the brain develops those parts involved in decision-making and impulse control. This mismatch can put youth at risk of engaging in substance use earlier. Understanding the cause for increased substance use behavior in early adolescents is necessary for developing prevention strategies that protect for the avoidance of lifelong problems with addiction, said Marceau.

The study was funded by the National Institute on Drug Abuse and used existing data from an investigation that spanned 20 years, from 1989 to 2009, for 534 boys at the Center for Education and Drug Abuse Research at the University of Pittsburgh. Half of the boys in the study came from families with fathers who had problems with substance use disorders, a rate far higher than the average population, but necessary for determining what role familial history plays in increasing the risk for substance use in adolescent males.

Boys matriculated into the study starting at age 11. Researchers followed the boy's relationship with substance use for ten different drugs at age 16 (alcohol, cannabis, cocaine, opiates, amphetamines, sedatives, tobacco, hallucinogens, PCP, and inhalants) until the age of 30. Nurses took observational measures of physical signs of puberty, and hormone concentrations at ages 11, 13 and 16.

The project's goal was to determine from the large dataset whether physical appearance or hormones are better at predicting the risk of substance use in adolescent boys. White boys, who entered puberty earlier, reported higher involvement in substance use activity by the age of 16-years-old than white boys who entered puberty later.

Testosterone and its initial timing rather than visible puberty-related changes and the pace at which boys progressed through puberty was identified as the culprit for the increased substance use behavior.

Based on Marceau's findings, future intervention strategies could take advantage of regular doctor's visits and the higher levels of testosterone that indicate the start of puberty at a younger age could act as a signal for physicians to warn parents of potential substance use risks.

"That the link between puberty and substance use is related to testosterone more so than physical changes doesn't mean that the same parenting strategies won't work," said Marceau. "You still would want to pay closer attention to where adolescents are and what they are doing to limit their opportunity to engage in substance use." She added that an increase in testosterone alone is not enough to determine if a young adolescent will develop addiction issues or not.

Also, when comparing the risk for increased substance use in non-white boys to white boys in the study, Marceau found that non-white boys (who were 87 percent African American and 13 percent bi or multi-racial), despite entering puberty earlier, did not show an increased risk for substance use. The earlier onset of puberty for African American adolescents than white adolescents is consistent with other puberty studies.

There are fewer studies on adolescent boys than girls and even fewer that look at ethnic-racial differences, said Marceau. A critical next step will be to "unpack" the link between substance use and testosterone by first replicating these findings in other studies that account for ethnic-racial differences.

16 July 2018

Source: Purdue University 

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18 JULY

Self-control and obesity: Gender matters in children

A toddler's self-regulation – the ability to change behavior in different social situations – may predict whether he or she will be obese come kindergarten, but the connection appears to be much different for girls than for boys.

Self-regulation is something all children must develop, and poorer self-control in childhood is associated with worse adult health, economic and social outcomes. However, a new study from The Ohio State University found that more self-regulation may not necessarily reduce the risk of obesity, especially in girls.

Girls who scored at either the low or the high end on measures of self-regulation when they were 2 years old were more likely than girls with average self-regulation to be obese at age 5, while boys with high self-regulation were less likely to be obese than their peers with low or average self-regulation, found the study, which appears in the journal JAMA Pediatrics.

The difference raises important new questions about the role of gender in the development of childhood obesity, said lead author Sarah Anderson, an associate professor in Ohio State's College of Public Health.

"Although we tend to assume that more self-regulation is always a positive, it may not be," she said.

Those seeking answers about how to prevent childhood obesity should be mindful of the possibility that interventions to improve self-regulation might not play out the same way for boys and girls, she said.

"People are trying ways to prevent obesity in young children, and some of those approaches involve improving self-regulation. Our study suggests that could have an unintended impact for some girls," Anderson said.

"This study leads one to think about how young children are potentially responding differently to messages and expectations based on whether they are boys or girls. We should be cautious about assuming that increases in self-regulation are optimal for everyone."

