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For the first time, the American Academy of Pediatrics published a policy statement that calls for gender-affirming health care for all transgender and gender-diverse (TGD) youth. The policy, which was posted online Monday and will be published in the next issue of the journal “Pediatrics,” is aimed at pediatricians who “are focused on promoting the health and positive development of youth that identify as TGD while eliminating discrimination and stigma.”
Noting that the field is “rapidly changing,” the AAP said in a statement that its new policy aims to address the disproportionate health risks faced by trans youth, like “high rates of depression, anxiety, eating disorders, substance use, self-harm and suicide.”
The main thrust of the proposal is what the AAP calls a “gender-affirmative care model,” or GACM, in which “providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.”
The GACM undergirds “a strong, nonjudgmental partnership with youth and their families can facilitate exploration of complicated emotions and gender-diverse expressions while allowing questions and concerns to be raised in a supportive environment.”
In an interview with NBC News, the lead author of the policy guidance paper, Dr. Jason Rafferty, said “the biggest thing right now is the lack of education around this issue.” He said the policy guidance aims to ease the process for transgender and gender-diverse children and their parents as they attempt to navigate the pediatric challenges posed by the transgender experience.
“At this point, there seems to be a threshold of research out there really supporting an affirmative approach and supporting the need that kids have for a nurturing, loving environment in which to self-discover and develop, that it was enough that they AAP could make an official position on this topic,” Rafferty said.
The policy statement, Rafferty added, is for parents as much as it is for kids and providers, “in terms of approaching a provider, approaching a situation, knowing what to expect from your provider – knowing what sort of practice the evidence supports.”
The policy statement also recommends messaging that expresses transgender identities are normal and not causally related to mental health disorders; it notes that “stigma” often is a root cause for trans youth with mental health disorders.
But it is not a major policy change, Rafferty stressed. What the policy statement does is bring the AAP’s policies more up-to-date with current best practices.
“That rapid evolution is very intimidating for anybody in science and anybody in medicine, and so just being able to stay on top of that gives the provider a sense of confidence and understanding that they actually can play an important role even if they're not the one providing the treatments,” Rafferty said. “Those initial steps of supporting someone through coming out, and through disclosure, and working with their family – it can really be lifesaving."
Ellen Kahn, director of the Children, Youth and Families Program at the Human Rights Campaign Foundation, a nonprofit LGBTQ advocacy group, applauded the AAP’s policy statement.
“Pediatricians have a critical role to play in both providing care to patients and in advocating for protections that support the mental and physical health of the public,” Kahn said in a statement shared with NBC News. “Today's statement by the AAP continues their long record of supporting the health of all youth."
By Tim Fitzsimons
17 September 2018
Estimates of the proportion of children in care who end up going to university could be vastly misrepresenting the true numbers, according to a new report.
The study, by the Centre for Excellence for Looked After Children in Scotland (Celcis) disputes the suggestion that fewer than one in 15 children who have spent time in care goes on to higher education.
Official figures count the number of young people of school leaving age who go to university, but only those who are still in care when they reach school leaving age.
But researchers say care leavers often go to higher education later, or take further education access courses first.
Those who are no longer in care by the time they leave school may not be counted. Meanwhile children who have spent time in care tend to leave school earlier on average – often before the age at which university would normally be a consideration, and are more likely to move and become unknown to the authorities at this point.
The report calls for more efforts to track the outcomes for young people who have spent time in care. However as some do not make a habit of talking about their care experience, it also calls for more students to come forward and “claim” their past.
It is commonly claimed that outcomes for young people who grew up in care are routinely poor – young people who are “looked after” by local authorities are more likely to end up inprison or homeless, addicted or with mental health problems.
Another commonly-cited figure is that only 6-7 per cent of care leavers end up in higher education, compared with around 40 per cent of the general population.
However the report says the figure could be much higher. It also says college is an important stepping stone for many children in care towards university and 40 per cent of the 506 school leavers who had spent the whole year in care last year took up an FE course, much higher than the general population of school leavers where it was 27 per cent.
The report says it remains important for universities and colleges to do more to support young people who have been in care, but data needs to be improved.
Students may choose not to declare their care background or may not realise that a part of their childhood qualifies them as “care experienced.”
“Universities and colleges ... are encouraging self-declaration of care identity as a positive action that can lead to additional financial and other support,” the authors add.
A spokesman for Celcis said it was not necessarily helpful to overstate the problems and barriers such children face.
