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Raising an Optimistic Child: A Proven Plan for Depresion-Proofing Young Children--for Life
(McGraw-Hill, 2006) by Bob Murray and Alicia Fortinberry

Read more about Creating Optimism

Creating Optimism:
A Proven Seven-Step Program for Overcoming Depression

(McGraw-Hill, 2004) by Bob Murray and Alicia Fortinberry

Childhood and Parenting

Written and researched by Bob Murray, PhD

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School of Hard Knocks Impairs Judgement

Sep 17, 2006

People who have suffered life's hard knocks while growing up tend to be more gullible than those who have been more sheltered, startling new findings from the University of Leicester reveal.

A six-month study in the University's School of Psychology found that rather than 'toughening up' individuals, adverse experiences in childhood and adolescence meant that these people were vulnerable to being mislead. The research analysing results from 60 participants suggest that such people could, for example, be more open to suggestion in police interrogations or to be influenced by the media or advertising campaigns.

The study found that while some people may indeed become more 'hard-nosed' through adversity, the majority become less trusting of their own judgment.

Kim Drake, a doctoral student at the University of Leicester, conducted the research with Professor Ray Bull and Dr Julian Boon of the School of Psychology. Kim said: "People who have experienced an adverse childhood and adolescence are more likely to come to believe information that isn't true--in short they are more suggestible, and easily mislead which may in turn impact upon their future life choices; they might succumb to peer pressure more readily."

'Adverse life experiences' examined included major personal illnesses/injuries, miscarriage (from the male and female perspective), difficulties at work (being fired/laid off), bullying at school, being a victim of crime (robbery, sexual violence), parental divorce, death of family member and others. Seventy percent of the variation across people in suggestibility can be explained by the different levels of negative life events that they have experienced, the study found.

"We also found that the way people cope with adversity had an impact on their psychological profile," said Kim. "The majority of people may learn through repeated exposure to adversity to distrust their own judgment; a person might believe something to be true, but when they, for example, read something in a newspaper that contradicts their opinion, or they talk to someone with a different view-point, that individual is more likely to take on that other person's view.

"This is because the person may have learned to distrust their actions, judgments and decisions due to the fact that the majority of the time their actions have been perceived to invite negative consequences. "Another example is in relationships. Women, as well as men, can become "brainwashed", and end up changing in their personality, their views and beliefs and in some extreme cases, they may even take on their views and ideas of the world and come to feel incompetent (in their partner's eyes)."

Kim added that there is already evidence to suggest that there is a relationship between intensity/frequency of negative life impacts and degree of vulnerability. Experience of adversity may have a knock-on effect on a person's mindset- they may come to believe that "they are no good", or "nothing they do is ever good enough". In contrast, the findings also suggest that early positive life events may have a protective influence over the effects of subsequent adversity: "If positive life events predate the negative life events then individuals may be more resilient in terms of, not being so badly affected, psychologically, by the subsequent adverse events. However, issues may arise if the reverse is the case; if the adverse life events precede the positive, those individuals may become, as a result, more susceptible to suggestion and misleading information.

The study found that the parental role is an important one. Parental education--showing parents functional ways of dealing with their children-leads to children will seeing positive role models, and learning "healthy" skills or ways of dealing with stress/negative life events. What's more this may help cultivate a positive mind-set within the child or adolescent which will stay with them throughout life.

Study not available on the web.

Read more in Raising an Optimistic Child (McGraw-Hill, 2004)

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ADHD Drugs Send Thousands to ERs

Sep 17, 2006

People who have suffered life's hard knocks while growing up tend to be more gullible than those who have been more sheltered, startling new findings from the University of Leicester reveal.

A six-month study in the University's School of Psychology found that rather than 'toughening up' individuals, adverse experiences in childhood and adolescence meant that these people were vulnerable to being mislead. The research analysing results from 60 participants suggest that such people could, for example, be more open to suggestion in police interrogations or to be influenced by the media or advertising campaigns.

The study found that while some people may indeed become more 'hard-nosed' through adversity, the majority become less trusting of their own judgment.

Kim Drake, a doctoral student at the University of Leicester, conducted the research with Professor Ray Bull and Dr Julian Boon of the School of Psychology. Kim said: "People who have experienced an adverse childhood and adolescence are more likely to come to believe information that isn't true--in short they are more suggestible, and easily mislead which may in turn impact upon their future life choices; they might succumb to peer pressure more readily."

'Adverse life experiences' examined included major personal illnesses/injuries, miscarriage (from the male and female perspective), difficulties at work (being fired/laid off), bullying at school, being a victim of crime (robbery, sexual violence), parental divorce, death of family member and others. Seventy percent of the variation across people in suggestibility can be explained by the different levels of negative life events that they have experienced, the study found.

"We also found that the way people cope with adversity had an impact on their psychological profile," said Kim. "The majority of people may learn through repeated exposure to adversity to distrust their own judgment; a person might believe something to be true, but when they, for example, read something in a newspaper that contradicts their opinion, or they talk to someone with a different view-point, that individual is more likely to take on that other person's view.

"This is because the person may have learned to distrust their actions, judgments and decisions due to the fact that the majority of the time their actions have been perceived to invite negative consequences. "Another example is in relationships. Women, as well as men, can become "brainwashed", and end up changing in their personality, their views and beliefs and in some extreme cases, they may even take on their views and ideas of the world and come to feel incompetent (in their partner's eyes)."

Kim added that there is already evidence to suggest that there is a relationship between intensity/frequency of negative life impacts and degree of vulnerability. Experience of adversity may have a knock-on effect on a person's mindset- they may come to believe that "they are no good", or "nothing they do is ever good enough". In contrast, the findings also suggest that early positive life events may have a protective influence over the effects of subsequent adversity: "If positive life events predate the negative life events then individuals may be more resilient in terms of, not being so badly affected, psychologically, by the subsequent adverse events. However, issues may arise if the reverse is the case; if the adverse life events precede the positive, those individuals may become, as a result, more susceptible to suggestion and misleading information.

The study found that the parental role is an important one. Parental education--showing parents functional ways of dealing with their children-leads to children will seeing positive role models, and learning "healthy" skills or ways of dealing with stress/negative life events. What's more this may help cultivate a positive mind-set within the child or adolescent which will stay with them throughout life.

Study not available on the web.

Read more in Raising an Optimistic Child (McGraw-Hill, 2004)

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Childhood Experience Influences Mood

Sep 17, 2006

Despite all the research that has been done over the last decade showing the prime importance of early childhood experience, there are still those, even in the psychiatric ands psychological professions who remain doubters. There are still parents who ignore the warning signs and give their children over to too-early childcare or insist on pursuing two full-time careers at the expense of their offspring.

Indeed there are still professional therapists telling parents that their own mood and the way that they interact with each other has no real influence on their children. To be frank, this is dangerous nonsense!

Not only their overall relationship, but also their prevailing mood and outlook can be a powerful life-long influence on the way their children view the world and can affect their life-chances. A new study published in the recent issue of the Journal of Personality finds a correlation between adult pessimism and childhood in a low socioeconomic status (SES) family.

By connecting socioeconomic status to pessimism, which in turn has in earlier studies shown to be related to physical and mental health, the current study provides critical information for policy makers and parents concerned with preventing the development of bad coping strategies of children.

Researchers compared optimism and pessimism levels of participants from different socioeconomic backgrounds and found that persons of high SES had a more optimistic outlook on life. This is hardly surprising. Further, it was discovered that the effect of childhood socioeconomic status on pessimism tended to remain in spite of socioeconomic fluidity.

A person from a low SES childhood who moved upwards in status was less likely to be optimistic as an adult than someone from a high SES childhood who remained in high SES. The inverse also held true, as people from a high SES childhood who moved downwards in socioeconomic status were more optimistic than those who remained in low SES.

"Children from the higher SES classes who are subsequently downwardly mobile may have learned successful coping strategies during childhood and consequently developed a sense of mastery and control that protected them in adulthood from the adverse effects of lower SES, whereas children from lower SES backgrounds who are subsequently upwardly mobile may not have had the opportunities to develop those psychological resources, and thus are not able to benefit as much as possible from the later success experiences," concludes the study's lead author.

Our own experience confirms what the researchers have found. However we would emphasize that children from a high-income home where one of the parents was pessimistic or depressed can also suffer from life-long depression or pessimism.

Read more in Journal of Personality

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In Childrearing it's the Relationship that Matters

May 25, 2006

In our latest book Raising an Optimistic Child we stress that the most important thing for a child's emotional and psychological welfare is a good relationship between his or her parents. This has now been reinforced by evidence from a study by researfchers at the University of Rochester.

The researchers found that six-year-olds whose parents displayed frequent disagreements in their relationship responded to subsequent parental conflicts with elevated distress and negative thoughts.