The study analyzed data from a nationally representative sample of 6,400 U.S. children born in 2001 to see whether a child's ability to self-regulate when they were 2 years old was associated with their risk of obesity in kindergarten – and to look for any differences between genders. The data came from the National Center for Education Statistics.

Self-regulation was measured using a four-part in-home assessment that looked at a child's adaptability, persistence, attention and frustration tolerance. Each child received from one point to five points on each measure, for a possible score of 20 – a very high level of self-regulation.

"Observers were looking at things like how readily a child gave up a block when an adult said it was time to play with something else, how difficult it was to hold their attention and how easily frustrated they became when things weren't going their way," Anderson said.

"Going in, we thought what many people think – that we would see lower rates of obesity as self-regulation increased."

But when they looked at their data, in which they separated children into quartiles ranging from "least regulated" to "most regulated," the researchers found that girls in the least and most self-regulated groups were more likely to be obese at kindergarten age than their female peers in the middle categories.

There was little difference in boys' risk of obesity except for among the most-regulated, who were least likely to be obese. Obesity was determined by measuring height and weight and defined as a body mass index greater than or equal to the 95th percentile.

"We should not assume that interventions to increase self-regulation will necessarily lead to benefits for both genders – it may be different for boys and girls," Anderson said

The researchers said there are many ongoing efforts to promote self-regulation in children for a variety of desired outcomes, including obesity prevention and improved school readiness.

In neither gender did the researchers see a clear step-wise pattern where increased self-regulation meant decreased rates of obesity.

Researchers believe that a variety of factors may contribute to links between self-regulation and obesity, including physiological differences and behavioral responses to demands in a child's environment that could affect appetite, food intake, sleep and activity level.

"Obesity prevention is a complex and humbling task. Gender is another social influence that may affect the success of obesity prevention efforts," said Anderson's co-author, Robert Whitaker of Temple University.

This study adds to other obesity research that has found important differences between genders, Anderson said.

"All we can do based on this research is speculate, but it's possible that girls and boys are reacting differently to social expectations and that could play a role in childhood obesity," Anderson said.

"If you're a boy and if the people around you are more OK with you getting easily frustrated and not paying attention, the social stress from your environment may be less than it is for a girl."

It's also possible that girls are rewarded more than boys for "good" behavior, propelling them to put themselves under added stress in the interest of appeasing adults, the researchers wrote.

"These stresses might result in differences in energy balance and metabolism between girls and boys, especially in the group observed to have high self-regulation."

16 July 2018

Source: Medical Press

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16 JULY

Explained: Why children lie at an early age

Children and teenagers of all ages lie about things ranging from who ate the last biscuit to where they've been with their friends.

The way they lie changes over time and contributes to different stages of their social development, experts say. Young children are more likely to lie for personal gain, and as they grow older they can get a grip on which lies people will believe and what is morally acceptable, reports The Conversation.

Scientists say lying is normal for children's development and, if they are encouraged to be open and honest, they will often grow out of it.

Lecturers at Macquarie University in Sydney, Australia, Penny Van Bergen and Carol Newall explain what makes children lie and how parents can stop it becoming a problem. The lecturers say making sure children know they are lying, encouraging open discussions and avoiding strict rules or excessive punishments can all help children be more honest.

Children typically begin lying in the preschool years, between two and four years of age. These intentional attempts at deception may worry parents, who fear their child will become a pint-sized social deviant.

But from a developmental perspective, lying in young children is rarely cause for concern. In fact, lying is often one of the first signs a young child has developed a 'theory of mind', which is the awareness others may have different desires, feelings, and beliefs to oneself.

When a child misleadingly claims 'Daddy said I could have an ice cream', they're using this awareness of others' minds to plant false knowledge.

While lying itself may not be socially desirable, the ability to know what others are thinking and feeling is an important social skill. It's related to empathy, cooperation, and care for others when they're feeling upset.

How lying changes with age
Young children's first lies are often more humorous than effective. Imagine the child who claims not to have eaten any cake while her mouth is still full, or who blames the family dog for drawing on the wall.

