Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Thursday, November 6, 2014

Want to Improve a Child’s Negative Self-Feelings? Try Unconditional Regard!

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Paul via Flickr
Ever see a child grow sullen after losing a game or getting a negative grade on a test? Ever see self-esteem suffer, making it harder to want to play in the next game or take that next test?

Brummelman et al. (doi: 10.1542/peds. 2013-3698) decided to see if having children reflect on how they are accepted unconditionally by a loved one could attenuate the negative self-feelings in a randomized experiment being published online this week as an early release article.

The authors had pre-teens and teens aged 11-15 years old randomly assigned as an intervention take 15 minutes to reflect on experiences of “unconditional regard”—meaning feelings that they are accepted and valued by others. Those who got low test scores in school three weeks later were then evaluated for their self-feelings. Interestingly, if students had been reflecting on their feelings of “unconditional regard”, their negativity was reduced compared to controls.

Seem too good to be true? You need to read this study and understand why we are publishing it. We hope that others will demonstrate similar findings so that reflection on one’s unconditional regard becomes more embedded into a child’s thought processes and in turn, they are better able to confront adversity and rebound positively.

Even if you don’t believe the findings in this well-done study, give the article your unconditional regard and then let us know your thoughts via a comment on this blog, an eLetter on our journal site, or on Twitter or Facebook.

Wednesday, September 17, 2014

Psychological Health of Transgender Adolescents After Puberty Suppression, Gender Reassignment

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our October issue. To learn more about Dr. Schulte, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH
Photo by Purple Sherbert Photography via Flickr

When I spent a year in Boston doing an editorial fellowship at a medical journal, I also saw adolescents at the Sidney Borum Clinic, on the edge of Chinatown. The clinic's location near the Boston Commons was one reason it had such a diverse patient population. Some were college students enrolled in the expensive, private colleges that surround the Commons. Others were the runaways and street kids who slept near the Boston’s Central Burying Ground, located alongside Boylston Street at the edge of Boston Common.

More than a few of the runaways were transgender adolescents who'd become estranged from their families. All adolescents face the tasks of figuring out who they are, but I thought the transgender adolescents had especially tough challenges. By definition, such adolescents have an assigned gender, but their experienced gender is different. Some of the adolescents can be diagnosed with gender dysphoria (GD). That means that a trans adolescent born a male considers himself to be of female gender and would be called a trans-woman. Likewise, a trans-man would have been considered female at birth but consider himself to be a man.

As any adolescent tries to figure out life and issues, he or she often finds their families are unable or unwilling to deal with the issues. To me, those stresses seemed worse for many of the transgender adolescents.

Some transgender adolescents have a better journey toward adulthood. Research published in the October issue of Pediatrics (doi: 10.1542/peds.2013-2958) describes one such group of 55 transgender adolescents followed and their successful transition to adulthood.

Dr. Annelou de Vies and her colleagues at VU University Medical Center in Amsterdam, Netherlands, assessed the psycho-social outcomes of adolescents who underwent treatment for puberty suppression followed by cross-sex hormones and gender reassignment surgery. The authors used the "Dutch model" for their treatment protocol. Under that protocol, adolescents undergo a comprehensive psychological evaluation with many sessions over a longer period of time. Those who are compliant with the protocol undergo puberty suppression, cross-sex hormones and gender reassignment surgery at the respective ages of 12, 16 and 18 years. Puberty suppression is only started when the adolescent reaches Tanner Stage 2 or 3.

Boston's Central Burying Ground, near where author
Joann Schulte's homeless, transgender teen patients
often slept. Photo by Joann Schulte. 
The researchers assessed the outcomes of the 55 subjects enrolled in the study and found they were functioning well as young adults. The study, while limited to one clinic, is considered important because it is the first long-term follow-up of a group that often has a tough, unsatisfactory transition to their adult years. The authors suggested that clinicians involved in the care of transgender adolescents need to realize both early medical intervention and a multi-disciplinary approach are needed for such a program.

The issue of transgender adolescents is one that many pediatricians are unfamiliar with and yet these adolescents represent a population who would be well-served by appropriate care. Finding that care and support can be difficult, but hopefully articles like this one by Dr. de Vies and colleagues can help.