He said using a single headline figure was not giving a reliable or clear picture of the true experience of care experienced young people, and ignored the considerable “school leaving age gap” between care experienced young people and their peers.
“ Care experienced young people face real personal and financial barriers to fulfilling their potential, but this paper highlights that what is out there isn’t the complete picture,” he added.
Read the report here
By Stephen Naysmith
12 September 2018
A long-established treatment used around the world to help troubled young people and their families tackle behavioural problems may not be as effective as its practitioners claim – a new study reveals.
Functional Family Therapy (FFT) is a short-term, evidence-based intervention provided at over 270 sites worldwide – mostly within the US, but also in Belgium, Ireland, The Netherlands, New Zealand, Norway, Sweden and the UK.
Researchers at the University of Birmingham recommend that greater examination of FFT is needed, after evaluating 31 existing reviews of research on the treatment's effectiveness in treating young people, aged 10 to 18.
They found that the quality of evidence in reviews was mixed and adversely affected by small sample sizes, no critical appraisal methods and a failure to examine evidence for risk of bias.
Paul Montgomery, Professor of Social Intervention in the University of Birmingham's School of Social Policy, said: "Our overview of FFT illuminates some real areas of concern around this treatment. It appears that in nearly 40 years of existence, there remain a number of unanswered questions about the effectiveness and implementation of FFT.
"FFT is intensive and costly. It may not be advisable to continue using the therapy without re-examining and testing its effects. Many reviews currently available are written by people developing and delivering FFT, demonstrating the need for independent and robust trials."
The study, published in Research on Social Work Practice, reveals that median rates of reoffending with FFT were 28 per cent; as opposed to 57 per cent for usual care. Impact on substance abuse was modest and reducing rates of out-of-home placements was not reported, despite being considered a main outcome of FFT.
Juvenile delinquency represents a major cost in many countries, with the US spending over $5.7 billion annually on incarcerating minors. In the UK, over 42 per cent of minors typically re-offend, up from ten years ago.
Family and youth dysfunction may lead to higher rates of abandonment, higher rates of alcohol and substance use, untreated mental health issues and other negative behaviours. These issues contribute to behavioural disorders resulting in higher likelihood of school drop-out, imprisonment, unemployment and anti-social activities.
FFT is designed to treat the behaviours and acting-out activities that take a toll on youth, families and communities. Additionally, FFT may be used as a re-entry programme for young people being released from institutional settings or at risk for removal from the home.
University of Birmingham
11 September 2018
Doctors should prescribe playtime for young children, the American Academy of Pediatrics says.
The most famous painting of children at play is “Children’s Games,” the 1560 work by Pieter Bruegel the Elder of a town square in which children from toddlers to adolescents (scholars have counted 246) are playing a range of timeless games. There are dolls and marbles and tiddlywinks, ball games and climbing games and riding games (scholars have counted 90 or so). The children are the only ones in town, and their activities offer a kind of taxonomy of play.
But some worry that our current culture is less friendly to play, and that children may not be getting the chance to explore all its possibilities. To try to address that, the American Academy of Pediatrics released a policy statement on Monday titled “The Power of Play: A Pediatric Role in Enhancing Development in Young Children.”
The statement characterizes play as intrinsically motivated, involving active engagement and resulting in “joyful discovery.” It summarizes extensive developmental and neurological research on play, and tries to tease out some of the specific developmental discoveries in peek-a-boo (repetitive games provide “the joy of being able to predict what is going to happen”) and Simon Says (builds impulse control and executive function). It also says that doctors should encourage playful learning for parents and infants by writing a “prescription for play” at every well-child visit in the first two years of life.
It’s a values statement because many who study play feel that it is under siege, even as new research emphasizes its importance in children’s development.
“We’re in a climate where parents are feeling like they need to schedule every minute of structured time, and 30 percent of kindergartens offer no recess,” said Dr. Michael Yogman, chairman of the A.A.P. committee on psychosocial aspects of child family health and the lead author of the statement. To some, he said, “play is seen as irrelevant and old-fashioned.”
Dr. Benard Dreyer, the director of developmental and behavioral pediatrics at New York University School of Medicine and a past president of the American Academy of Pediatrics, said, “The old saying is, play is the work of children. Play is the way they learn and the way they develop. It’s important to understand how all of us, and especially parents, can encourage play.”