Young children may know they can deceive others, but they don't yet have the sophistication to do so well.

Before age eight, children frequently give themselves away when lying. In one study, children aged three to seven were asked not to peek at a mystery toy (Barney) that had been placed behind them. Nearly all did, and nearly all lied about it later (increasing with age).

But across the group, children also had trouble maintaining the lie.

Liars aged three to five were surprisingly good at keeping a straight face but typically gave themselves away by describing the Barney toy by name. Liars aged six and seven had mixed success, with half feigning ignorance and half accidentally saying Barney's name.

As children get older and their perspective-taking ability develops, they're increasingly able to understand the kinds of lies that will be believable to others. They also become better at maintaining the lie over time. Moral development also kicks in.

Younger children are more likely to lie for personal gain, while older children increasingly anticipate feeling bad about themselves if they lie.

Older children and teens are also more likely to draw distinctions between different kinds of lies. White lies, to them, are considered more appropriate than harmful or antisocial lies.

While studies that estimate the frequency of lying among children and teens are rare, teenagers are especially likely to lie to parents and teachers about things they consider their own personal business.

One study found 82 per cent of US teenagers reported lying to their parents about money, alcohol, drugs, friends, dating, parties, or sex in the past year. They were most likely to lie about their friends (67 per cent) and alcohol/drug use (65 per cent). Perhaps surprisingly, they were least likely to lie about sex (32 per cent).

When reading short scenarios in which the protagonist lied to his or her parents, the teens were also likely to consider the lying acceptable if it was to help somebody or keep a personal secret, but not if it was to harm or hurt someone.

Is lying a cause for concern?
Despite its prevalence, lying among children is rarely cause for concern.

It's important to remember many adults also lie – sometimes for good, as in the case of white lies that protect someone's feelings, and sometimes for ill. While estimates vary, a study found approximately 40 per cent of US adults reported telling a lie in the past 24 hours.

In some instances, chronic lying can become a concern if they occur alongside a cluster of other behaviours that are maladaptive. For example, deceitfulness through lying is often present in conduct and oppositional defiant disorders (ODD).

Young people with conduct disorders or ODD cause considerable disruptions in the home or at school through persistent aggression and harm to others or property. But to meet diagnoses, lying would have to occur with a cluster of other symptoms such as refusal to comply with authority figures, persistent violations of rules, and failure to take responsibility for their actions.

Another cause for parental concern is if lying serves to mask other mental health problems due to fear or shame. For example, a child or adolescent suffering from severe anxiety may lie chronically to avoid confronting situations that make them afraid (for example, school, parties, germs).

They may also lie to avoid the stigma of mental health disorders.

In these instances, consulting your doctor or a mental health professional (such as a psychologist or psychiatrist) will help clarify whether lying is indicative of a mental health concern.

Parents and teachers can encourage children to tell the truth
While lying is developmentally normal, parents and teachers can support children's truth-telling in three ways, Van Bergen and Newall say.

First, avoid excessive or over-the-top punishments.

In a study comparing a West African school that used punitive punishments (such as hitting with a stick, slapping, and pinching) and a school that used non-punitive reprimands (such as time outs or scolding), students at the school with punitive punishments were more likely to be effective liars. Children from families that place a strong emphasis on following the rules and not open dialogue also report lying more frequently.

Second, discuss emotional and moral scenarios with children.

This 'emotion coaching' supports children's understanding of when lies are most harmful, how they affect others, and how they themselves might feel when they lie. Children increasingly anticipate pride for telling the truth, and parents can emphasise these positive aspects of truth-telling.

Third, ensure the lie really is a lie.

Very young children are prone to blend real life and imagination, while older children and adults frequently remember arguments differently to one another. If a child reports physical or sexual abuse, these allegations must always be investigated. By distinguishing whether or not there is a deliberate attempt at deception, parents and teachers can target their response effectively.

Lying in children is developmentally normal
Lying is developmentally normal and an important sign other cognitive skills are also developing.

