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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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Demystifying foster care in Zambia 

The news item of a baby that was dumped on the rail line near Kuku compound and broadcast on Zambia National Broadcasting Corporation TV 1 recently brought about sad feelings about the extent of child abandonment and neglect, an abhorrent practice which often happens in the country.

This sad story is simply one isolated case among many other child abandonment stories which reveals the vulnerability of children and calls for promoting foster care, kinship and adoption.

Occasionally, abandoned children are sheltered in childcare homes, while a small number is fostered and adopted. According to the Ministry of Community Development and Social Services (Nationwide Assessment of Child Care Facilities, 2017), there are 6,413 children living in childcare homes countrywide. Additionally, the Central Statistical Office reports that Zambia has a total of 1.2 million orphans and vulnerable children and also about 8,470 child-headed households.

However, due to misconceptions derived from some cultural beliefs, formal foster care is still not a popular mode of alternative care in Zambia. The Child Alternative Care study report of 2014, which was facilitated by SOS Children’s Villages Zambia, narrates that key informant interviews suggested that the small number of children under foster care in Zambia was mainly due to limited knowledge by the community on the procedure of child fostering, the relevance of child fostering and lack of incentives from the government for families who may want to foster children.

 “Child fostering is something our society does not often talk about. I think that most people are not aware about foster care. Besides, it goes against our values which require us to help OVCs, who are related to us without any formal contracts” (NGO staff). Further, it was reported that the concept of child fostering conflicts the African culture which expects that relatives are supposed to care for children without following any legal/ court processes.

In the past, communities believed that every child belongs to the community and that it was everyone’s responsibility to raise a child. However, due to eroding ubuntu cultural values and various societal changes, precipitated by socio-economic upheavals, this is no longer binding. But the onus is still on society to take an active role in caring for these children and also on Government to raise awareness on other alternative care forms as well as financially supporting foster care programmes in the country.

According to the UN Guidelines for Alternative Care, foster care is defined as: “Situations where children are placed by a competent authority for the purpose of alternative care in the domestic environment of a family other than the children’s own family that has been selected, qualified, approved and supervised for providing such care” (UN 2010, Para. 29). The success of foster care programmes in Zambia requires concerted efforts from all relevant stakeholders who are in contact with the child, who include Government, caregivers, police, teachers, religious leaders and many other people. They are supposed to work towards overcoming the possible misconceptions and stigma associated with foster care.

There are some positive outcomes recorded in countries where community members have been sensitised on foster care. For instance, in Japan, municipalities that were open to foster care and acknowledged its benefits over residential care had higher foster care placement rates (Human Rights Watch 2014). In contrast, in Armenia, limited awareness of foster care was identified as one of the factors leading to the slow growth and expansion of foster care (Save the Children and Center for Educational Research and Consulting 2013). In some settings, awareness raising is important to overcome significant cultural barriers to non-kin foster care.

There is much evidence to suggest that such cultural barriers can be overcome and country-level experience and existing literature point to a number of possible foster care awareness-raising interventions. We also have some other examples of best practices on raising awareness on foster care by government such as the case of Bulgaria. In order to raise awareness and understanding about foster care, the Government of Bulgaria, with support from UNICEF, developed a TV documentary series: ‘Life as it is – foster care.’ The documentary followed 11 foster families for seven months, showcasing both the positive aspects and the challenges of fostering. The TV series was very popular and more than 270 new foster families were approved during the airing of the show.

 As a childcare and development-focused organisation, SOS Children’s Villages Zambia believes that Government should prioritise raising awareness on foster care programmes, provide sustainable financial support in form of foster care grants to foster parents, and also invest in training children to fit into foster families and training foster parents in the upbringing of foster children.

By Gerald Kaputo

28 November 2017

The author is national advocacy officer at SOS Children’s Villages Zambia. He co-authored the article with Joseph Munsanje, the national director.  




Self-harm cases surging among girls

There's a new sign of mental distress among American girls: Nearly 20 percent more young teen and preteen females have sought emergency room treatment for poisoning, cutting or harming themselves yearly since 2009, research shows.

Girls ages 10 to 14 had an 18.8 percent increase per year in treatment for self-inflected injuries – the sharpest rise among young people ages 10 to 24, according to an analysis of ER data from 66 U.S. hospitals.

Poisoning was the method used most often, said researchers led by Melissa Mercado. She's a behavioral scientist with the National Center for Injury Prevention and Control at the U.S. Centers for Disease Control and Prevention.

The overall increase in self-harm was more than 8 percent every year among all females studied, Mercado's team found.

No similar upswing was seen among males.

"Self-inflicted injury is one of the strongest risk factors for suicide," said Mercado.

And suicide among youths is a growing problem. "In 2015, suicide was the second leading cause of death among U.S. youth aged 10 to 24 years," she added.

Last week, a study published in Clinical Psychological Science identified a surge in depression incidence, suicidal thoughts and suicide among teenage girls.

That study, led by Jean Twenge of San Diego State University, linked the upswing to time spent online and on social media.

"It is imperative that we determine why so many more girls are harming themselves," said Twenge, a psychology professor who wasn't involved in the current research.

Mercado and her colleagues focused solely on care provided in an ER setting. They believe the numbers may actually underestimate the scale of the trend, given that some young people likely sought care outside of an ER.