In the latest issue of the journal Child Development, the team reported examining 223 children twice during a one-year period for their reactions to conflicts between their parents. First, their mothers and fathers participated alone in an exercise in which they attempted to manage and resolve a common point of disagreement. The researchers rated the parents' level of hostility or indifference to capture the characteristic ways that parents managed their conflicts. Then the children observed their parents working through two simulated telephone conversations: a short conflict and a resolution.

Researchers found that the ways parents managed conflicts in the exercise predicted how children responded to the simulated phone conflict--both within a two-week period and one year later. Parents who displayed high levels of discord had children who responded with greater than expected distress to the simulated phone conflict.

"The stressfulness of witnessing several different types of conflict may have long-term implications for children's functioning by directly altering their patterns of responding to those conflicts," says Patrick T. Davies, lead author and professor of psychology at the University of Rochester. "Our results highlight the possibility that several different types of conflict between parents may negatively affect the well-being of children over time."

According to the authors, prior experiences with parental conflicts can alter the way children cope with later conflicts. "Conflict between parents may have distinct meanings and implications for the child and family system even after considering the effects of parenting difficulties," Davies points out.

Although previous work has shown that children don't get used to their parents discord but, instead, become more sensitive to it, Davies and his colleagues wondered if different forms of destructive conflict between parents played different roles in children's reactions. It didn't matter whether the adults disagreed in openly hostile ways or appeared indifferent during the arguments. Both ways of managing conflict were linked with higher than expected distress in children that lasted even one year later.

Read more in Child Development

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Stress Sparks Male Foetus Death

May 25, 2006

A woman's body may actively kill off weaker male foetuses during times of stress, new research suggests. It is known that fewer boys tend to be born during times of hardship, such as a natural disaster. Male foetuses and embryos are weaker than females and are less likely to survive to birth. However it is not known why this should be the case.

University of California researchers examined data on Swedish births from 1751 to 1912. These findings demonstrate yet again that we need not go to museums of natural history to find evidence of natural selection.

Two explanations have been suggested as to why the proportion of newborn boys often dips sharply during times of stress. One is that mothers' stress responses damage their unborn babies, affecting already weaker males disproportionately and spontaneously aborting more males than usual. But a competing explanation is that mothers' bodies under stress have less tolerance for unhealthy embryos and foetuses, and thus spontaneously abort offspring that would have been otherwise carried to birth. The scientists said their analysis supported the latter explanation.

Lead researcher Dr Ralph Catalano said that if stress was simply damaging male foetuses then it could be expected that even those boys that made it to full term would be damaged, and consequently their life expectancy would be shorter. However, the researchers found the opposite to be true. Those males that survive to full-term actually lived longer than the average.

This suggested that only weak foetuses were selectively targeted by the mother's body, giving more robust males every opportunity to thrive. They argued that actively culling weak male foetuses might increase the overall chance that a woman's genetic line will survive down the generations, as weak individuals were more likely to produce fewer offspring.

Writing in Proceedings of the National Academy of Sciences, the researchers said their findings may also have implications for public health. Changes in the proportion of male and female newborns may give a clue as to what proportion of the population are likely to suffer from stress-related illnesses.

Read more in Proceedings of the National Academy of Sciences

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Our Over-Drugged Children

Nov 1, 2005

For a long time we have been saying that pharmacology has been replacing adequate parenting as the preferred means of raising kids in the US and other Western countries. A new report adds weight to this argument.

Pediatric polypharmacy, the practice of prescribing two or more medications for psychiatric symptoms in children, is on the rise in the United States, raising concern about unknown side effects, according to a new study appearing in the August issue of the journal Psychiatry 2005.

"This is a critical issue -- it's not uncommon to find a child on an anti-depressant, a mood stabilizer, and a sleep agent all at the same time, but there's no research to see how these drugs interact with each other" says co-author Joseph Penn, MD a child psychiatrist with the Bradley Hasbro Children's Research Center (BHCRC) in Providence, RI and Brown Medical School.

The authors of the study reviewed 10 years of scholarly articles pertaining to polypharmacy in pediatric settings, and found that all the studies comparing these rates across time showed an increase in the practice. However, the authors warn there are almost no studies or published research on which to justify prescribing multiple medications for psychiatric disorders in children. Indeed many of the drugs - such as antidepressants - have been shown to be ineffective in people under 18.

According to the study, the most frequent combination were stimulants such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine, Adderall) commonly used to treat ADHD, with another psychotropic medication. And this despite the fact that ADHD is the most mis-diagnosed of all pediatric mental disorders and that Ritalin and other drugs have been shown to lead to long-term adult depression (arguably a much worse disorder than ADHD).

Another contributing factor to the increased risks of prescribing multiple drugs is the prevalence of off-label prescriptions -- the practice of prescribing a medication to children when there is not a FDA approved indication for that disorder in children.

"For example, aytpicals like risperidone are sometimes used to symptomatically treat psychosis or aggression in children, but most of these medications don't have FDA approval for use on psychiatric symptoms in the pediatric age group," says co-author Henrietta Leonard, MD, also a child psychiatrist with the Bradley Hasbro Children's Research Center and Brown Medical School. "We just don't have the efficacy or safety data to back up what is common clinical practice."

Because there are limits to the data available on the efficacy of a single medication in the pediatric age group, the authors express deep concern over the rise in polypharmacy because it could multiply the risk of adverse events. "The FDA recently questioned whether there is a link between the use of antidepressants in children and suicidal thoughts -- if there is so much concern over the effects of a single drug, how much riskier is it to prescribe multiple drugs?" Penn says.

The authors cite examples of a child on two medications for ADHD who died suddenly, and additionally describe serotonin syndrome, a serious and potentially fatal illness that can result when a child receives two medications with serotonergic properties.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) has issued a policy statement saying, "Little data exist to support advantageous efficacy for drug combinations, used primarily to treat co-morbid conditions." The authors concur. "We need more systematic studies to establish the safety and efficacy of medications in the pediatric age group," says Penn.

Amen to that!

Our next book Raising an Optimistic Child is to be published by McGraw-Hill in February, 2006 - BM

Read more in the Psychiatry 2005

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Encouraging Kids to Make Choices

Nov 1, 2005

A new study published in the August issue of Journal of Personality finds that parents who provide their preschoolers with choices and encourage them to take on responsibilities were helping their children in the long run.

This pattern of parenting called "autonomy supportive" was shown to lead to high academic and social adjustment in eight-year-olds. Teacher reports and standardized tests showed that this flexible and responsive parenting technique that focused on the child's perspective, explaining the rationale for requests, providing choices, and not using controlling language lead to better outcomes.

"Autonomy support was found to increase the odds of children being both high in social and academic adjustment, as well as high in both social adjustment and in reading achievement," the authors state. The results held true regardless of socio-economic status, gender, or IQ. The study interviewed the mothers of five-year-olds to measure the level of autonomy support and other parenting dimensions. Three years later, the study looked at the children's social adjustment and achievement in reading and math in grade three.

"Maternal autonomy support measured in kindergarten was positively associated with social adjustment, academic adjustment, and reading achievement in third grade," the authors cite as their most important finding.

Read more in Journal of Personality

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Katrina, Kids and PTSD

Nov 1, 2005

The devastating effects of Hurricane Katrina have been felt across the country during the past weeks. Thousands of children are survivors of Katrina, while millions of others around the country have observed horrific sights via media coverage. Although they were not directly involved with the tragedy, repeated television viewing of the disaster puts these children at high risk for developing Post-traumatic Stress Disorder (PTSD), anxiety and depression.

"Research on the impact of the World Trade Center attack indicates that children who viewed more television news of the attack were two times as likely to develop symptoms of PTSD than children with lower TV exposure," said Harold S. Koplewicz, M.D., Director of the NYU Child Study Center. "Our job as parents is to protect our kids from unnecessary media coverage of this event. Good parents will stop the television."

The NYU Child Study Center recommends that parents limit television viewing of the disaster for children under 12 years of age, and eliminate all viewing when possible. For teenagers ages 12-17 it can be harder to completely eliminate television. Parents should take this opportunity to start a dialogue about the events, making sure kids understand what has occurred and know that they can continue the conversation if future questions or concerns arise.

Kids' questions and concerns are likely to be tough to answer, but as with all important discussions, keeping communication lines open is critical and honesty is essential. Some concerns don't get settled quickly, and more than one conversation may be necessary as events unfold.

"The effects of witnessing or being a victim of Katrina will vary for children depending on their age, how they experienced the event and their ability to understand what has happened," said Marylene Cloitre, Ph.D., Director of the NYU Child Study Center Institute for Trauma and Stress. "Parents should allow children to express themselves, give them a sense of security, and be open and available to discuss various issues."