If lying is persistent and is impairing the child's ability to function effectively in everyday life, it's worth consulting a mental health expert or your doctor. But in other situations, remember that lying is just one way children learn to navigate the social world.

Open and warm discussions about telling the truth should eventually help to reduce children's lies as they develop.

By Penny Van Bergen and Carol Newall

8 July 2018

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13 JULY

Youth report improved wellbeing as result of tailored mental health services

In a new study from Lawson Health Research Institute and Western University, researchers partnered with youth receiving care at the First Episode Mood and Anxiety Program (FEMAP) at London Health Sciences Centre (LHSC) to better understand personal perspectives on care and treatment outcomes. The study found that patients experienced lasting improvements in managing their symptoms and improvements in academics, work performance and relationships, and they reported that these benefits involved being empowered by feelings of self-acceptance.

The study included 22 patients from FEMAP, a novel outpatient mental health program at LHSC that provides treatment to 'emerging adults,' ages 16 to 25, with emotional concerns that fall into the categories of mood and anxiety symptoms. Treatment at FEMAP takes a patient-centred approach and the research involved looking at what is meaningful and valuable to patients during their care journey.

"The transition from adolescence to adulthood is challenging. FEMAP employs an innovative model of care tailored to the needs of this complex population," said Dr. Elizabeth Osuch, a clinician-scientist at Lawson, associate professor at Western University's Schulich School of Medicine & Dentistry and medical director at FEMAP. "By engaging patients in a reflection of their experience, we can learn how effective the program is from the patient perspective."

Participants shared their experiences through open-ended interviews with Dr. Osuch's research team. Interview transcripts were collected and analyzed to determine common themes around treatment and outcomes. These themes were then presented back to the research participants for validation.

The study found that treatment led to development of coping strategies to better manage symptoms. Research participants credited these strategies for better functioning in academics, careers and personal relationships. Challenges in these areas are common among emerging adults and are often stressors that lead to youth seeking mental health care.

Participants characterized their treatment at FEMAP as an important investment in their mental health and wellbeing, and credited a collaborative partnership with their care provider for keeping them engaged in treatment. They appreciated the ease of accessing treatment at FEMAP where they could receive care from a psychiatrist, social worker, addictions counsellor, family counsellor and a psychologist, depending on their needs.

The research found that the complexities of treatment were initially frustrating to patients as they were seeking an "easy fix" to their mental health concerns, but they ultimately appreciated that mental health recovery is a journey. They valued that care providers partnered with them to set long-term treatment goals, choose the best treatment options and provide support both during and between appointments.

"Patients may prefer FEMAP over other mental health services because the care is tailored to emerging adults," said Justin Arcaro, first author on the study and a former MSc candidate at Schulich Medicine & Dentistry and research associate at FEMAP. "There's an important balance between recognizing emerging adults' personal autonomy and their need for comprehensive support."

Study results demonstrated that through treatment at FEMAP, patients realized they are not alone in their mental health journey which led to improved self-acceptance and self-compassion. Participants reported feeling empowered to create meaningful changes in their lives.

Participants also discussed the decision to seek mental health care in the first place. Many struggled with the decision of whether or not treatment was needed. "This shows a need for targeted campaigns to help emerging adults distinguish between normative feelings and those that indicate a need for help," said Dr. Osuch.

This study also aligns with other research projects at FEMAP that suggest a need for targeted education campaigns about mental health care as a process with solutions that are not necessarily quick or easy. The research team highlights the importance of these findings in informing future funding decisions and policy around mental health care for emerging adults. The findings emphasize the need for quick engagement with a trusted care provider and an integrated treatment team that can partner with patients to support them while enhancing independent growth and self-acceptance.

The study, "Emerging adults' evaluation of their treatment in an outpatient mood and anxiety disorders program," is published in Emerging Adulthood.

11 July 2018

Source: Lawson Health Research Institiute 

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11 JULY

Severe childhood trauma, stresses in parents' lives linked to behavioral health problems in children

A new study finds that severe childhood trauma and stresses early in parents' lives are linked to higher rates of behavioral health problems in their own children.