The emergency room data came from hospitals across the country. In all, investigators studied more than 43,000 self-inflicted injury-related ER visits between 2001 and 2015. They focused on three methods of self-harm: poisoning, sharp object and blunt object.

Overall, ER visits due to self-harm among boys and girls rose nearly 6 percent since 2008.

Researchers can't say precisely why rates remained stable for males, but jumped so dramatically among girls.

Unfortunately, "the data used in this study does not allow us to understand why rates have increased among females," Mercado said. "However, these findings are consistent with previously reported upward trends in youth suicide rates during 1999-2014," she noted. Those reports have documented rate increases after 2006, with 10- to 14-year-old females at greatest risk.

"These findings also coincide with increased reports of depression among youth, especially girls," Mercado said.

She stressed that "suicide is preventable."

Clearly, the trends observed "underscore the need for the implementation of evidence-based, comprehensive suicide and self-harm prevention strategies within health systems and communities targeted at young people," Mercado said.

Twenge said the results add to "the mounting evidence for a sudden increase in mental health issues, especially for girls."

Based on her own research, Twenge offered some advice to parents: "Be aware that seeing friends in person is better for mental health than communicating via the phone," she said.

Also, make sure that teens' phones are shut off overnight so they get enough sleep, she said.

"We found that suicide risk factors increased after two hours a day or more of electronic device use, suggesting that keeping use to two hours a day or less is a reasonable limit to set," Twenge added.

The findings appear in a letter to the editor in the Nov. 21 issue of Journal of the American Medical Association.

By Alan Mozes

21 November 2017 



The importance of an indomitable will

In a recently released article in Pediatrics, Dr. Amanda Jichlinski from Children’s National Medical Center in Washington, DC continues an ongoing discussion about the development and management of toxic stress. Her article, which won second place in the Section of Pediatric Trainee’s First Annual Advocacy Essay Competition, provides a comprehensive overview of the topic and outlines a stepwise approach to combat toxic stress. We have known for some time that the long term effects of adverse childhood events (ACEs) such as exposure to abuse and severe household dysfunction are intimately linked to some of the leading causes of deaths in adults (Felitti et al Am J Prev Med. 1998). We also now understand that the key to limiting the effects of toxic stress is the development of resilience. Yet we are still working to successfully translate this understanding into our daily, clinical practice in a way that allows us to effectively intervene in this devastating cycle.

Dr. Jichlinski suggests that we must follow three steps: 1) Enhance provider awareness so we can more effectively identify those patients at risk of toxic stress; 2) Create a network of support through integration of social workers and other support services into a single medical home; and 3) Work with the local community to foster discussions from multiple perspectives that can aid in the development of resilience.

Unfortunately, it has been shown that only 4% of pediatricians routinely screen for ACEs, which reflects the fact that only 11% of pediatricians have reported familiarity with the 7 identified ACEs (Kerker et al Acad Pediatr. 2016). The reasons for this are multifactorial, but increasing provider awareness and education needs to remain a key focus within high priority pediatric initiatives. This is especially true given that intervention during a child’s developing years may significantly and positively alter their adult health (Garner et al Pediatrics 2012). With help from social support services, pediatricians are uniquely positioned to connect families with additional services that mitigate toxic stress such as legal aid, housing referrals or food pantries, and counselling. Furthermore, as Dr. Jichlinski points out, involvement of the local community is fundamental in the development of childhood resilience, since kids spend far more of their time with parents, teachers, counselors and coaches than with physicians.

Dr. Jichlinski’s article opens with a well-known quote by Mahatma Gandhi: “Strength does not come from physical capacity. It comes from an indomitable will.” Long before research could support his claim, Gandhi understood the power of resilience. As physicians and advocates, we must focus more of our attention on the identification of ACEs and reach out to our local communities to better address toxic stress. Only then, as an interdisciplinary team, can we help our young patients develop the indomitable will that may prove to be critical in their overcoming the toxic stress and ACEs that can prevent them from achieving optimal physical and mental health as they grow up.


• Felitti, Vincent J, et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine, vol. 14, no. 4, 1998, pp. 245–258., doi:10.1016/s0749-3797(98)00017-8.
• Kerker, Bonnie D., et al. “Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?” Academic Pediatrics, vol. 16, no. 2, 2016, pp. 154–160., doi:10.1016/j.acap.2015.08.002.
• Shonkoff, J. P., et al. “The Lifelong Effects of Early Childhood Adversity and Toxic Stress.”Pediatrics, vol. 129, no. 1, 2011, doi:10.1542/peds.2011-2663.

By Catherine Spalding

17 November 2017 



Ethnic and gender differences in youths' developing gender identity

The extent to which youths feel typical of their gender and the pressure they feel to conform to traditional gender roles are related to adolescents' well-being. Because many gender-related expectations are culturally based, a new longitudinal study examined how French middle school adolescents' feelings about the development of gender identity differed across groups of teens from different ethnicities, cultures, and genders.

The study was conducted by researchers at the University of North Carolina at Chapel Hill, Nimes University, Montpellier University, Universite Savoie Mont Blanc, and Aix-Marseille Universite. It appears in the journal Child Development.