Further Reading:

Wednesday, September 10, 2014

Two Studies on Bullying Share New Information on This Tough Topic

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by tamckile via Flickr
There has been much written and studied about bullying and victimization of being bullied, and this week we share two studies that shed even more new light on this important topic.

The first by Bowes et al. (doi:10.1542/peds.2014-0832) discusses the mental health harm incurred when a sibling turns out to be the bully also. The authors ran a longitudinal study of more than 6,900 subjects—all in a community birth cohort in the UK—and then followed those children bullied by their siblings over 12 years. The results are sad ones given the higher frequency of mental health and self-harm issues in children who were bullied by siblings compared to those who were not.

The second study by Wolke et al. (doi:10.1542/peds.2014-1295) looked at sleep problems in those who were bullied by peers. More specifically, the authors collected interview data on children longitudinally to identify bulling and then, several years later, asked about nightmares, night terrors and sleep-walking in those who had been bullied. The findings are eye-opening and should suggest inquiring about sleep behaviors in those who have been bullied—but even more importantly, asking about bullying in those experiencing parasomnias.

Have you found the same findings in either or both of these studies are true for your patients who may be victims of bullying? Share your thoughts on sibling bullying or sleep disorders in those being bullied via a response to this blog, an eLetter at our journal site, or on Facebook or Twitter.

Related Reading:

Wednesday, July 23, 2014

HIV & Child Mental Health: A Case-Control Study in Rwanda

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our August issue. To learn more about Dr. Schulte and her work in general pediatrics and preventive medicine, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH
Photo by Julien Harneis via Flickr

Every pediatric practice has such children: She might be an older sister of an ex-preemie who gets short shrift of maternal time because her mother spends much of the week taking the infant to an endless series of medical appointments. Maybe he is the 5-year-old who had a kidney transplant and now seems to do nothing but fight with the younger brother who was once his constant companion.

Chronic medical conditions impact siblings and families. So it is not surprising that the stigma of HIV influences not only the children and adults who are infected with the virus, but also children who are affected by HIV, but not infected themselves.

The topic was explored in a study published in the August issue of Pediatrics and studied children aged 10 to 17 years in Rwanda. Betancourt et al. (doi: 10.1542/ peds.2013-2734) found HIV-affected children were more likely to be depressed, anxious and have conduct problems than their counterparts who were either HIV-infected or HIV-negative.

Researchers enrolled 683 children of whom 218 were HIV-infected, 228 HIV-affected (negative for HIV but with family members infected) and 237 were HIV-unaffected (HIV negative and no family members infected). The study was a collaboration between faculty at the Harvard School of Public Health, the Rwandan Ministry of Health and Partner in Health, a Boston-based NGO.

What does this mean for you? The healthy children in your practice whose siblings have chronic illness have their counterparts in Rwanda. Dealing with mental health is an issue, no matter what chronic illnesses impact children or what language they speak.

Related Reading: 

Monday, June 2, 2014

Adjustment of Boston-Area Youth in the Aftermath of the Boston Marathon Bombing: Lessons Learned

By: Lewis First, MD, MS

While more than a year has passed since the tragedy of the Boston Marathon bombing, many are still affected psychosocially and emotionally—especially children and teenagers. Even those who were not at the site of the immediate tragedy remain troubled nonetheless simply from living in the city where this traumatic event occurred and watching it unfurl through extensive media coverage. Just how troubled are these children and teens?

Photo by Rebecca Hildreth via Flckr
Comer et al. (doi: 10.1542/ peds.2013-4115) share with us the result of a survey of more than 450 Boston parents and caretakers who share their child’s experiences with this mass trauma and comment on their children’s psychosocial functioning in its aftermath six months following the event. Attack experiences were not the only thing that left children troubled—the manhunt events did as well. Just what were the emotional difficulties and how did the constant watching of the attack and manhunt contribute to post-traumatic stress disorder symptoms in children makes for a troubling but important read.

While we hope nothing like what happened at the Boston marathon ever happens again, this study provides enormous insight into lessons learned for both providers and young patients when faced with a terrorism or mass casualty situation. If you live in the Boston area, we would value hearing how this tragedy affected the patients in your practice. You can share your thoughts by commenting on this blog, on Facebook or Twitter or via an eLetter to our journal.