The types of childhood hardships included divorce or separation of parents, death of or estrangement from a parent, emotional, physical or sexual abuse, witnessing violence in the home, exposure to substance abuse in the household or parental mental illness.

"Previous research has looked at childhood trauma as a risk factor for later physical and mental health problems in adulthood, but this is the first research to show that the long-term behavioral health harms of childhood adversity extend across generations from parent to child," said the study's lead author, Dr. Adam Schickedanz. He is a pediatrician and health services researcher and assistant professor in the department of pediatrics at the David Geffen School of Medicine at UCLA.

The study showed that the children of parents who themselves had four or more adverse childhood experiences were at double the risk of having attention deficit hyperactivity disorder and were four time more likely to have mental health problems.

A mother's childhood experiences had a stronger adverse effect on a child's behavioral health than the father's experiences, the study found.

Parents who lived through adverse childhood experiences were more likely to report higher levels of aggravation as parents and to experience mental health problems, the researchers found. However, these mental health and attitude factors only explained about a quarter of the association to their child's elevated behavioral health risks. The remainder of how the parent's adverse childhood experiences are transmitted to their child's behavior deserves further study.

The findings add to the evidence supporting standardized assessment of parents for adverse childhood experiences during their child's pediatric health visits.

"If we can identify these children who are at a higher risk, we can connect them to services that might reduce their risk or prevent behavioral health problems," Schickedanz said.

The researchers used information from a national survey containing information from four generations of American families, including information from parents about whether they were abused, neglected or exposed to other family stressors or maltreatment while growing up, and information on their children's behavior problems and medical diagnoses of attention deficit disorder.

With this data, they were able to find strong associations between the parents' adversity histories and their children's behavioral health problems, while controlling for factors such as family poverty and education level.

The next step for researchers is to look at how resilience factors, such as the support of mentors or teachers, could offset the harms of childhood traumas, Schickedanz said.

The study was published in the journal Pediatrics.

9 July 2018 

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9 JULY

Lifetime sentence: Incarcerated parents impact youth behavior

A new study published in Pediatrics found that young adults who had a parent incarcerated during their childhood are more likely to skip needed healthcare, smoke cigarettes, engage in risky sexual behaviors, and abuse alcohol, prescription and illicit drugs. These findings have potentially broad impact, as over five million U.S. children have had a parent in jail or prison.

Strikingly, incarceration of a mother during childhood, as opposed to a father, doubled the likelihood of young adults using the emergency department instead of a primary care setting for medical care.

Young adults whose mothers had been incarcerated also were twice as likely to have sex in exchange for money, while those with histories of father incarceration were 2.5 times more likely to use intravenous drugs.

"The United States has the highest incarceration rates in the world. With the climbing number of parents, especially mothers, who are incarcerated, our study calls attention to the invisible victims – their children," says lead author Nia Heard-Garris, MD, MSc, a pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago and Instructor of Pediatrics at Northwestern University Feinberg School of Medicine. "We shed light on how much the incarceration of a mother versus father influences the health behaviors of children into adulthood."

Dr. Heard-Garris and colleagues analyzed national survey data from over 13,000 young adults (ages 24-32), finding that 10 percent have had a parent incarcerated during their childhood. Participants were on average 10 years old the first time their parent was incarcerated.

Additionally, young Black adults had a much higher prevalence of parental incarceration. While Black participants represented less than 15 percent of the young adults surveyed, they accounted for roughly 34 percent of those with history of an incarcerated mother and 23 percent with history of an incarcerated father.

"The systemic differences in the arrest, prosecution, conviction, and sentencing of people of color impact the future health of their children," says Dr. Heard-Garris.

Previous research shows that individuals with a history of parental incarceration have higher rates of asthma, HIV/AIDS, learning delays, depression, anxiety and post-traumatic stress disorder.

"It's possible that because these young adults are more likely to forgo medical care and engage in unhealthy behaviors, they are at higher risk to develop these physical and mental health conditions," says Dr. Heard-Garris. "By pinpointing the specific health-harming behaviors that these young adults demonstrate, this study may be a stepping stone towards seeking more precise ways to mitigate the health risks these young adults face. Hopefully, future studies will teach us how to prevent, screen for, and target negative health behaviors prior to adulthood."