“Kids develop 21st-century skills in play,” said Dr. Yogman, who is chief of the division of ambulatory pediatrics at Mount Auburn Hospital in Cambridge, Mass. These include social and emotional skills and executive function, “skills that are crucial for adults in the new economy, that help them collaborate and innovate.”
A fundamental job in pediatric primary care is to strengthen the parent-child relationship, he said, and play is important in that area as well. Even with a very young child, he said: “When a 3-month-old smiles and a parent smiles back, those kinds of turn-taking activities are not only far from trivial,” but are actually important for developing language and social-emotional skills, such as taking turns.
The stable relationships with parents and other caregivers that are built through these interactions are also important for helping children navigate stress and trauma and preventing what we have come to call “toxic stress” from damaging the child’s development.
And the policy statement goes into detail on recent research showing that play can affect the developing brain, both in its basic structure and in function, with changes that can be traced to play showing up at the molecular and cellular level, as well as at the level of behavior and executive function.
“I think there’s a real pediatric role in pointing out the real profound importance of play on many levels,” Dr. Yogman said. “Parents are looking to us for what do I do with my child, how many activities do I get them in,” he said. “I’m really thrilled the academy was willing to endorse the idea of a prescription for play.”
“It’s not about fancy toys,” he said. “It’s about common household items that kids can discover and explore,” like putting spoons and plastic containers on the floor “and bang them and see what the child does with them.” Parents often tell him, “Gee, I always believed in that. Nice to have it validated,” he said.
“The goal is not to make parents feel guilty or to lord it over them as an expert,” Dr. Yogman said, but rather to look for moments during an office visit that a parent might build on, and to talk about what is coming up developmentally for the child – which is a basic imperative of primary care in pediatrics.
And there are ways to work play into the medical visit, like blowing bubbles to help fearful children, or using hand puppets to demonstrate what’s going to happen in an exam. It may help to take the family out to the waiting room and see what the child does with the toys there.
The statement is advocating for a balanced curriculum in prekindergarten that does not ignore playful learning and doesn’t regard time spent in the block corner as somehow beside the point, Dr. Yogman said. Playful learning means supporting young children’s intrinsic motivation to learn and discover, instead of imposing extrinsic motivations like test scores.
What parents need to do, Dr. Dreyer said, is be there to help their children with “scaffolding.” That means “you don’t control the play for your child, but when you see they’re ready to go to the next step, support that.”
For example, you wouldn’t do the puzzle for the child, but you might point out a clue to help figure out where the piece might fit. Giving parents positive reinforcement for what they are already doing is what helps most, he said, not criticizing them for what they aren’t doing.
I’ve spent a great deal of my own time in pediatrics thinking about how we can encourage parents to read with their children as part of the primary care visit. And I recently wrote about efforts to “prescribe” going to play in parks.
But can we successfully “prescribe” reading, playing, going outside and all the other essential pieces of a healthy busy childhood?
There are crucial underlying themes that connect all these different ideas; the importance of interacting with children, responding to their cues and questions, the value of the old-fashioned kind of face time, with parents and with peers, and the importance of helping kids find a variety of experiences that are not all about screens and screen time in a world that is increasingly virtual for both parents and children.
“Reading is also having kids imagine what their role would be, which is playful,” Dr. Yogman said. “Getting outside and getting physical exercise is playful.”
“A ‘prescription for play’ I might hand to parents at the end of a visit is really just saying, it’s O.K. to go back and rely on your common sense about where you think you can share some of the joy as your child is exploring the world,” he said. “The goal is really validating what I think parents might come to on their own but are feeling pressured by a culture that says no, they really need to do special video games on an iPad or they need to have every minute of structured time.”
“Play is the most important part of childhood,” Dr. Dreyer said. “It’s how they develop emotionally, cognitively and in language – the statement comes out to help pediatricians and parents understand the importance and how to even do it better.”
By Perri Klass
20 August 2018
Childhood anxiety can feel overwhelming for both the parent and the child, but it is definitely treatable. While visiting a mental health expert is the best course of action, there are things parents can do at home to ease the child’s anxious thoughts.
The foremost thing to remember is that the goal is not to eliminate the triggers from the children’s lives but to manage their emotional responses to the trigger. If in the course of helping children, we set out to remove the triggers what we will be unintentionally teaching children is not coping, but avoidance.
Instead we should focus on teaching them how to function even with anxiety, or managing around the trigger. As a by product of that, the anxiety will automatically reduce.