Related Reading:

Monday, April 21, 2014

Pay Attention: Two Studies on ADHD-Associated Language Problems, Anxiety Disorders

Photo by Lars Ploughmann via Flickr
We are always
looking for new findings that can be helpful to clinicians managing children with attention deficit hyperactivity
disorder (ADHD),
and this week we are releasing two such studies.

The first by Sciberras et al. (doi: 10.1542/peds.2013-3355) looked at the prevalence of language problems on the social and academic functioning of ADHD children in a cross-sectional study of children ages 6-8 years with and without this disorder. Even when one controls for socio-demographic factors and comorbidities, language problems appear to have a higher prevalence in those with ADHD. Just why this happens and what it means (or doesn’t mean) for social and academic function makes for interesting reading.

Likewise the role of anxiety or more than one anxiety comorbidity can also potentially hamper the quality of life of a child with ADHD and Dr. Sciberras et al. (doi:10.1542/peds.2013-3686) again study this association by noting the effect of one or more anxiety disorders in these patients. While one anxiety disorder is by itself not a major contributor to reduced quality of life, the same does not hold true when the number of disorders increases—and Dr Sciberras and her colleagues explain their findings in a fascinating discussion section.

Focus on both of these studies with your full attention, and you’ll be in much better shape monitoring your ADHD patients for associated difficulties up the road.

Have you found similar co-morbidities and subsequent worse outcomes in your own patients with ADHD? Share your thoughts with a response below, an eLetter, or via Facebook and Twitter.

Related Reading:

Friday, January 10, 2014

Good News in Regard to Antidepressant Usage in Teens and Its Association with Increased Suicide Risk

With a flurry of news activity surrounding the possible risk of suicide in depressed teens using fluoxetine and a resultant need to always discuss this risk when starting the drug in one of our patients, concerns certainly can also arise in regard to the use of other antidepressant SSRI medications.

Photo by Brandon Giesbrecht via Flickr
Cooper et al. (doi: 10.1542/peds.2013-0923) looked at almost 865 depressed children age 6-18 years enrolled in Tennessee Medicaid from 1995 to 2006 who were prescribed an SSRI antidepressant to determine if they were at an increased risk of suicide compared to new users of fluoxetine.

The results will hopefully reassure you that newer SSRIs are not putting our patients at any more risk than fluoxetine, small though that drug’s risk may be. To get the details, give this study your attention—certainly before you prescribe any form of SSRI in your depressed teenage patients—since it may reassure them and you that the benefits of these medications will hopefully outweigh the risks.

Related Reading:

Friday, October 25, 2013

Depression Screening for Children with Chronic Illness

Photo by George Hodan
Quality Reports Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our November issue: 

We all know that children with chronic illness are at increased risk for depression. Many children, such as those with diabetes, are seen fairly regularly with specialty care providers. However, screening for depression in specialty care clinics can be challenging — what tool should be used? Who should do it? Will families be accepting of screening? And how can positive screens be handled in the context of a busy specialty care clinic?

Dr. Corathers and colleagues (doi: 10.1542/peds. 2013-0681) share their highly successful approach to adolescent depression screening in an endocrinology clinic. Take a look and see how they were able to implement comprehensive depression screening. Leave a comment below and let us know if this is something you can implement in your clinical setting!

Related Reading:

Friday, October 18, 2013

Cognitive Behavioral Therapy and Functional Abdominal Pain: A Therapeutic Option You May Not Have Considered

When a child presents with chronic recurrent functional abdominal pain of no definitive etiology, it is frustrating for all involved—the patient, the family and the clinician trying to help. While the pain is real, in the absence of a defined cause, we are eager to try to find ways to reduce the severity of the pain—even while we continue to observe the course of the pain closely.

Photo by hellocoolworld via Flickr
Recently, cognitive-behavioral therapy has been suggested as a non-pharmacologic approach to helping children deal with their functional pain—but it was not well-studied with a randomized controlled trial until this week when we share the result of such a trial by van der Veek et al. (doi:10.1542/peds.2013-0242). The authors randomized over 100 children ages 7-18 with functional abdominal pain to get 6 sessions of cognitive-behavioral therapy taught by masters’ students in psychology or 6 visits to the pediatrician for routine diagnostic and therapeutic care.