"Our study – one of the first to examine these issues longitudinally and outside of the United States – shows that boys experience greater pressure than girls to conform to gender expectations, which most likely places nonconforming adolescent boys at higher risk than girls for psychological distress," according to Adam J. Hoffman, a postdoctoral research fellow at the University of Michigan who coauthored the study when he was at the University of North Carolina at Chapel Hill.

Researchers examined youths' developing gender identity in survey responses from French adolescents over four years, starting in sixth grade and following them each year until ninth grade. Surveys were collected from 570 students of European origin ("European French") and 534 students of North African origin ("North African French"). Youths were asked in the surveys about their feelings related to "gender typicality" (how much they felt typical of their gender) and "felt pressure," the pressure they felt from parents, peers, or themselves to conform to traditional gender roles. All the European French youths were born in France, while the North African French youths were of Algerian, Moroccan, or Tunisian ancestry, with 78% born in France. Most adolescents were from low-income households and attended urban schools.

In sixth grade, girls in both the European French and North African French groups reported lower levels of gender typicality and felt pressure than boys; contrary to expectations, the two ethnic groups did not differ in this respect at the beginning of middle school. Over the four years of middle school, European French girls and boys, and North African French girls reported a decrease in how much they felt typical for their gender, while North African French boys did not change in this respect.

Girls in both groups reported declining pressure to conform to gender norms over the four years, European French boys did not change on this measure, and North African French boys reported increasing felt pressure.

"Cultural differences in gender norms provide North African French boys less freedom to deviate from traditional gender roles and norms than that experienced by European French boys," explains Isabelle Regner, professor of psychology at Aix-Marseille Universite and the National Center for Scientific Research (CNRS), who coauthored the study. "The greater pressure to conform to gender roles that North African French boys feel may be a response to contrasting messages about social status they are exposed to-one from their ethnic and cultural groups that says masculinity has greater power and prestige, the other from the broader social context that says their ethnic and cultural groups have lower status and are discriminated against."

Given the important role of culture in shaping the development of aspects of gender identity, the authors point to the need for parents, teachers, and others who interact with youths to be aware of cultural differences in gender norms. For example, teachers should talk with parents to gain a better understanding of how individuals from different cultural backgrounds think about gender and the importance of gender to different cultures.

14 November 2017

Source: Society for Research in Child Development 



Cognitive behavioral therapy for children and adolescents with OCD works in the long run

Some children and adolescents think that they will have an accident if they do not count all the lampposts on their way to school. Or cannot leave the house unless they have washed their hands precisely twenty-five times. They suffer from OCD, Obsessive Compulsive Disorder, which is an extremely stressful psychiatric disorder that affects between 0.25 and 4 per cent of all children.

Fortunately, the treatment method – cognitive behavioural therapy – is both effective and well-documented. The hitherto largest research study of OCD treatment for children and adolescents aged 7-17 now shows that cognitive behavioural therapy also has a long-lasting effect. The Nordic research project, which involves researchers from Aarhus University and child and adolescent psychiatry clinics in Norway and Sweden, has shown that children and adolescents who benefited from the therapy were also free of patterns of compulsive behaviour and compulsive thoughts one year after the treatment ended.

"The study makes clear that cognitive behavioural therapy reaches beyond the treatment period. This knowledge is important, both for the practitioners, but not least for the affected children and their families," says Per Hove Thomsen, one of the researchers behind the study and professor at Aarhus University and consultant at the Centre for Child and Adolescent Psychiatry, Risskov. He is also the final author of the results, which have just been published in the scientific journal Journal of the American Academy of Child and Adolescent Psychiatry.

"OCD is a very difficult disorder which demands a colossal amount of the child in question. It is almost impossible to live a normal life as a child and teenager with a normal level of development, if you need to wash your hands a hundred times a day in a particular way in order not to be killed, which is something that compulsive thinking can dictate. For the same reason, early intervention is necessary before the disorder has disabling consequences in adulthood," says Per Hove Thomsen.

The children from the study were treated with cognitive behavioural therapy, which is a behavioural psychological treatment. Fundamentally it involves getting help to refrain from acting on compulsive thoughts and instead incorporating new thought patterns. The method also involves the whole family, as the effect is strengthened by the mother and father supporting the methods that the child is given to overcome the OCD.

Furthermore, according to Psychologist and PhD David R.M.A Højgaard, who is the lead author of the scientific article, once the treatment is completed a watchful eye should still be kept on the child or teenager.

"The results of the study indicate that to maintain the effect in the longer term you need to remain aware and detect OCD symptoms so you can nip them in the bud before they develop and become worse. This is done by offering booster sessions to refresh the treatment principles and thereby prevent OCD from getting a foothold again," says David R.M.A Højgaard.

The collaboration with the Norwegian and Swedish child and adolescent psychiatry clinics has added knowledge that can be significant for the organisation of OCD treatment.

"The biggest challenge facing OCD treatment is that there are not enough specially trained therapists and treatment facilities to meet needs. The study shows that if the level of training of therapists is consolidated and if supervision is provided, then it is possible to provide treatment in an isolated corner of Norway that is just as effective as the treatment provided at a university clinic," says Per Hove Thomsen.