They suggest the following advice for parents, family or teachers to help their children cope with the recent or similar tragedies:

  • Limit both your own and your children's exposure to television reports of the event.
  • Discuss the tragedy, but start by finding out what your child understands about the event. Be available for more than one conversation; children's understanding of events and their questions will change over time.
  • Reassure your child of their current safety, and remind them of all the different resources in your community that provide them with safety.
  • Maintain as usual a routine as possible. Maintaining normal bedtimes and participating in familiar activities provides children with a sense of normalcy.
  • When children receive news of a sad and shocking event it is normal for them to have some fluctuations in mood and irritability. Some children will become more clingy and may seek and need more reassurance and contact with caregivers.
  • Help your child regain a sense of control. Let them be proactive by taking them to purchase a toy or other needed goods for a child who was affected by the hurricane.

If you are concerned about your child's reactions to Hurricane Katrina, listen to your parental intuition. A child who has an intense or prolonged reaction, or begins having difficulties at school, with their peers, or at home may need help from a counselor or other mental health professional.

For more information and resources on how to help your child deal with Hurricane Katrina or other traumatic events, visit AboutOurKids.org

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Caffeinated Colas Linked to Inattention, Hyperactivity in Kids

June 6, 2005

When parents or teachers complain about a child being inattentive, restless, and having difficulty sleeping, physicians may want to consider the caffeinated soft drinks in the school vending machine or the home refrigerator before they screen for attention deficit/hyperactivity disorder (ADHD), according to findings presented here at the 2005 American Psychiatric Association Annual Meeting.

In a double-blind study of first-grade children, researchers found that they had more behavior problems on the days that they were exposed to caffeinated colas than on the days that they had caffeine-free drinks. These findings may provide a simple answer to some instances of children's hyperactivity, according to principal investigator Alan R Hirsch, MD.

"We found that exposure to caffeinated cola drinks impaired children's learning ability by causing restlessness, hyperactivity, and inattention," Dr Hirsch said. "On the days that the children were drinking caffeinated drinks, their hyperactivity/inattention scores increased an average of 5.5 points compared with the days when they were only drinking caffeine-free drinks." Dr Hirsch is an assistant professor of both neurology and psychiatry at Rush Medical College in Chicago.

The study involved 20 first-grade children, 10 boys and 10 girls. In three-hour time segments that occurred sequentially for a two-week study period, the students were given up to 12 oz of either a caffeinated cola drink or a caffeine-free cola drink. The children were given 10 dimes with which they could "buy" repeat servings of their designated drink for the study session after an initial serving of 2 oz. At the end of each session, the children's teacher, who did not know the purpose of the study or the type of soda each child consumed, assessed each child's behavior.

On the study days, the children consumed an average of 7.55 oz of caffeine-free cola and 9.45 oz of caffeinated. Among the individual students, 60% had elevated hyperactivity/inattention scores on the caffeine days, while only15% had higher scores on the caffeine-free days. The remaining 25% had consumed the maximum servings of both types of drinks and were not included in the analysis.

After adjusting for noncaffeine-related factors, such as the number of ounces consumed and the amount of sugar in the drinks, the scores were still higher on the caffeine days. The findings should support physicians' recommendations regarding restricting children's dietary caffeine, and it could also have implications regarding school systems' friendly relationship with vendors.

"Children ages 6 to 11 years old conservatively drink an average of seven to eight oz of carbonated soda per day," said Dr Hirsch. As the findings show, "this can have a substantial impact on children's behavior in school."

The study also underscores why it is so important to completely evaluate young children who are having behavioral and emotional problems and to review the child's dietary habits, including caffeinated beverages, as part of the evaluation.

In our upcoming book "Raising Optimistic Children" (McGraw-Hill, Feb 2006) we argue strongly that ADHD is the result of nurture and other environmental influences. This research supports our conclusions. BM

Note: The research is not available online.

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PTSD in the Womb

June 6, 2005

In writing our new book on preventing depression in very young children one of the things we noted was how kids could be born depressed or anxious depending on their mothers' experiences--especially negative relationship stressors--during pregnancy.

Now new research published in the May edition of the Journal of Clinical Endocrinology and Metabolism shows that pregnant women who witnessed the September 11 World Trade Center collapse have passed on markers of posttraumatic stress disorder to their unborn babies through transgenerational transmission. The findings strengthen the evidence for in utero or early life risk factors for the later development of adult mental or physical disorders.

Previous studies led researchers to believe that reduced cortisol levels observed in the adult children of Holocaust survivors could be attributed to mostly environmental factors, such as the stress of living with a parent who is depressed or anxious, or the experience of vicarious traumatization based on hearing stories of how parents suffered, rather than a "transmitted" biological trait.

"In the current study, reduced stress hormone levels were observed in infants, suggesting a larger role for very early environmental, genetic, or genetic-environmental interactions than previously thought," explains Rachel Yehuda, PhD, principal investigator of the study.

Scientists at Mount Sinai School of Medicine and the University of Edinburgh studied the relationship between maternal PTSD symptoms and salivary cortisol levels in 38 women and their infants. Mothers who experienced symptoms of PTSD in response to 9/11 had lower cortisol levels compared to mothers who did not develop this condition. Moreover, approximately one year after birth, the babies of mothers who had developed PTSD symptoms had significantly lower cortisol levels compared to that in babies of mothers who developed only minimal symptoms. This decrease in cortisol levels among the infants was similar to their mothers' hormonal response to PTSD.

Since lower cortisol levels in relation to maternal PTSD were most apparent in babies born to mothers who were in their third trimester on 9/11, the data implicate the possibility of in utero effects as contributors to a putative biological risk factor for PTSD.

"The findings suggest that mechanisms for transgenerational transmission of biologic effects of trauma may have to do with very early parent-child attachments," says Dr Yehuda, "and possibly even in utero effects related to cortisol programming."

Read more in the Journal of Clinical Endocrinology and Metabolism

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How Babies Learn Language

April 1, 2005

Adults may feel silly when they talk to babies, but those babies will learn to speak sooner if adults talk to them like infants instead of like other adults, according to a study by Carnegie Mellon University Psychology Professor Erik Thiessen published in the March 2005 issue of the journal Infancy.

Most adults speak to infants using so-called infant-directed speech: short, simple sentences coupled with higher pitch and exaggerated intonation. Researchers have long known that babies prefer to be spoken to in this manner. But Thiessen's research has revealed that infant-directed speech also helps them learn words more quickly than normal adult speech.

In a series of experiments, he and his colleagues exposed 8-month-old infants to fluent speech made up of nonsense words. The researchers assessed whether, after listening to the fluent speech for less than two minutes, infants had been able to learn the words. The infants who were exposed to fluent speech with the exaggerated intonation contour characteristic of infant-directed speech learned to identify the words more quickly than infants who heard fluent speech spoken in a more monotone fashion.

Thiessen's study may also explain why many adults struggle to learn a second language even though they are able to use their own language effortlessly. Children, after all, learn to speak practically from scratch, and most experts believe infants are more adept than adults at language learning. "Learning a language is one of the most critical things that an infant has to do, because communication with other people is tremendously important," Thiessen said. "It makes a great deal of sense that the special way we have of talking to babies would help them learn."

Read more in Infancy

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The Ritalin Debate Hots Up

January 11, 2005

If antidepressants don't work and are dangerous, what about that other terribly over-prescribed drug Ritalin? It, too, is coming under fire both for its efficacy, or lack of it, and also for its potentially dangerous side-effects. One of those side-effects has now been shown to be adult depression.

A new study conducted in rats by the National Institutes of Health (NIH) and McLean Hospital/Harvard Medical School suggests that the misdiagnosis of attention-deficit hyperactivity disorder (ADHD) combined with prescription drug use in children may lead to a higher risk of developing depressive symptoms in adulthood.

This work, released at the annual American College of Neuropsychopharmacology (ACNP) conference in Puerto Rico, is among the first to examine the effects of early Ritalin exposure on behavior and brain function during later periods of life.

"Attention-deficit hyperactivity disorder can be a serious medical problem for children and their parents," says lead researcher William Carlezon, PhD, director of McLean Hospital's Behavioral Genetics Laboratory and associate professor of psychiatry at Harvard Medical School. "While Ritalin is an effective medication that improves the quality of life for many children with ADHD, accurately diagnosing and identifying the correct treatment regimen for the disorder is essential, especially when considering health effects that can last through adulthood."

Ritalin is a generic medication prescribed for children with ADHD, a condition that consists of a persistent pattern of abnormally high level of activity, impulsivity, and/or inattention. Usually diagnosed in children of preschool or elementary school age, ADHD has been estimated to affect 3 to 12 percent of children and is twice as common among boys. Children with ADHD are also likely to have other disorders, such as a learning disability, oppositional defiant disorder, conduct disorder, depression, or anxiety.