The authors also stress that more research is needed to identify specific barriers to healthcare, targeting this population's under-utilization of care.

"We need to consider how to help youth of incarcerated parents receive timely healthcare," says senior author Matthew Davis, MD, MAPP, Senior Vice-President and Chief of Community Health Transformation at Lurie Children's and Professor of Pediatrics, Medicine, Medical Social Sciences and Preventive Medicine at Northwestern University Feinberg School of Medicine.

 "We must intervene if we are going to change the health trajectories for these kids."

9 July 2018

Source: Ann and Robert H. Lurie Children's Hospital of Chicago

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6 JULY

Your child is a liar, but don't worry it's a good thing

Children typically begin lying in the preschool years, between two and four years of age. These intentional attempts at deception may worry parents, who fear their child will become a pint-sized social deviant.

But from a developmental perspective, lying in young children is rarely cause for concern. In fact, lying is often one of the first signs a young child has developed a "theory of mind", which is the awareness that others may have different desires, feelings, and beliefs to oneself. When a child misleadingly claims "Daddy said I could have an ice cream", they're using this awareness of others' minds to plant false knowledge.

While lying itself may not be socially desirable, the ability to know what others are thinking and feeling is an important social skill. It's related to empathy, cooperation, and care for others when they're feeling upset.

How lying changes with age

Young children's first lies are often more humorous than effective. Imagine the child who claims not to have eaten any cake while her mouth is still full, or who blames the family dog for drawing on the wall. Young children may know they can deceive others, but they don't yet have the sophistication to do so well.

Before age eight, children frequently give themselves away when lying. In one study, children aged three to seven were asked not to peek at a mystery toy (Barney) that had been placed behind them. Nearly all did, and nearly all lied about it later (increasing with age).

But across the group, children also had trouble maintaining the lie. Liars aged three to five were surprisingly good at keeping a straight face but typically gave themselves away by describing the Barney toy by name. Liars aged six and seven had mixed success, with half feigning ignorance and half accidentally saying Barney's name.

As children get older and their perspective-taking ability develops, they're increasingly able to understand the kinds of lies that will be believable to others. They also become better at maintaining the lie over time.

Moral development also kicks in. Younger children are more likely to lie for personal gain, while older children increasingly anticipate feeling bad about themselves if they lie.

Older children and teens are also more likely to draw distinctions between different kinds of lies. White lies, to them, are considered more appropriate than harmful or antisocial lies.

While studies that estimate the frequency of lying among children and teens are rare, teenagers are especially likely to lie to parents and teachers about things they consider their own personal business.

One study found 82 per cent of US teenagers reported lying to their parents about money, alcohol, drugs, friends, dating, parties, or sex in the past year. They were most likely to lie about their friends (67 per cent) and alcohol/drug use (65 per cent). Perhaps surprisingly, they were least likely to lie about sex (32 per cent).

When reading short scenarios in which the protagonist lied to his or her parents, the teens were also likely to consider the lying acceptable if it was to help somebody or keep a personal secret, but not if it was to harm or hurt someone.

Is lying a cause for concern?

Despite its prevalence, lying among children is rarely cause for concern. It's important to remember many adults also lie — sometimes for good, as in the case of white lies that protect someone's feelings, and sometimes for ill. While estimates vary, a study found about 40 per cent of US adults reported telling a lie in the past 24 hours.

In some instances, chronic lying can become a concern if it occurs alongside a cluster of other behaviours that are maladaptive. For example, deceitfulness through lying is often present in conduct and oppositional defiant disorders (ODD).

Young people with conduct disorders or ODD cause considerable disruptions in the home or at school through persistent aggression and harm to others or property. But to meet diagnoses, lying would have to occur with a cluster of other symptoms such as refusal to comply with authority figures, persistent violations of rules, and failure to take responsibility for their actions.