The study is part of The Nordic Long Term OCD Treatment Study (NordLOTS) and comprises 269 children and adolescents with OCD from Denmark, Norway and Sweden.

The results showed that 92 per cent of the 177 children and teenagers who immediately benefited from the treatment were still healthy and free of symptoms one year after the treatment ended. Of these, 78 per cent had no clinical symptoms of OCD.

14 November 2017

Source: Aarhus University



Teens getting less sleep with rise of smartphones, study says

Teens are getting less sleep than they did before smartphones became commonplace, prompting concerns about potentially serious health consequences, researchers say.
A study published in the current issue of the journal Sleep Medicine examined data from two surveys of U.S. adolescents conducted over many years and including questions about how many hours of sleep they got. Almost 370,000 adolescents participated.

The researchers focused on how much sleep teens reported getting in the years from 2009 to 2015, "when the mobile technology really saturated the market among adolescents," said Zlatan Krizan, a psychologist specializing in sleep and social behaviour at Iowa State University and co-author of the study.

Over the course of that six-year period, they found "a seismic shift in the amount of sleep that a typical teen gets," Krizan told CBC health reporter Vik Adhopia. Krizan and his colleagues found that teens were 16 to 17 per cent more likely to report getting less than seven hours of sleep a night in 2015 than they were in 2009. The recommended amount of sleep for 13 to 18-year-olds is eight to 10 hours per night, according to the U.S. Centers for Disease Control and Prevention.

What's keeping them up?

The researchers looked at other factors besides electronic devices that might affect the amount of sleep teens were getting, including working after school, homework and watching TV, but the number of hours spent on those activities remained "relatively stable or reduced" between 2009 and 2015.

"The only factor that also increased during the time that could be responsible for the shortened sleep is social media, news online and the kind of activities that mobile phones are used for," Krizan said.

The researchers emphasize that the amount of time teens spend on their phones – not just whether they're using them at night – is an important factor in whether or not they're losing sleep. Teens who used the technology for two hours or less a day didn't appear to suffer any adverse effects on their sleep, Krizan said. "[But] once you get five hours of use a day or more, you really see a heavily curtailed sleep," he said.

Getting enough sleep in adolescence is "crucial," the study says. In addition to immediate effects, such as performance in school, sleep habits established in the teen years can contribute to sleep patterns and health for adulthood. Lack of sleep has been linked to health problems ranging from obesity and diabetes to depression and substance use.

"[Sleep is] just one of those things that really reaches into all corners of our lives," Krizan said.

Lack of sleep 'getting worse'

Lack of sleep is an issue affecting more and more teens, said Dr. Rachel Morehouse, medical director of the Atlantic Sleep Centre at Saint John Regional Hospital in New Brunswick.

"It just seems like it's getting worse," she told CBC News.

Morehouse said staff at her clinic "often" hear about teens using smartphones at night.

"They're putting it under their bed and they're responding to texts and emails and so on as they come in," she said. "So that's just another disruptor of sleep in adolescence."
The actual reality of sleep deprivation among teens is probably even worse than the study suggests, Morehouse said. She estimates fewer than one-quarter of teens get the eight to nine hours of sleep a night they need.

"It is truly an epidemic, I think."

3 November 2017




Drumming program improves boys' mental health and delinquent behaviour

An innovative, ten-week program that combines hand drumming and therapeutic talking has been found to significantly assist disadvantaged boys’ mental health and antisocial behaviour.

Dr Karen Martin, an Assistant Professor from The University of Western Australia’s School of Population and Global Health, led a one year evaluation of the Holyoake DRUMBEAT (an acronym for Discovering Relationships Using Music – Beliefs, Emotions, Attitudes and Thoughts) program in three Western Australian secondary schools.

DRUMBEAT sessions are led by a trained facilitator who teaches hand drumming and generates discussions about self-expression, communication, emotional regulation, self-worth, problem solving, confidence and teamwork.

DRUMBEAT started as a pilot program for young Aboriginal men in the Western Australian Wheatbelt region and quickly expanded across the state, nation and around the world.

The study, recently published in Children Australia, found that boys who participated in the program reported significantly better mental health and lower post-traumatic stress symptoms after they completed the ten-session program.

Notably, antisocial behaviour of the boys also significantly dropped, by an average of 25%, once they had been in the program.

Teachers noted that the students who participated in DRUMBEAT were more respectful, calm and considered towards their peers and teachers after being in the program.

Some boys reported the program to be life changing and that the activities helped them learn how to better connect with other people, control their anger and improve their communication and relationships with peers, teachers and their families.

Dr Martin said that with mental health and suicide being such a catastrophic issue for our young people, we need to implement programmes that are appropriately tested.

“Our research suggests that DRUMBEAT is an effective, targeted strategy which significantly improves the mental health and behaviour of disadvantaged adolescent boys,” she said.

“Ongoing difficult and delinquent behaviour of young people is almost always a result of great childhood adversity or trauma we need programs that assist these adolescents to heal and supportive strategies to teach them how to regulate their behaviour.”

Dr Martin also found that, while the program does not provide trauma therapy, post-traumatic stress symptoms decreased for the boys participating in DRUMBEAT.

“Schools are in such a unique position to assist troubled youth, and when they combine programs such as DRUMBEAT with a supportive and trauma-informed culture, the future of these children can be shifted completely.”