Because most children show some of these behaviors of inattention and hyperactivity at times, the diagnosis of ADHD is a complex process that should involve specialists. It is critical to determine whether a child's behavior is simply immature or exuberant, related to another issue such as a vision problem or learning disability, or is characteristic of a disorder such as ADHD.

In the work funded by the NIH, Dr Carlezon and his chief collaborator, Dr Susan Andersen, examined the effects of exposing rats to Ritalin during early development on behaviors later in life. They exposed normal rats to twice-daily doses of Ritalin during a period that is equivalent to approximately 4-12 years of age in humans. Examining the behavior during adulthood, Carlezon and Andersen conducted several types of tests that all showed that the animals had a reduced ability to experience pleasure and reward. In addition, they found that the animals exposed to Ritalin during pre-adolescence were more prone to express despair-like behaviors in stressful situations (such as swim tests) as adults. Overall, the animals showed more evidence of dysfunctional brain reward systems and depressive-like behaviors in adulthood.

These findings are critical because they suggest that Ritalin can have long-term consequences on normal-functioning brains. The study is particularly relevant when considering the difficulty in correctly diagnosing children with ADHD. In 1999, approximately 90 percent of children diagnosed with the disorder were taking Ritalin, with children beginning drug therapy at younger ages today, even during preschool in some instances. There is increasing evidence to suggest that correct diagnosis of ADHD is of the highest importance--children who are misidentified as having ADHD and subsequently placed on prescription drug therapy could face possible impaired brain performance as adults.

This research paper is not available on the web.

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Top 10 Toys for Kids with ADHD

December 6, 2004

What do you give the child who has everything--ADD/ADHD, anxiety, depression. Well this season some experts are offering tips. They have published the top 10 toys for children with attention-deficit/hyperactivity disorder (ADHD), along with selection criteria designed to help guide parents as they shop for toys for a child with ADHD.

All the toy selections as well as the criteria used are posted on www.ADHDSupportCompany.com.

The Top 10 list of toys has been developed based on the specific needs of children with ADHD, including the need to better focus attention, to gain self-confidence and to learn to socialize and interact appropriately with other children.

The selection criteria used to choose these toys may provide useful guidelines for parents to consider when shopping for toys that their child with ADHD can enjoy. Together, the toy list and criteria may help parents interact with their child and also assist them to direct the child's energy in a more productive way.

The 10 toys on the list are:

  • Gertie ® Balls from Small World Toys (preschool, early school years)
  • Cranium Hullabaloo TM from Cranium (early - late school years)
  • Magz-x 106 TM from Progressive Trading (early - late school years)
  • Wonderfoam ® Giant USA Puzzle Map from Chenille Kraft Co. (late school years)
  • Letter Factory Game TM from Leap Frog (preschool, early school years)
  • Leap Pad ® Plus Writing Learning System from Leap Frog (preschool, early school years)
  • I Never Forget A Face Memory Game from eeBoo (preschool, early school years)
  • Old Century Shut-the-Box from Front Porch Classics (late school years)
  • Deluxe Tumble Treehouse and Skycoaster from Maxim Enterprises (preschool)
  • Bird Diner Kit ® from Balitono (early - late school years)

As the holiday season approaches, parents can use the following criteria to choose the most appropriate toys for their child with ADHD:

  1. Play to their strengths. Many children with ADHD have plenty of energy that they need to use so physical activity should be encouraged. For example, sports like swimming or karate can provide a valuable outlet.
  2. Build confidence. Children with ADHD have trouble completing lengthy tasks because they often become frustrated and discouraged. While bringing home an elaborate and complicated puzzle or construction set might seem like a great treat, it may be too intimidating for a child with ADHD. Instead, start out simpler and give your child a puzzle or construction set that has fewer components and is recognizable, such as an oversized map.
  3. Remove distractions. Does your playroom look like a toy store? Children with ADHD are easily distracted when there are lots of toys around vying for their attention. To help your child focus, it might be helpful to have a play table where only one game or toy can be played with at a time. Place other toys in closed cabinets. In this case, less is definitely more.
  4. Keep it short. Games with short play times are a better choice than those with lengthier ones. Selecting games with only a few easy to understand rules is the best choice for children with ADHD.
  5. Dramatic play. Giving children the props for pretend play, whether it's a set of costumes, puppets or a playhouse, also are solid choices for helping children to develop their imaginations and communication skills. Role-playing with dolls, stuffed animals or action figures allows children to express feelings that they might not otherwise be able to do directly.
  6. Artistic expression. Many children with ADHD are often told that they are not doing something the right way. Open-ended art supplies like clay, big markers, or paints give children an opportunity to express themselves in a non-verbal way. There is no right or wrong way to use these art supplies. As a parent, it is also your job to provide positive reinforcement. For example, you can help coordinate an art show for family members to attend.
  7. Make sure everyone is on the same team. Be aware that you can help children cope with ADHD and create a supportive environment that involves the whole family. Extended family members should be encouraged to interact with children who have ADHD, but be sure that these family members have reasonable expectations. For example, children with ADHD cannot be expected to sit still for long projects or games. It is important for everyone to be aware and considerate of each other so that no one will end up frustrated or in tears.

Read more at ADHDSupportCompany.com Beware: This is a drug company site, do not give personal information.

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Babies Who Cry Too Much

November 6, 2004

ADD/ADHD has become very controversial in academic circles of late with a number of studies throwing light on its origin and possible cure and on the dangers of excessive drug use-ritalin and others.

Now, according to a US National Institutes of Health published in the journal Archives of Disease in Childhood, babies who continue to cry excessively for no obvious reason can go on to have difficulties in childhood.

Excessive, uncontrolled crying that persisted beyond three months of age was linked with behavioral problems and lower IQ at the age of five. However experts said most crying was normal and parents should not be unduly concerned.

The NIH team, working with researchers at the Norwegian University of Science and Technology, looked at 327 babies and their parents. They assessed the babies' crying patterns at six and 13 weeks of age and whether or not the crying could be explained by simple colic. When the children were five years old, the researchers assessed their intelligence, motor abilities and behavior.

The children who had continued to cry beyond three months of age as infants, which was not due to colic, had intelligence scores (IQs) nine points lower than the other children studied. Prolonged crying was also linked with poorer fine motor abilities, hyperactivity and discipline problems in childhood.

In 2002, a team of UK researchers, led by Professor Dieter Wolke at Bristol University, found children who had cried excessively as babies, beyond three months, were 14 times more likely to develop attention deficit hyperactivity disorder (ADHD) and do worse at school as eight year olds.

Professor Wolke told the BBC Online "This confirms what we found. Now there really is more certainty there is really something going on." He believes the core of the problem is one of under-regulation. "With ADHD you can't regulate your attention. You can't concentrate, for example. The same thing is happening with crying. Picking up problems early. With these babies, it may be that their brains are built in a way that they have problems regulating themselves. They don't learn to calm themselves down, even with the best parenting."

He pointed out that most crying in babies was completely normal, and that this excessive crying linked to later problems occurred in only about 2-5% of cases. "But that's still quite a lot of children -- between 14,000 and 35,000 children per year in Britain alone," he said.

He said it might now be possible to pick up ADHD as early as six months and intervene. "These babies, because they are under-regulated, they need incredibly regular routines. Some babies you can take to noisy parties and they will sleep and won't cry. But these babies, any change to their routine and they can't cope. A very strict, regulated parenting pattern but which is warm and loving seems to reduce the amount of crying. What we really need now is a good randomized controlled trial on a large scale to look long term whether intervention has an effect."

Heather Welford from the National Childbirth Trust also told the BBC Online: "We know that a good close attachment between parents and babies is very important for intellectual and emotional development."

Separately in a study published in the latest edition of the journal Child Development researchers led by Bea RH Van den Bergh of the Catholic University of Leuven in Belgium found that children whose mothers who suffered significant stress between 12 and 22 weeks of their pregnancy were far more likely to develop ADD/ADHD later on. Stress later in pregnancy (32 to 40 weeks) did not seem to have the same effect.

Read more on BBC Online

Read more in Archives of Disease in Childhood

Read more in Child Development

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Toddlers' Imitation Predicts a Well-Developed Conscience

November 6, 2004

A recent study tested whether naturally-occurring differences in how 1-year-olds imitate their mothers can predict which children will show a well-developed conscience as preschoolers. The study, led by David Forman, Concordia University in Montreal, found evidence that babies who enthusiastically imitate their parents develop a sense of right and wrong earlier than those who don't.

The report appears in the October 2004 issue of the journal Psychological Science.