Another cause for parental concern is if lying serves to mask other mental health problems due to fear or shame. For example, a child or adolescent suffering from severe anxiety may lie chronically to avoid confronting situations that make them afraid (for example, school, parties, germs).

They may also lie to avoid the stigma of mental health disorders. In these instances, consulting your doctor or a mental health professional (such as a psychologist or psychiatrist) will help clarify whether lying is indicative of a mental health concern.

Parents and teachers make a difference

While lying is developmentally normal, parents and teachers can support children's truth-telling in three ways.

First, avoid excessive or over-the-top punishments. In a study comparing a West African school that used punitive punishments (such as hitting with a stick, slapping, and pinching) and a school that used non-punitive reprimands (such as time outs or scolding), students at the school with punitive punishments were more likely to be effective liars.

Children from families that place a strong emphasis on following the rules and not open dialogue also report lying more frequently.

Second, discuss emotional and moral scenarios with children. This "emotion coaching" supports children's understanding of when lies are most harmful, how they affect others, and how they themselves might feel when they lie. Children increasingly anticipate pride for telling the truth, and parents can emphasise these positive aspects of truth-telling.

Third, ensure the lie really is a lie. Very young children are prone to blend real life and imagination, while older children and adults frequently remember arguments differently to one another. If a child reports physical or sexual abuse, these allegations must always be investigated. By distinguishing whether or not there is a deliberate attempt at deception, parents and teachers can target their response effectively.

Lying in children is developmentally normal

Lying is developmentally normal and an important sign other cognitive skills are also developing.

If lying is persistent and is impairing the child's ability to function effectively in everyday life, it's worth consulting a mental health expert or your doctor. But in other situations, remember that lying is just one way children learn to navigate the social world. Open and warm discussions about telling the truth should eventually help to reduce children's lies as they develop.

By Penny Van Bergen and Carol Newall

Penny Van Bergen is a senior lecturer in educational psychology and Carol Newall is a senior lecturer in early childhood at Macquarie University, Australia

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4 JULY

UK

Virtual reality 'helps professionals spot signs of child abuse'

Training professionals with virtual reality technology can help them to be better at spotting signs of child abuse, academics have found.

A three-year study by University College London and Goldsmiths examined the potential for using a virtual reality simulation of an encounter with a child and parent to train professionals to spot subtle signs of potential abuse that are hard to teach in a classroom-type environment.

The virtual reality simulation used in the study recreated an encounter with a parent with a complex medical condition and their young child, both of whom were recreated using video game-style computer graphics based on the motions of real actors. The visual cues and dialogue were adjusted to make the signs of abuse more overt, or subtle.

The researchers asked 64 general practitioners to experience the simulation while wearing virtual reality headsets and then write up their notes, which the researchers then analysed to see how well they picked up on the signs of potential abuse.

The aim of the study was to determine whether a GP's experience and personality affected their ability to spot signs of child abuse. The researchers found that experienced GPs were no more likely to spot the more subtle warning signs of abuse in the simulation than their more junior counterparts. It also found that GPs that were "less neurotic" and "more extrovert" were most likely to flag up their concerns.

They concluded that similar virtual reality simulations have "considerable potential" as a tool for training professionals to spot abuse, especially as using real-life child actors in role-plays about spotting abuse is problematic.

Dr Caroline Fertlman, the study's medical lead and a paediatrician with child safeguarding expertise, said: "For ethical reasons it would be impossible to recreate this kind of sensitive scenario using child actors. What we have shown, for the first time, is that we can create virtual reality characters of abused children and their parents that doctors believe in and interact with in a realistic way, enabling them to learn how to spot the subtle warning signs of abuse."

"An advantage of our approach is that, unlike with actors, we have absolute control over our virtual characters," added Dr Sylvia Xueni Pan, who led on the study's virtual reality work.

"This means we can subtly alter the behaviour and responses of these virtual patients. Our results show that medical doctors responded to this, as those given less obvious behavioural cues were not as effective as those given more obvious cues."