“It is so heartening to see so many teachers and school leaders who are prepared to explore strategies to assist today’s youth. Putting supportive programs into place in schools takes time, it is clear these educators really care.”

Dr Karen Martin was funded by a Healthway Research Fellowship.

3 November 20017 



The power of play in children’s health

The impact of play in the life of children has long been debated. Throughout American history, dating back to colonial times, adults have struggled with understanding the importance and value of play in the lives of our youngest citizens. Over time, however, it has been recognized as a key driver of child development, even recognized by the United Nations Commission on Human Rights as a basic privilege that should be afforded to all children.

Over the decades, much research has been done on play, and although many advantages have been described and accepted, little quantitative information exists to illustrate its importance. At its very core, play allows for self-expression and communication of the point of view of a child who may not have all of the vocabulary to explain their thoughts on the things going on in the adult world around them. It allows for engagement in society, with peers and with those in authoritative positions without seeming threatening. Play allows for a safe environment to learn and solve problems, acquire language skills and support novel behaviors to hone important life skills. Free play can help children acquire a new set of skills that allow them to make sense of the world, decrease stress and help define personal responsibility to society. It can allow a glimpse into the desired future state from the child's point of view, inherently filled with potential and hope.

As the most important tool in a child's repertoire, imagination needs to be protected. Play must belong to the child and must not be directive. When adults do get involved in play, which can be a very powerful form of connection, there needs to be a recognition that authority gradient is erased during the activity. There is acceptance of the child driving the rules and power sharing in the experience. And while many adults may view child's play as simple, it is comprised of many complex factors. Small children are often guided by fantasy and symbolic play, which can be frustrating to adults who see it as suspending reality rather than recognizing it as a complicated mosaic of processing the surrounding world. Older children may have in-depth, detailed rules for which they have a total reverence for keeping intact. This can often result in the playing field becoming a minefield for well-intentioned grown-ups.

There is a set of adults, however, who can immerse themselves in play and do so every day. Child life specialists are individuals who have degrees rooted in child development. Teams of child life experts have multiple venues to impact the lives of the young, particularly in the health care setting. In therapeutic play, these experts have the ability to allow kids to release the emotional expressions about how they feel about their health care experience. This can permit the child to process what is happening to them. The child, often tagged with a diagnosis he or she cannot control, can find a space in the context of play where they can exert some power and make some choices. The diagnosis and stay in the hospital can result in significant feelings of conflict, internally and externally. This conflict can induce stress in the child, who often has few outlets to resolve this angst. Play will allow processing of events and feelings without the risk of adult disapproval. This can eventually lead to mastery of positive coping mechanisms and acceptance of the situation at hand.

Child life experts understand the power of play in the lives of the kids they treat. They can help the child in numerous ways, including returning from a place of fear to one of comfort, expressing their feelings so that they have a relief valve, and communicating to doctors and parents what is important to them in the situation. In addition, they can instruct on medical procedures and equipment, taking some of the unknown and trepidation out of the situation. This teaches young patients to be active participants in their health care from a young age, allowing for better self-advocacy in all ways as they grow up. Child life specialists are also key players on the medical team, designing physiologically enhancing play regimens such as blowing bubbles and karaoke exercises to improve lung health, a different type of prescription for wellness. While there is evidence that when these specialists are consulted, there can be decreased use of pain medication and sedation, the purest evaluation is in the eyes of the patients and families they serve, all of whom talk about their child life specialist for years after they have left the healthcare arena. There is no stronger evidence than high praise from a child.

Recently, child life specialists have partnered with the community in novel ways to continue to support all types of play in children tethered to the health care setting. Take, for example, the Teammates for Kids Foundation. This group has made a mission of building play spaces within the confines of children's hospitals all over the country. These child life zones recognize the power of play in the lives of kids, injecting a bit of joy, a bit of cognitive processing and just some happiness into an otherwise tough experience. The zones are set up to assist in therapeutic play but also make sure the some normalcy of childhood is maintained in the middle of the health care tsunami. There is an oasis of respite for both kids and caregivers right in the middle of the hospital. And while it may seem totally unstructured and out of control, there is much work going in every minute of play that occurs in each zone. And there are the Playmakers from the Life is Good Kids Foundation who are teaching healers how to incorporate the aspects of play into their lives and their work to spread the optimism to children.

The attributes that come from play read like the list of qualities on a job description for any CEO in the country: adaptation to change; strength finding; innovative, cooperative, fostering engagement; conflict resolution skills and the art of negotiation; resiliency; and critical and higher level thinking. Perhaps if we want our children to be leading the world someday, we should slow down, stop overscheduling and insisting every moment is filled with structured enrichment activities. Perhaps we can step back and allow play to grow organically – every messy, sticky, silly, inconvenient moment of it. And just maybe, we adults in charge of leading our economy, government, health care system and other critical functions of the grown-up world should consider stepping into the sandbox. It certainly seems that we as a society could take a lesson from the smallest of teachers.

By Elaine Cox

8 November 2017



Can rigid gender stereotyping increase a child’s risk of depression?

It begins at 10.