Imitation was measured when children were 14 and 22 months old. Mothers demonstrated simple actions and asked their children to copy them, and researchers noted how much, and how eagerly, each child imitated his or her mother. Children were tested again at 33 and 45 months old, this time for conscience development. Enticed with gift-wrapped prizes, children played games designed to be impossible to win by following the rules and were watched to see whether they cheated. In another test designed to measure guilt, an apparently valuable object fell apart as soon as each child handled it. The results were dramatic. Children who eagerly imitated their mothers were more likely to follow the rules and more likely to show guilt when they broke something than were children who didn't, up to two-and-a-half years later. The authors suggest that eager imitation reflects a relationship in which both mothers and children are highly responsive to each other, and that this kind of relationship can give conscience development a boost.

Read more in Psychological Science

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Childhood Abuse Raises Heart Disease Risk

October 1, 2004

It has been accepted that depression and heart disease are closely linked and that either may be a causal factor in the other. Now an article in Circulation, the journal of the American Heart Association, has dotted the Is and made the link between abuse and heart problems.

The link between adverse childhood experiences and heart disease seems to be forged more by psychological factors than traditional risk factors (smoking parents etc), lead author Dr Maxia Dong, from the Centers for Disease Control and Prevention and colleagues suggest.

Their findings are based on an analysis of survey data from 17,337 adult health plan members collected between 1995 and 1997. Two weeks after their medical history was recorded, the subjects were sent a questionnaire regarding adverse childhood experiences and health-related behaviors from adolescence through adulthood.

Of the 10 types of adverse childhood experiences investigated, 9 were found to increase the risk of heart disease. The increased risks ranged from 1.7-fold for emotional abuse and crime within the household to 1.3-fold for emotional neglect and substance abuse within the household. Strage as it may seem parental marital discord was the only adverse childhood experience not tied to an elevated risk of heart disease.

As one might expect as the number of adverse childhood experiences increased, so did the risk of heart disease. For example, the presence of just one adverse childhood experience had a relatively mild effect on risk, whereas having seven or more nearly quadrupled the risk.

In fact what the study showed was that psychological factors were a more powerful predictor of heart disease than things which we generally associate with cardiac problems with the single exception of obesity.

Read more in Circulation

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Hold the Ritalin, Hug a Tree

September 1, 2004

Kids with attention deficit hyperactive disorder (ADHD) should spend some quality after-school hours and weekend time outdoors enjoying nature, say researchers at the University of Illinois at Urbana-Champaign. The payoff for this "treatment" of children, 5 to 18 years old, who participated in a nationwide study, was a significant reduction of symptoms.

The study appears in the September 2004 issue of the American Journal of Public Health.

"The advantage for green outdoor activities was observed among children living in different regions of the United States and among children living in a range of settings, from rural to large city environments," wrote co-authors Frances E Kuo and Andrea Faber Taylor. "Overall, our findings indicate that exposure to ordinary natural settings in the course of common after-school and weekend activities may be widely effective in reducing attention deficit symptoms in children."

The findings are similar to the large study that was carried out some years ago in the Georgia state school system which pointed to children being confined for too long in class rooms without the ability to play in natural surroundings as being one of the prime causes of ADD/ADHD.

ADHD is a neurological disorder that affects some 2 million school-aged children in the United States. Those with ADHD often face serious consequences, such as problems in school and relationships, depression, substance abuse and on-the-job difficulties. "These findings are exciting," said Kuo, a professor in the departments of natural resources and environmental sciences and of psychology at Illinois. "I think we're on the track of something really important, something that could affect a lot of lives in a substantial way," she said. "We're on the trail of a potential treatment for a disorder that afflicts one of every 14 children--that's one or two kids in every classroom."

If clinical trials and additional research confirm the value of exposure to nature for ameliorating ADHD, daily doses of "green time" might supplement medications and behavioral approaches to ADHD, the authors suggest in their conclusion.

Kuo recruited the parents of 322 boys and 84 girls, all diagnosed with ADHD, through ads in major newspapers and the Web site of Children and Adults with Attention Deficit/Hyperactivity Disorder. The parents were interviewed by means of the Web and asked to report how their children performed after participating in a wide range of activities. Some activities were conducted inside, others in outdoor places without much greenery, such as parking lots and downtown areas, and others in relatively natural outdoor settings such as a tree-lined street, back yard or park.

The researchers found that symptoms were reduced most in green outdoor settings, even when the same activities were compared across different settings.

"In each of 56 different comparisons, green outdoor activities received more positive ratings than did activities taking place in other settings, and this difference was significant or marginally significant in 54 of the 56 analyses," Kuo said. "The findings are very consistent."

The two researchers have been pursuing the ADHD issue as an extension of a long line of previous research they've conducted on the nature-attention connection among the general population in mostly urban settings.

"The medications for ADHD that are currently available often have serious side effects. Who wants to give their growing child a drug that kills their appetite day after day and, night after night, makes it hard for them to get a decent night's rest? Not to mention the stigma and expense of medication."

Simply using nature, Kuo said, "may offer a way to help manage ADHD symptoms that is readily available, doesn't have any stigma associated with it, doesn't cost anything, and doesn't have any side effects--except maybe splinters!" There are a number of exciting possible ways in which "nature treatments" could supplement current treatments, she said.

Spending time in ordinary "urban nature"--a tree-lined street, a green yard or neighborhood park--may offer additional relief from ADHD symptoms when medications aren't quite enough. Some kids might be able to substitute a "green dose" for their afternoon medication, allowing them to get a good night's sleep.

"A green dose could be a lifesaver for the 10 percent of children whose symptoms don't respond to medication, who are just stuck with the symptoms," Kuo said. As Kuo and Faber Taylor wrote, a dose could be as simple as "a greener route for the walk to school, doing classwork or homework at a window with a relatively green view, or playing in a green yard or ball field at recess and after school."

Read more in the American Journal of Public Health

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Cut Kids' TV To Protect Health

August 4, 2004

A study published in the medical journal The Lancet found adults who had been avid TV watchers as children were more likely be overweight, to smoke and to have high cholesterol. Researchers from the University of Otago, New Zealand, said parents should “lead by example” and turn the TV off. Other experts said the study bolstered the argument for banning junk food ads during children's programs.

This follows earler research which showed that watching too much TV early in life can lead to ADD/ADHD and depression.

The researchers followed 1,000 children born in 1972 and 1973 from the ages of three up to the age of 26. Every two to three years, they interviewed their parents, then in adolescence the children themselves, to see how much TV they watched each day. When the study participants were 26, the researchers assessed their adult health. They checked blood pressure and cholesterol levels, participants' height, how fit they were, whether they smoked and their body mass index (BMI) -- which indicates whether a person is a healthy or unhealthy weight.

It was found watching more than two hours of TV a day as children and teenagers was linked with an increased risk of being overweight, smoking and having poor cardiovascular fitness -- a measure of how well the heart is working. It was found 17% of weight problems, 15% of raised blood cholesterol, 17% of smoking and 15% of poor cardiovascular fitness could be linked to excessive TV viewing in childhood and adolescence.

Read more in The Lancet

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What Are Babies Thinking?

August 4, 2004

Look who's thinking! A study published in the July 22 issue of Nature shows that babies are quite thoughtful, even if they don't have the words to express their thoughts.

The research was conducted by Sue Hespos, assistant professor of psychology at Vanderbilt University, and Elizabeth Spelke, professor of psychology at Harvard University. “It's been shown in previous studies that adults actually categorize things differently based on what language they speak,” Hespos said. “So, if language is influencing adults' thought, one of our questions was, what's going on with preverbal infants? Do children think before they speak?

“Language capitalizes on a pre-existing system of 'I live in a 3-D world, I know how objects behave and interact,'” she continued. “This pre-existing ability suggests that children do think before they speak.”

Previous research has found that infants are sensitive to the acoustic variations that signal meanings in all the world's languages that adults can no longer hear, even those variations that their own language does not use and that the adults around them no longer hear. For instance, an adult native-English speaker will not hear all of the sounds of Korean and vice versa. Infants hear these subtleties but lose this awareness as their language skills develop over the first year of life.

“The languages of the world vary both in the sounds they require speakers to distinguish and in the meanings they require speakers to convey, and these differences influence what speakers of a language readily hear and think about,” Spelke said. “Our research asked how these differences arise: Does the experience of learning to speak English or Korean make you aware of the categories your language honors?”

The example they used to explore this question was differences between how different languages describe space. For example, the distinction between a tight fit versus a loose fit is marked in Korean but not in English. A cap on a pen would be a tight fit relationship, while a pen on a table would be a loose fit relationship. English does not mark this distinction in the same way, instead emphasizing the “containment” versus “support” relationship, for example: the coffee is in the mug or the mug is on the table.

Hespos and Spelke tested whether five-month-old infants from native English-speaking homes noticed whether objects fit tightly or loosely. The tests were based on infants' tendency to look at events that they find to be novel. Infants were shown an object being placed inside a container that fit either tightly or loosely until the time they looked at the object being placed inside the container decreased. They were then shown new tight and loose fit relationships. The researchers found that the babies looked at the objects longer when there was a change between tight or loose fit, illustrating that they were detecting the Korean concept.