The outcome was self-report of pain by those enrolled as well as a variety of secondary outcomes involving comorbid conditions and quality of life. The results will make you happy no matter what arm of the study you choose. If you don’t believe me (or are not a fan of CBT) be mindful of the results of this study the next time you need a treatment plan for one of your patients with functional abdominal pain—you’ll be glad you did.

Related Reading:

Monday, September 30, 2013

Psychotropic Medication Use in Very Young Children: Is It Getting Better or Worse?

We all probably hesitate in considering whether or not to use psychotropic medication in very young children, given the limited evidence available on their benefits versus their risks.  Yet they are being used—and the question is: are they being used more and more on children between the ages of 2 and 5 years of age?  Chirdkiatgumchai et al. (doi: 10.1542/peds.2013-1546) studied this question using data from national surveys obtained on more than 43000 very young children between 1994 and 2009 looking at 4 year time intervals to sample.  The trend analysis is very interesting and shows some ups and downs that are worth reading about. In addition, the authors provide an epidemiologic profile of demographic variables that are associated with use of these drugs that identifies some sociodemographic disparities in who is and is not receiving these medications.  While it is not clear what might be causing these disparities, the authors offer some thoughts as they discuss their findings.

While needing to put a young child on a psychotropic medication is a bitter pill to swallow, this study will provide you with a healthy dose of data to better understand just who is receiving these medications so you can better assess whether or not you need to prescribe them for very young patients in your own practice.

Tuesday, September 17, 2013

Children Who Are Bullied and Their Psychosomatic Problems: Is There an Association?

We certainly worry that a child who has been the victim of bullying behavior may have after-effects —perhaps in terms of an increase in somatic complaints in the months and years that follow—but does the literature provide the evidence to support that worry?  Gini and Pozzoli (doi: 10.1542/peds.2013-0614) review the evidence for an association between bullying and psychosomatic problems in a meta-analysis being released this week in our journal.  30 studies met criteria for analysis, 6 longitudinal and 24 cross-sectional, and confirm a relatively strong association not just in the US, but around the world.

If you never realized that bullying and its after-effects represent a public health problem given how wide spread these effects can be, then please read this important meta-analysis, and in turn, monitor your own patients for their psychosomatic concerns, especially in the setting of their having been bullied.

Thursday, September 5, 2013

Coffee and Mental Health

Associate Editor Dr. William V. Raszka offers insight into topics in the news. This week, he reflects on recently reported mental health disorders associated with coffee consumption: 

I begin each day with at least one large cup of coffee (usually two), and I often have one more cup mid-morning. While I do not think I have a “problem,” I do occasionally wonder what would happen if I suddenly stopped all caffeine consumption.

According to the latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, coffee consumption is associated with two – and possibly three – mental health disorders. Coffee intoxication and coffee withdrawal are mental health disorders when they impair function, and caffeine use disorder – now a research diagnosis requiring further study – is diagnosed when a coffee drinker complains of adverse effects and cannot quit.

As reported in The Wall Street Journal (Your Health: June 10, 2013), such designations were not without controversy. Some argue that clinically significant side effects of coffee withdrawal are uncommon and labeling an individual experiencing them as having a mental health disorder is excessive. Others argue that individuals in many studies report withdrawal symptoms, and that health care professionals need to include the possibility in the differential diagnosis and be able to manage it.

The diagnosis of caffeine withdrawal is supported if an individual reports at least three of following symptoms within a day of discontinuing caffeine consumption: headache, poor concentration, nausea or muscle pain, irritability or decreased mood, and fatigue or drowsiness. Symptoms may occur at different times, as the half-life of caffeine ranges from two to eight hours, and tend to last two to nine days. In patients who have experienced withdrawal symptoms, some recommend stopping cold turkey, but most seem to recommend tapering caffeine consumption over a few weeks.

As for me, I do not think I will attempt to see what happens, but continue to savor freshly brewed coffee in the morning with my wife.

*This filler excerpt can be found in the August 2013 Pediatrics print journal p. 289, or online here.