That is the provocative title of a new study, published in October in the Journal of Adolescent Health. The subtitle, “How Gender Expectations Shape Early Adolescence Around the World,” explains what the researchers, from the World Health Organization and Johns Hopkins Bloomberg School of Public Health, were looking for. What they found was all over the world children are exposed to rigid gender stereotyping, and these norms are well-established in children by age 10 or 11. And that can have a significant impact on children’s mental and behavioral health as they grow older.

Called the Global Early Adolescent Study, this project took nearly four years and included interviews with parents or guardians and their children from 15 countries on five continents. They were asked about their experiences growing up, including what it meant to be a boy or girl in their culture.

The study highlighted five specific findings:

1. Around the globe, schools, parents, media and peers reinforce the myths that girls are vulnerable and boys are strong and independent. “Even in sites where parents acknowledged the vulnerability of their sons, they focus on protecting their daughters,” the researchers note.

2. Boys are universally viewed as predators and girls as potential targets and victims. “Messages such as – do not sit like that, do not wear that, do not talk to him, boys will ruin your future – support the gender division of power and affect while promote [sic] sex segregation to preserve girl's sexuality,” they write. “In some places, girls come to internalize these norms to even a greater extent than boys.”

3. As a result of these perceptions girls are far more restricted in their movement than boys are. “As one girl in Assiut, Egypt noted: ‘A girl cannot go out as she wishes because she is a girl and if a girl came home late her parents would shout at her, but it is okay for a guy.’”

4. Boys are considered dangerous. “Because of adult concerns about their sexual vulnerability, girls are repeatedly told to stay away from boys and there are sanctions if they do not – punishment, social isolation, sexual rumor and innuendo. Both boys and girls lament this situation. They played together as children and were friends, but now with puberty, those friendships are no longer legitimate.”

5. Both boys and girls are well aware that some of their peers are gender nonconforming. “Young people (as well as a number of parents) spoke of peers whose interests, appearance, dress and/or appearance was more typical of the opposite sex than their own. For such young people, there were significant sanctions and pressures to conform to what is seen as gender-appropriate behaviors; and our quantitative data suggest that boys are even less tolerant of such peers than girls.”

Serious implications

The authors of the study write that these beliefs have significant implications for both sexes. The consequences for girls include child marriage, dropping out of school, pregnancy, HIV and sexually transmitted infection risk, exposure to violence and depression. And they add that “despite popular perceptions boys are not unscathed,” these norms put boys at a higher risk than girls to engage in and become victims of physical violence. Boys die more often from unintentional injuries, are more likely to engage in substance abuse and commit suicide and, as adults, have a shorter life span than women.

“What stood out to me most was the breadth of this study,” said Dr. Natalia Ramos, assistant clinical professor at the David Geffen School of Medicine and a child, adolescent and adult psychiatrist at UCLA Health. “There are so many commonalities, even among very different places, about quote-unquote boys’ and girls’ behaviors. We know stereotyping is culturally based, so it is a little surprising that these stereotypes have become so international.”

These beliefs are not benign, particularly on those who do not conform to the stereotypes. Dr. Jack Turban, a psychiatrist at Massachusetts General Hospital, where he studies pediatric gender identity, said of the study: “The mental health significance of these societal gender expectations was striking. What we have learned over the past several years is that shame and stigma are dramatic risk factors for mental health problems. When children are shamed for gender ‘atypical’ interests, they become anxious, depressed and isolated.”

The effects of these messages add up over time. “It is important not to underestimate what these unconscious attitudes and messages have on development,” says Ramos, who is also the medical director for the Child Psychiatry Consultation Liaison Service at UCLA Santa Monica. Those who do not fit into these classifications may feel stress, a prime risk factor for depression. “Any time you are in position of ‘otherness,’ with no representation that reflects you, can be a dangerous and scary place to be in.”

Stress and fear, particularly at a young age, may set a foundation for later depression. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, states that what are known as “adverse childhood experiences," or ACE, especially when there are multiple, diverse types, "constitute a set of potent risk factors for major depressive disorder.” A 2004 study found that, “exposure to ACEs is associated with increased risk of depressive disorders up to decades after their occurrence.”

Room for hope

Gender differences, the researchers point out, are socially – not biologically – determined. That means the process is “amenable to change by fostering gender equitable approaches that have the potential to improve the well-being of adolescent boys and adolescent girls in the short and long terms,” the study authors write.

That is a challenge, they admit. “This study showed us that society places extreme pressures on children to conform to gender norms,” Turban says. “It’s a parent’s job to bolster children’s self-esteem and to protect them from these forces. Parents may not be able to change society, but parental support and acceptance can go a long way in fostering resilience in children.”

That includes encouraging kids to be curious, to explore and to have access to a wide array of toys, media and people, Ramos says. “Development is a long process,” she says. “Kids evolve and need exposure” to a variety of ideas, especially those that integrate and validate their nonconforming traits. “Kids don’t understand super-abstract concepts like stereotypes, but you can have simple conversations about what people are wearing, simpler ways of talking about gender in terms of character and behavior,” she says. “Challenge some stereotypes. Ask, ‘Why is that princess always wearing pink?’”