Hespos and Spelke also conducted the experiment with adults to confirm that English-speaking adults do not spontaneously make the tight versus loose fit distinction. “Adults ignore tight fit versus loose fit and pay attention to 'in' versus 'on,'” Hespos said. “Adults were glossing over the distinction that the babies were actually detecting.”

“These findings suggest that humans possess a rich set of concepts before we learn language,” Spelke added. “Learning a particular language may lead us to favor some of these concepts over others, but the concepts already existed before we put them into words.”

Read more in Nature

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Even Toddlers Get the Blues

June 26, 2004

Your 3-year-old isn't her usual spry self. She no longer brightens at the sight of you first thing in the morning. She refuses to eat, and she hasn't been this cranky since she first started teething. Instead of tagging along with her older siblings or contentedly scribbling in her favorite Blues Clues coloring book, she gazes blankly out the window, listless and dejected. Could she be depressed?

Like most people, you probably assume preschoolers are too young to get the blues. Indeed up until the early 1990s that was the commonly heald view of most mental health professionals. But new research shows clinical depression knows no age. Depression--and even thoughts of suicide--are as likely to affect toddlers and adolescents as they are adults.

In an ongoing National Institute of Mental Health study, researchers at Washington University School of Medicine revealed that children experience the same symptoms of depression often found in adults, and with the same severity. Children are more depressed than ever before, prompting a major Surgeon General report on children's mental health.

According to the National Mental Health Association, one in three American children suffers from depression. Unlike the reddish, raised bumps of chickenpox or the leaky nose of the common cold, the symptoms of depression are not so concrete and, consequently, often go unnoticed by unsuspecting parents.

What are the signs of childhood depression? What behaviors should parents look out for? Toddlers who are depressed are persistently irritable, withdrawn and lethargic, says Dr. Elizabeth Rody, child and adolescent psychiatrist and medical director for Magellan Behavioral Health's New Jersey Regional Service Center. "Depressed children lose interest in activities that once captivated them," says Rody. "Like adults who are depressed, an overwhelming sense of hopelessness and doom prevails."

Other symptoms parents should be aware of include:

  • Excessive crying and persistent sadness
  • Lack of enthusiasm or motivation
  • Increased agitation and irritability
  • Chronic fatigue and lack of energy
  • Withdrawal from family, friends and activities once enjoyed
  • Changes in eating and sleeping habits (significant weight loss or gain, excessive sleep, insomnia)
  • Frequent complaints of physical problems, such as stomachaches and headaches
  • Lack of concentration and memory loss
  • Major developmental delays (in toddlers--not walking, talking or expressing self)
  • Pay that involves harm toward self or others, or that revolves around sad or morbid themes

It's not unusual for children to feel down in the dumps from time to time. Knowing this, how can parents tell normal fluctuations in mood apart from serious depression? The answer is in the duration of the depressive behavior. According to "Mental Health: A Report of the Surgeon General," children who are depressed experience depressive episodes that last on average from seven to nine months, although some child development experts say depressive behaviors lasting beyond two weeks warrant further investigation.

on the National Institute for Mental Health website

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Lifelong Consequences of ADHD

May 11, 2004

Adults with attention-deficit/hyperactivity disorder (ADHD) may have grown up with the condition, but have they outgrown its effects? Findings from a new national survey, "Capturing America's Attention," indicate that adults with ADHD experience life-long impairments in several facets of their lives, including educational and professional achievements, self-image and interpersonal relationships.

This survey is the first to examine the long-term impact of ADHD among 1,001 adults. Results were presented at the recent American Psychiatric Association (APA) annual meeting.

While the exact number of adults with ADHD is unknown, it is estimated that four percent of the U.S. adult population is affected by ADHD. The survey found that the repercussions of ADHD may prohibit adults with the condition from reaching their full academic and occupational potential, and limit their satisfaction with themselves and their relationships.

"The importance of diagnosing and helping adults with ADHD has often been debated by individuals, health care professionals and by society in general," said Joseph Biederman, MD, Professor of Psychiatry, Harvard Medical School and Chief of Pediatric Psychopharmacology at Massachusetts General Hospital. "The compelling results of this survey reinforce the fact that ADHD is a serious medical condition causing significant, life-long impairments. ADHD can no longer be dismissed as a 'fake' or 'made-up' disorder."

Adults with ADHD are three times more likely to suffer from stress, depression or other problems with emotion. These emotional and physical effects can cause people with ADHD to "lose" days of their lives. "Lost days" may manifest as a day absent from work or several times throughout the month when the person is not fully engaged both physically and emotionally. About one in four (24 percent) adults with ADHD said that on 11 days per month, on average, they were prevented from normal activities such as work, due to poor mental or physical health, compared to only nine percent of the adults without ADHD.

Adults with ADHD are less likely to express a positive self-image. Only 40 percent of the adults with ADHD "strongly agree" that they have a bright outlook on their future, versus 67 percent of the adults surveyed without ADHD. Additionally, only half (50 percent) of the adults with ADHD surveyed like being themselves and accept themselves for who they are compared to 76 percent of the adults without ADHD.

Adults with ADHD are more likely to engage in harmful or antisocial behaviors, like smoking and drug use. Over 60 percent of the adults with ADHD surveyed have been addicted to tobacco while 52 percent have used drugs recreationally. In addition, people with ADHD are twice as likely to have been arrested, with 37 percent of the adults with ADHD surveyed acknowledging a prior arrest.

Adults with ADHD have less stable relationships than those adults without ADHD. The survey found that people with ADHD are twice as likely to be divorced and/or separated. Less than half of those surveyed who are currently in a relationship say they are "completely satisfied" with their relationship partners or loved ones, compared to 58 percent of those people surveyed without ADHD.

Further, adults with ADHD tend to report lower educational achievement. They are less likely to be high school or college graduates. Approximately 17 percent of the adults surveyed with ADHD did not graduate high school, while only seven percent of those without ADHD did not graduate from high school. Only 18 percent of the adults with ADHD graduated from college compared to 26 percent of the adults without ADHD.

Adults with ADHD generally had a higher number of jobs over the course of the past ten years than adults without ADHD. On average, those with ADHD had 5.4 jobs compared to adults without ADHD who had 3.4 jobs. Of those surveyed, only 52 percent of the adults with ADHD are currently employed, compared to 72 percent of the adults surveyed without ADHD.

"By determining how people's lives are impacted starting from childhood, we can begin to help people take control and reduce the potential for life-long impairment," said Stephen V Faraone, PhD, Harvard Medical School Department of Psychiatry at Massachusetts General Hospital.

Other recent research has confirmed that the origin of ADHD lies in a variety of factors experienced in childhood. These can include not enough play time, watching too much TV at a very young age, too high expectations being placed on the child, parental stress (even maternal stress while the child is in the womb) or arguing. Other researchers have begun to see ADD/ADHD as a kind of depressive or anxiety disorder.

This story is based on a paper not yet published.

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Be Careful How You Eat--Someone's Watching!

May 11, 2004

Mealtime is a nightmare, the baby won't eat what's on his highchair, and instead he seems to grab for whatever mom and dad have on their plates. For many parents it's a familiar and frustrating story. But while parents may describe their baby as a difficult eater or an overeater, it could be just a sign that the child is more tuned in to the eating habits of those around him.

Which is not so surprising since we learn by observation.

A new study by University of Michigan Health System researchers looked at the eating behaviors of babies who were described by their mothers as difficult eaters or overeaters and compared them to similar children whose mothers did not report problems during meals. Results of the pilot study were presented at the Pediatric Academic Societies' annual meeting in San Francisco.

The difficult eaters and overeaters were more likely to eat when their mother handled their food. And the more mom touched the food, the more likely baby was to feed himself or herself. This same relationship was not found in children who were not difficult eaters or overeaters.

"We know the way human beings eat is not regulated by whether you're hungry as much as by social cues in the environment: You eat lunch because it's noon or because you want to take a break or your friends are going out," says study author Julie Lumeng, MD, clinical instructor in the Department of Pediatrics at U-M Medical School. "This study suggests maybe there are some babies who are much more tied in to those social cues than others. Maybe these kids are much more cued in to how people around them are eating. With the obesity epidemic, that could be significant as these infants grow up."

As part of the Michigan Family Study, a longitudinal study of infant development, families were videotaped in their home during a normal feeding when the infant was 15 months old. Mothers filled out a questionnaire describing their baby's eating behavior.

Watching the videotaped feeding, the researchers marked every time the mothers handled the food or fed the babies a bite and every time the babies fed themselves a bite. They also looked at how the babies behaved and ate during fussy moments.