1. Don't say that their fears are unrealistic
Instead express hope and believe. If Sheena is anxious about not doing well academically or being rejected by her peers – you cannot promise her that those things may not happen, because they actually may and if it does, the anxiety increases while her trust decreases. What the parent can do is express confidence in the child. Saying things like, “I know you’re going to be okay” or that she’ll manage no matter what happens. It will encourage her to face her fears.
2. Talk about their anxieties
Don’t let their anxieties be the pink elephant in the room. Talk to them about it, question them. Opening up a conversation with, “What would be the worst thing if you actually failed the test?” will not only help them open up about their feelings but might also help them make a plan for the future. Having a plan helps a lot of children with anxieties since it helps them realistically assess and decide their next course of action, hence reducing the helplessness they feel.
3. Encourage them to focus on the present
When they worry about what may happen, ask them to focus on what is true for the present moment. Rihaan might be worried that his friend won’t speak to him, ask him what does his friendship look like today. When you bring them back to the present, you alleviate their tendency to get anxious over things which may not have any base in reality – and instead you teach them to be more mindful. Mindfulness activities, like letting thoughts pass or focusing on breaths can be particularly helpful too.
4. Ask them to list down their anxieties
Encourage them to write out their anxious thoughts. A lot of times, children with anxieties often bottle up their feelings in the worry of not worrying anybody else, or sounding stupid, or maybe they are just shy and not comfortable with sharing such thoughts. Teach them to dedicate a few minutes in the day to list out their thoughts. They can either keep a journal, which will help them see how they’ve faced issues in the past, over time, or they can just write out stuff and tear it out which will help with the expression and make them feel relief when torn. The point is to get out the worry from their system.
5. Motivate them to practise self-compassion
Teach them self-compassion by practising it. When you beat yourself about small things which happen to you throughout the day, like forgetting your keys or being late for meetings in front of your child, it teaches them to do the same. They are unintentionally passed on the message that if I am not perfect, it’s bad; that they should be perfect. If you let go of debilitating negative self-talk, you’ll teach them to do the same; to know that it’s okay to make mistakes. Remember they’ll always learn what you do.
By Prachi Jain
28 August 2018
Around 15 percent of all children have tics, and up to one percent of these children have tics that are classified as chronic. In the case of Tourette's syndrome, tics continue for more than a year and include both vocal and motor tics. This disorder can be debilitating for a child, according to Danish researcher Judith Becker Nissen.
Therapy against tics works, and both group and individual treatment are suitable methods to achieve a good effect, according to Nissen and a group of Danish researchers who compared the effect of different types of tic training based on a new Danish manual. This means that therapists in the future can plan a much better course of treatment for those children who have difficulty with tics. The research has been published in European Child & Adolescent Psychiatry.
Nissen, an associate professor at the Department of Clinical Medicine at Aarhus University and a consultant at the Centre for Child and Adolescent Psychiatry, Risskov under the Central Denmark Region, says, "The study confirms that children and young people with tics can be effectively treated by training in accordance with the strategies that are described in the manual we have developed. This treatment can take place both in groups and individually. This means that many more children and young people can be offered relevant treatment, which is very welcome news for the affected families.
"Some children suffer from tics to such an extent that they must be given pain relief. They can find it difficult to concentrate, for example because they struggle to keep the tics in check so they don't disturb their classmates, or because their blinking tics make it difficult to focus. In addition, a child who makes strange noises or sudden movements can suffer bullying. We therefore need to help these children get treatment, even though we know that tics often decrease as the brain matures. But the early years are so crucial for a child's development, thus everything that may reduce tics intensity and frequency needs to be done."
The results from the research provide important information for parents who are naturally interested in whether their tic-suffering children are being offered the most effective treatment. According to Nissen, it is particularly important to know the effects of group therapy. "Some parents are concerned that in group therapy, their child will copy the other children's tics and end up with more of them. On the contrary, the children in group therapy are given a selection of exercises that can support them in developing strategies that they and their parents can use if new tics turn up later in their lives."
Together with her colleagues, Nissen has compiled experience and data from the work with children and parents. These experiences are now gathered in the first Danish manual, available for therapists and affected families to use. It qualifies previous instructions, among other things, because it is based on Danish data, explains Judith Becker Nissen.
"It has the advantage of both describing individual and group therapy and of combining multiple methods, so the children are given a broad repertoire of methods and strategies. Previously, we've relied on American and other guidelines, but cultural differences and experience may play a role for treatment outcome, so it is valuable that Danish children and their parents contribute to the manual," says Judith Becker Nissen.
30 August 2018