By David Levine

3 November 2017 



Early childhood adversities linked to health problems in tweens, teens

Adverse experiences in childhood – such as the death of a parent, growing up in poverty, physical or sexual abuse, or having a parent with a psychiatric illness – have been associated with physical and mental health problems later in life. But new research at Washington University School of Medicine in St. Louis has shown that multiple adverse experiences in early childhood are linked to depression and physical health problems in kids as young as 9 to 15. Further, the researchers have identified a potential pathway in the brain to explain how such stressful experiences influence poor health in kids.

The researchers found that a key brain structure involved in regulating emotions and decision-making is smaller in kids who have lived through three or more adverse experiences before the age of 8, compared with kids whose lives were more stable. Young children who faced multiple adverse experiences also were 15 percent more likely to develop severe depression by their preteen and early teen years and 25 percent more likely to have physical health problems, such as asthma and gastrointestinal disorders. Due to the health problems, these kids were more likely to miss school.

The new findings are published Oct. 30 in the journal JAMA Pediatrics.

"We did not expect we would see health problems in children so young," said senior investigator and Washington University child psychiatrist Joan L. Luby, MD. "Our findings demonstrate how powerful the psychosocial environment can be. A child's brain doesn't develop based solely on its genetic infrastructure. It's influenced by the stresses of poverty, violence, the loss of a parent, and other adverse experiences, which together can have serious health consequences evident as early as the teen and preteen years."

The study involved 119 children, who were ages 3 to 6 when the project began. The researchers tracked adverse experiences in the kids' lives – which also included experiences such as natural disasters, a parent's arrest, or a parent with a serious illness requiring hospitalization. The children in the study averaged more than five such experiences before the age of 8.

The researchers also performed multiple MRI brain scans of these children when they were ages 6 to 13. The first scans, performed when the children reached school age, showed that the inferior frontal gyrus was smaller in children who had more adverse experiences. The researchers also determined that the structure appears to be part of a pathway through which the stresses of adverse childhood experiences may influence mental and physical health.

"People exposed to adversity early in life experience changes in the volume of the inferior frontal gyrus that probably can make children more vulnerable to behavioral issues and bad decision-making," theorized Luby, director of Washington University's Early Emotional Development Program. "We suspect that such changes are associated with issues such as poor diet, risky and more dangerous behavior and generally not taking very good care of yourself, and overall, this contributes to poorer mental and physical health outcomes."

Previous research has connected adverse childhood experiences to problems such as cancer, heart disease and mental illness in older people, but no one had looked at whether those stressful experiences are linked to health problems in adolescents. And until now, researchers had not been able to explain how such experiences could contribute to poor health in these kids.

The researchers found that when kids had three or more adverse experiences, they also had smaller brain volumes that, in turn, were associated with lower scores on a scale that measures how well a child expresses emotions. Poor emotional expression has been associated with depression and worse social and emotional outcomes.

Such children also had more physical health problems. Parents reported that kids who had more adverse experiences were more likely to have significant health problems that appeared to affect school attendance.

In earlier research, Luby, who also is the Samuel and Mae S. Ludwig Professor of Psychiatry, found that kids can be resilient and, with nurturing parenting, may be able to overcome individual stressors such as poverty or the loss of a parent. This new research indicates that when kids accumulate multiple stressors, the experiences pile up and cause problems early in their lives, and family members and doctors need to be aware of the powerful influence of these psychosocial risks so that kids can get the help they need.

Luby added that the study could alter the way doctors and researchers think about the development of disease.

"We know toxins in the environment can contribute to disease, but this study suggests that kids can experience physical and mental health problems from exposure to psychosocial 'toxins,' too," she said.

Luby and her colleagues plan to continue tracking the health of these children as they grow into adulthood. Meanwhile, the researchers also are beginning a multidisciplinary study to follow pregnant women and their infants to see whether psychosocial stressors and adversity experienced during pregnancy and the first three years of a child's life also affect brain development and overall health.

30 October 2017

Washington University School of Medicine



Study: Digital self-harm rampant among teenagers

Self-cyberbullying, where adolescents post, send or share mean things about themselves anonymously online, is alarmingly prevalent, warn scientists

An alarming trend of a new form of selfharm is emerging in teens, where they anonymously post mean things about themselves online, scientists have found.

Adolescents harming themselves with cuts, scratches or burns has gained a lot of attention over the years not just because of the physical damage and internal turmoil, but also because it has been linked to suicide.

More recently, self-cyberbullying in youth has emerged and is a cause for concern, researchers warn.

“Digital self-harm,” “self-trolling,” or “self-cyberbullying,” is a behaviour where adolescents post, send or share mean things about themselves anonymously online.

“The idea that someone would cyberbully themselves first gained public attention with the tragic suicide of 14-year-old Hannah Smith in 2013 after she anonymously sent herself hurtful messages on a social media platform just weeks before she took her own life,” said Sameer Hinduja, a professor at Florida Atlantic University in the US.

“We knew we had to study this empirically, and I was stunned to discover that about one in 20 middle- and high-school-age students have bullied themselves online,” said Hinduja.

Researchers used sample of 5,593 middle and high school students between the ages of 12 and 17 years old living in the US to find out how many youth participated in digital self-harm, as well as their motivations for such behaviour.

They also examined if certain correlates of offline self-harm also applied to digital forms of selfharm.