Babies who were difficult eaters or overeaters were more likely to feed themselves after their mother handed them bites or handled their food. But among the controls, there was no link between the mothers handling the food and the babies eating.

"It's not as simple as saying that mothers who think their babies are difficult feeders are handling the food more and hovering over the high chair tray with a jar of baby food. It's not that the mother is trying to feed the child more; it's that the child who is a difficult eater is much more likely to feed himself when his mother is there," says Lumeng,

During fussy moments, babies were less likely to eat. But the babies continued to feed themselves bites at random times. While babies who were not fussy gradually slowed their eating over time, the fussy babies did not show those signs of becoming full. This could indicate a link between emotions and eating, similar to the comfort eating of many adults.

"Infants are really hard wired to want what you are eating. If part of the difficulty of the feeding is that mom's eating BBQ chicken and the baby's getting squash and rice, the answer is to let the baby try a bite of BBQ chicken. Some of these kids that mothers perceive as difficult eaters may just have a natural inclination to eat what they see their mother eat or handle or prepare," Lumeng says.

This story is based on a paper presented at the Pediatric Academic Societies, May 1, 2004 and not yet published.

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Pill-Popping Pre-Schoolers

April 3, 2004

Where are we going as a society?! The use of Paroxetine and other antidepressant medications continues to grow by about 10% annually among children and adolescents, according to a study published in the April issue of Psychiatric Services. The study profiles trends of prescription antidepressant use in children and adolescents using prescription claim information from a random, nationwide sample.

The findings tie in with an earlier Harvard study which found that the rate of depression among children was increasing by 23% a year!

The study examined antidepressant use among approximately two million commercially-insured, pediatric beneficiaries 18 years and younger from 1998 to 2002. The fastest growing segment of users were found to be preschoolers aged 0-5 years, with use among girls doubling and use among boys growing by 64%.

For the entire sample, antidepressant use increased from 1.6% in 1998 to 2.4% in 2002, a 49% increase. Over the course of the study, the growth in use was greater among girls (68%) than boys (34%) and, for each gender respectively, growth was higher among younger boys and older girls.

"A number of factors acting together or independently may have led to escalated use of antidepressants among children and adolescents," said Tom Delate, PhD, Director of Research at the firm which carried out the study. "These factors include increasing rates of depression in successive age groups, a growing awareness of and screening for depression by pediatricians and assumptions that the effectiveness experienced by adults using antidepressant medications will translate to children and adolescents."

Throughout the five-year period of the study, selective serotonin reuptake inhibitors (SSRI's) were the most commonly dispensed antidepressants, while tetracyclics were the least. SSRI's include paroxetine (also known as Paxil ©), Prozac © and Zoloft ©. Use of Paroxetine increased 113% and 91% in females and males, respectively, over the study period. The US Food and Drug Administration (FDA) has recommended that Paroxetine not be used in children and adolescents because, among youths, its efficacy has not been established for depression and its use is associated with increased risk of suicidal thinking and suicide attempts. Of the SSRIs, only Prozac has been approved by the FDA for treating depression in children and adolescents.

Authorities in the UK have come to a similar conclusion.

in Psychiatric Services

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Childhood Relationships Affect Health

April 3, 2004

We have long held that a poor relationship environment in childhood was the prime cause of adult depression and anxiety. Now researchers have found that it may be responsible for a lot more as well.

The new study involving a nationally representative sample of nearly 3,000 adults finds that people with abundant parental support during childhood are likely to have relatively good health throughout adulthood, whereas people with inadequate parental support while growing up are likely to have poorer health as adults. The findings are reported on in the March issue of Psychology and Aging.

Previous studies have found that adult psychological and physical health is influenced by the amount of social support adults receive. Now, Benjamin A Shaw, PhD, Assistant Professor at the School of Public Health, University at Albany and colleagues from the University of Michigan investigated for the first time whether the health effects of parental support received during childhood persist throughout adulthood into old age. The researchers analyzed responses from 2,905 adults, ages 25-74, who participated in the National Survey of Midlife Development in the United States.

The participants were asked about the availability of emotional support from their mothers and fathers during the years they were growing up, such as "how much could you confide in her or him about things that were bothering you?" and "how much love and affection did she or he give you?" Depressive symptoms, chronic health conditions and self-esteem were also assessed through survey questions.

Results of the study indicate that adults' current mental and physical health is influenced not only by current psychosocial conditions, but also by earlier life psychosocial conditions dating back to early childhood, including parental support. The researchers found a lack of parental support during childhood is associated with increased levels of depressive symptoms and chronic health conditions (such as hypertension, arthritis and urinary problems) in adulthood, and this association persists with increasing age throughout adulthood into early old age. The association appears to be more strongly linked to mental health than physical health problems, which may be due to differences in how these problems develop over time, according to the authors.

"These findings are important because they not only reveal a strong association between early parental support and adult health status, but also provide some preliminary insight into factors that link early social conditions with adult health and wellbeing," says Dr Shaw. "In this study, we found that the association between early parental support and adult health may be largely due to the long-term impact of parent-child relationships on important psychosocial resources. Specifically, early parental support appears to shape people's sense of personal control, self-esteem and family relationships, which in turn affect adult depressive symptoms and physical health."

The authors say the implications of these findings may be far-reaching for predicting who is at elevated risk for ill health in late life, and for improving the physical and mental health of older adults.

in Psychology and Aging

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Selecting the Sex of Offspring

February 18, 2004

It would seem that reproductive science is only just catching up with Nature. While biologist, ethicists and others are arguing over whether it is morally or socially good to predetermine the sex of a child female snow skinks (a kind of lizard) select the sex of their offspring by regulating the amount of basking in the sun that they do. Those that bask more while they are pregnant givce birth earlier and have more daughters, while those that bask less have more sons. This unusual form of temperature-dependent sex determination allows the skink to control the gender of her little skinks by her body temperature. The researchers do not say whether skinks exhibit "boy-bias" or not.

in Biology Letters

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School Bullying on the Increase

December 16, 2003

More than one in five 12-year-olds are repeatedly either bullies, victims or both, and bullies are often popular and viewed by classmates as the "coolest" in their classes, according to new University of California at Los Angeles research from the most comprehensive study on young adolescent bullying in an ethnically diverse, large urban setting.

Bullies, who make up seven percent of the student population, are psychologically strong. The research proves, for the first time that bullies don't show signs of depression or social anxiety and they don't feel lonely.

"Bullies are popular and respected: they are considered the 'cool' kids," said Jaana Juvonen, UCLA professor of psychology, and lead author of "Bullying Among Young Adolescents: The Strong, the Weak and the Troubled," published in the December issue of the journal Pediatrics.

"We hope that these findings help us dispel the myth that bullies suffer from low self-esteem," Juvonen said. "Our data indicate that bullies do not need ego boosters. Unfortunately, this myth is still guiding many programs conducted in schools. Instead, we should be concerned about the popularity of bullies and how to change the peer culture that encourages bullying."

Depression, social anxiety and loneliness are common among victims of bullies, who are nine percent of the students in the UCLA study. "Young teens who are victims of bullying are often emotionally distressed and socially marginalized," said Juvonen. "Many of the victims are disengaged in school. Victims are reluctant to talk about their plight," she said. "They suffer in silence and often blame themselves. This is one of our challenges for intervention: We need to provide students with educational settings in which they feel comfortable talking about their plight. But we also need to give kids tools to effectively deal with bullying. One method of doing so involves engaging students to talk about strategies that might help them stop bullying and tactics that make them feel better after being bullied. Teachers can facilitate the generalization of these skills if they help students mediate incidents between students."

Students who witness bullying often encourage bullies by watching someone getting pushed around or called names or helping a classmate spread rumors about another student, Juvonen said. Bystanders rarely intervene with bullying. Juvonen regards this as one of the biggest challenges for effective anti-bullying intervention.

"Bully-victims," the six percent of students who both bully and get bullied, are the most disturbed group of all, Juvonen and her colleagues found. They are by far the most unpopular students, least engaged in school, most disruptive in class and they also reported somewhat elevated levels of depression and loneliness, Juvonen said. Teachers ranked these "bully-victims" as having by far the most conduct problems.

The UCLA study shows that the bully-victim group has the worst of both worlds of bullies and victims, and a unique risk profile. "Their high levels of disruptive behavior, disengagement from school and social problems with their peers suggest they are a particularly high-risk group," Juvonen said.

Bullying is a significant problem in schools and is associated with a range of problems, including poor mental health and violent behavior, the researchers found. Other studies have shown that bullies are significantly more likely to engage in antisocial behavior later in life, particularly assaults and rapes. Additional research from Juvonen's project, not yet published, shows that victims of bullying experience headaches, stomach aches and colds more often than students not involved in bullying.