The study, published in the journal Frontiers in Robotics and AI, also found that GPs who were less stressed and more extroverted tend to be better at raising child protection concerns in their notes.

Law and ethics professor Sylvie Delacroix, who was also involved in running the study, said this was an important finding.

"Our results show that GPs who are less stressed, less neurotic, more agreeable and extroverted tend to be better at raising potential child abuse issues in their notes. These results not only indicate the considerable potential of virtual reality as a training tool – they also highlight fruitful avenues for further research and potential strategies to support GPs in their dealing with highly sensitive, emotionally charged situations."

By Tristan Donovan

2 July 2018 

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2 JULY

AUSTRALIA

5000 kids arrived alone at a homeless service seeking help last year

Homelessness is growing faster in NSW than anywhere else in Australia and despite more than $100 million of funding to help homeless youth, 5000 children arrived alone to seek help or shelter last year.

In the decade to 2016 the number of people aged between 12 and 24, estimated to be homeless increased 82 per cent in NSW while all homelessness rose by more than one-third in just five years.

But these numbers may underestimate the problem with new data showing in 2016-17 there were 19,000 people aged between 15 and 24 who were helped by homelessness services in NSW. Research shows young people leaving out-of-home care suffer high levels of homelessness.

In 2016 the NSW government promised to spend $55 million each year on more than 100 specialist homelessness programs for young people through to 2020, adding to a 2015 promise of $40 million over four years, under the Premier’s Youth Initiative to address youth homelessness more broadly. And in April an extra $13.9 million to increase the availability of 24/7 crisis beds and support was added.

Despite these investments, neither the NSW Department of Family and Community Services (FACS) nor the homelessness sector was able to provide answers to a "number of critical questions" asked by the NSW Ombudsman because "basic data is either not being captured or is unreliable".

For more than a decade the NSW Ombudsman has been raising concerns about the system that's meant to protect homeless children in NSW and last week he reported on "unresolved legal, policy and service gaps" including a "lack of decision-making authority" within the sector.

Many children seeking support from homelessness services have suffered some form of trauma or abuse, may be disengaged from school and/or caught up in the criminal justice system, NSW Ombudsman Michael Barnes' report said.

"Our inquiry has put a spotlight on the need for FACS to finally settle effective operational arrangements with homelessness services that clearly spell out the roles and responsibilities of FACS and services in supporting

"We should start with the basics – that a young person has secure accommodation and making sure that we know where they are and getting the services that they need, but because the system is so stretched it's failing to be able to provide that.

"Finding these young people accommodation in the marketplace is almost impossible so the only options they have are these services or friends and family... they are locked into a cycle of homelessness because they cycle through the system and can't get rental properties."

The NSW government has been talking about increasing affordable housing options – social or affordable housing – "but we haven't really seen those targets being met yet" and by not making housing more affordable, more people are pushed into homelessness, Ms Acheson said.

"We have to create safe and secure housing stock for under 16-year-olds, so that they can maintain their schooling or get a job or progress in their life.. most of the housing stock that is available is not going to young people," she said.

NSW Minister for Family and Community Services Pru Goward said the government will do more to address the issues in the report and directed her department to start to implement the ombudsman's recommendations.

"We need to do more to work with children, their families, communities, non-government agencies and across government departments to address this," Ms Goward said. "As an immediate response, the government will invest $4.3 million over three years to introduce nine non-government therapeutic caseworkers to work with unaccompanied children who present to homelessness services."

A spokesman for the minister said more than 25,000 social housing dwellings will be built by 2026 to help provide permanent shelter and the Premier has set a target of more than 34 per cent of young people to move from specialist homelessness services to long-term accommodation by 2019.

Labor's family and community services spokeswoman Tania Mihailuk said the government had been "throwing money away" on programs it wasn't assessing and settling for "temporary fixes that put people in motels, caravan parks and pubs".

"There are large numbers of kids ending up in motels and transitional housing that they shouldn't be in," she said. "Why should anyone 12 to 16 have to suffer moving from one transition housing arrangement to another?"

By Nigel Gladstone

28 June 2018 

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