The findings, published in the Journal of Adolescent Health, show that nearly six per cent of the teens reported that they had anonymously posted something mean about themselves online.

Boys were more likely to participate in this behaviour compared to girls. Their reasons varied dramatically. Boys described their behaviour as a joke or a way to get attention while girls said they did it because they were depressed or psychologically hurt.

This finding is especially worrisome for the researchers as there may be more of a possibility that this behaviour among girls leads to attempted or completed suicide.

To ascertain motivations behind the behaviour, researchers included an open-ended question asking respondents to tell them why they had engaged in digital self-harm. Most comments centred around certain themes: self-hate; attention seeking; depressive symptoms; feeling suicidal; to be funny; and to see if anyone would react.

Qualitative data from the study showed that many who had participated in digital self-harm were looking for a response.

Teens who identified as non-heterosexual were three times more likely to bully themselves online.

In addition, victims of cyberbullying were nearly 12 times as likely to have cyberbullied themselves compared to those who were not victims.

Those who reported using drugs or participating in deviance, had depressive symptoms, or had previously engaged in self-harm behaviours offline were all significantly more likely to have engaged in digital self-harm.

“Prior research has shown that self-harm and depression are linked to increased risk for suicide and so, like physical self-harm and depression, we need to closely look at the possibility that digital self-harm behaviours might precede suicide attempts,” said Hinduja .

1 November 2017 




Immigrant parents, refugees face greater mental health challenges; Kids' learning at risk

Research findings come as the Canadian government prepares to release its 2018 immigration policy – which it says will boost the economy and help refugees.

The initial study – the first of its kind in Canada – 'Emotional Problems Amongst Recent Immigrants and Parenting Status', published in Public Library of Science's journal PLOS One, shows parents who are new to Canada have higher rates of depression and emotional problems than new Canadian non-parents. This finding is particularly strong among immigrants who were single, female or refugees.

In the second study, 'School Readiness Amongst Urban Canadian Families', published in the American Psychological Association's Journal of Educational Psychology, the children of many Canadian immigrant families were found to be behind their peers in learning and development before kindergarten. This included early reading and math knowledge, attention, and social skills.

Researchers say this is often because many recent immigrant parents are socioeconomically disadvantaged compared to the rest of the population. Many struggle to provide their children with learning opportunities before they reach school-age.

'Particularly vulnerable'

"When we look at the results of these two studies together, we can see that immigrant families are particularly vulnerable," said Dr. Dillon Browne, who led the studies during his PhD at OISE. "Not only are the parents at higher risk for mental health issues and financial challenges, but their kids' learning development is impacted before they have even reached the classroom – this could have long-term implications," he continued. "These studies show that it's important to look at how we as a society can better support new Canadian families."

Dr. Jennifer Jenkins, Chair of Early Child Development and Education at the Atkinson Centre at OISE, said, "As a society, it is imperative that every child and every family has the opportunity to grow and thrive. This cannot happen unless there is equal opportunity for economic stability and mental health."

Depression, emotional state of Canadian immigrant parents studied

In the first study, researchers tracked the self-reported rates of emotional and mental health issues of 7,000 immigrants across Canada during their first four years in the country. Results showed Canadian immigrants had a high rate of emotional problems, with one-in-three reporting significant challenges by their second year in the country. These rates were even higher among immigrants who were parents.

"When we saw the impact on parents in particular, it prompted us to dig further – we needed to see how their kids were doing," said Dr. Browne.

In their second study, researchers followed 500 immigrant and non-immigrant families in the Greater Toronto Area from the time a child was born until they entered school.

Results show that two-thirds of the struggling families were headed by immigrant parents living in poverty, whose children who were behind in social, emotional and academic skills by the time they began kindergarten.

"In other words, there were gaps in learning before children entered school due to the family's living circumstances after arriving in Canada" said Dr. Browne. "One reason is families struggle to provide their children with enrichment and learning opportunities in the early years. Another reason is parents become stressed by economic and employment challenges and struggle to create a household environment that promotes learning," he continued.

Researchers say this pattern holds for many urban immigrants in Canada. Ultimately, they say, it's a matter of economic opportunity for new Canadians.

Rise in refugees

These findings are particularly important given the recent spike in refugees in the country. Study authors say they hope the Canadian government, which will release its 2018 immigration plan on Nov. 1, takes notice.

"Policies need to facilitate socioeconomic success and mental health following arrival in Canada, given the effects of poverty and stress on early learning, and the effects of early learning on society," said Dr. Browne.

In short, researchers say immigration policies need to consider the following – which are necessary for new immigrants to thrive:

• Parenting supports that promote healthy parent-child relationships and child development across the early years
• Access to childcare -- particularly high-quality childcare that significantly exposes children to English/French during periods of rapid language growth
• Culturally sensitive mental health services for children and families that have undergone trauma before, during and after migration
• Opportunities for family economic success including initiatives that reduce barriers to employment and income supplements

The study team hopes to see a government response that involves increased spending for early learning, childcare, and family supports amongst families who have recently arrived.

Recognizing this research comes as the government's plan is announced, Dr. Browne says, "We hope this research will impact future policy decisions so that the right supports are put in place to help foster healthy family resettlement and, ultimately, the success of the nation."

25 October 2017

University of Toronto 


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