Read more in Pediatrics

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Abuse Now, Ill Health Later

October 31, 2003

The most recent research was summarized in an article by Tanya R Anderson, MD and others of the University of Illinois in Chicago in the October edition of Psychiatric Times, one of my favorite journals.

Prior research on the impact of childhood abuse and trauma has been limited in scope, mostly concentrating on the psychological effects of childhood abuse and trauma. What's more previous studies have focused mainly on single forms of adversities. Stressful life events do not occur in pure forms, and the researchers felt that further work was needed to assess the effects of multiple trauma and abuse on adult health.

The Adverse Childhood Experiences (ACE) Study examined the association between multiple childhood trauma and health outcomes in adults. Questionnaires on adverse childhood experiences were mailed to 13,494 adults who completed a standardized medical evaluation in a large California HMO, with the final sample consisting of 9,508 participants.

The questionnaire assessed seven categories of adverse experiences: 1) psychological abuse; 2) physical abuse; 3) sexual abuse; 4) violence against the respondent's mother; 5) living with household members who were substance abusers; 6) living with individuals who were mentally ill or suicidal; or 7) living with individuals who had ever been imprisoned. The researchers instructed respondents to limit their responses to events that occurred during the first 18 years of life. Additional health risk factors and disease conditions used to assess adult health status were: smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, any drug abuse, parental drug abuse, high numbers of lifetime sexual partners, a history of having a sexually transmitted disease (STD), ischemic heart disease, cancer, stroke, chronic bronchitis, emphysema, diabetes, hepatitis or jaundice, and any skeletal fracture.

Of the total sample, more than half (52%) of the respondents experienced one or more types of adverse childhood exposures, and 6.2% reported four or more exposures. Those with multiple categories of childhood exposure were more likely to have multiple health risk factors later in life.

The results clearly show that adverse childhood experiences, including living in a dysfunctional household are significantly associated with negative health outcomes in adults, including being prone to the problems listed above.

The authors of the article argue strongly for preventive programs to target homes that are at high risk for family violence and dysfunction and where children are at an increased risk for exposure to abuse or trauma. Medical practitioners need to engage these individuals and their families in comprehensive home assessments and structured interventions that are aimed toward promoting more adaptive family functioning. What's more entire communities need to be educated regarding the potential harmful effects of prolonged exposure to family dysfunction and childhood trauma.

Read more in Psychiatric Times

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Self-Destructive Behavior Seen In More Adolescents

October 31, 2003

Child hood abuse leaves a sense of guilt in the survivor, especially when that abuse happened at a very early age. The victim cannot understand why he or she is being punished and, since he or she firmly believes that the abusers (especially if they are the child's parents) are infallible he or she comes to believe that there is something inherently wrong with him or herself. Self-mutilation and self-abuse are a way of perpetuating the abuse -- continuing the punishment.

These self-destructive and often mutilating behaviors show up most frequently in adolescents. It was reported in one study that the incidence of self-mutilation occurred at an estimated 1,800 out of 100,000 adolescents and young adults between the ages of 15 and 35.

A common example of self-mutilating behavior is cutting the skin with a knife or razor until pain is felt and/or blood has been drawn. Other examples are burning the skin with metal or a lighted cigarette or picking the skin. These problematic behaviors are to be distinguished from tattooing or body piercing behaviors that are not typical of self-mutilation.

Those individuals seeking body adornment differ, psychologically speaking, from individuals practicing self-abuse as an attempt to escape from intense emotion or to achieve some level of focus.

Many individuals practicing self-abusive behavior report doing so in an attempt to relieve stress, pain and escape from fear or anxiety. Self-abusers who cut themselves are sometimes referred to as "cutters." Cutting sometimes has a "contagious" component, with group cutting occurring in settings such as prisons (a huge proportion of prisoners were themselves abused as children) or even in schools.

Cutting seems to appear more often in females than in males. Cutting also often co-exists with other problems such as eating disorders.

Self-injurers are not usually planning suicide. However, tragedies, including serious medical complications or death, can and do occur. Many reasons have been proposed to explain why people practice self-abusive behaviors. Biological, psychological and social explanations have all been proposed as reasons to explain self-mutilation.

Like many problematic behaviors where the perceived need for control exists, self-mutilation and self-injurious behavior serves to express, validate or regulate emotional problems such as depression, tension, pain or anger.

Read more in Intelihealth

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Unborn Babies Can Smile

September 21, 2003

Advances in ultrasound scanning have allowed doctors to see that babies in the womb exhibit facial expressions as a reflex in preparation for birth, obstetrician Stuart Campbell said. It was previously thought babies learned to smile after birth by copying their mothers.

Since 2001 Professor Campbell has captured images of babies smiling, using a revolutionary 4D scanner. "They make breathing movements inside the uterus, but there is no air, and they blink, but there is no light, so it seems they are making preparations for birth," he said.

Babies do not normally smile after birth until they are about six weeks old. "This may indicate the baby's calm, trouble-free existence in the womb and the relatively traumatic first few weeks after birth, when the baby is reacting to a strange, new environment," Prof Campbell said.

"I don't think people realise the range of facial expressions you get inside the uterus, or indeed that babies blink. With 2D scanning you can see the eyeballs rolling, but now with 4D scanning it is quite clear that they are opening their eyelids, and that is in a very dark environment, so it must be a reflex."

Smiling, however, cannot be interpreted as preparation for birth but may be a reflex, Prof Campbell said. "What's behind the smile, of course, I can't say, but the corners turn up and the cheeks bulge It must be some indication of contentment in a stress-free environment."

The 4D scanner, which produces detailed 3D images that move in real time, has shown that babies start making finger movements at 15 weeks, yawning at 18 weeks and smiling, blinking and crying at 26 weeks.

Read more in BBC News Online

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What Makes a Psychopath?

September 21, 2003

Many people tell the odd white lie--taking a day off "sick" or halving the amount they spend on a shopping trip. But most feel a little bit guilty about the deception. Scientists have now found that twinge of conscience can be seen in increased activity in the brain. But people with psychopathic tendencies find lying as easy as telling the truth.

The reason is that when children develop the ability to deceive--around the age of three of four--they also develop the ability to empathize. But researchers say people with aggressive and antisocial personality disorders do not develop this ability, and therefore they have no moral compass.

The researchers say traumatic experiences and a lack of contact with understanding adults could be to blame.

Dr Sean Spence of the University of Sheffield has found parts of the frontal lobe area of the brain are more active when someone was lying than when they were telling the truth. This confirms earlier studies which showed the neurological activity involved in lying.

Dr Spence said: "When we're lying, there is a moral part of us that doesn't wish to manipulate others or take advantage of them. In psychopaths, there is no activity in that area of the brain, and deception is OK to them. They don't have any qualms about doing it."

He said a lack of adults displaying empathy towards them as children meant psychopaths could not learn from example, and developed the aggressive antisocial personality disorder.

"If they have experienced gross sexual abuse of severe physical violence, they may never have been in contact with the feeling of empathy."

Dr Spence said "good parenting" was a crucial part of preventing these tendencies developing.

"Even if people have had an experience such as sexual abuse, if they have had at least one good relationship with an adult figure, they don't become delinquent."

Childhood diets could also influence whether people develop psychopathic tendencies, experts say. Professor Adrian Raine, a psychologist from the University of California, gave a group of three-year-olds from Mauritius a program of an enriched diet, exercise and cognitive stimulation-- being read to and involved in conversation.

By the age of 11, they showed increased activity on brain scan readings, and by 23, they were 64% less likely than a group of children who had not been on the program to have criminal records.

Professor Raine said: "This is not a silver bullet to solving crime and violence, but I think it's certainly one of the ingredients. The take-home point is that the seeds of crime are sown early in life." Dr Spence added that alcohol or drug abuse could also cause damage to the brain and cause psychopathic behaviour.

But he said that even people who had never before shown any signs of psychopathic behavior could behave very cruelly in extreme situations. "In Rwanda, around 800,000 people were killed in 100 days. Most people doing the killing had been 'normal' before--it was something in their environment that changed."

Read more in BBC News Online

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Violence Is Learned Behavior

August 13, 2003

Children who witness their parents using violence against each other and who regularly receive excessive punishment are at increased risk of being involved in an abusive relationship as an adult, according to a 20-year study that followed children into adult romantic relationships.

In partner violence cases that result in injury, the study finds that being the victim of physical abuse and conduct disorders as a child are also important risk factors. The findings are reported on in the Journal of Consulting and Clinical Psychology.

Research shows that violent behavior toward a romantic partner is difficult to change and that more needs to be done to develop prevention programs that identify major risk factors for partner violence before adult relationships develop.

Results of the latest study indicate that child behavior problems (conduct disorder, or CD) are important predictors of adult partner violence and that exposure to violence between parents and harsh punishment are also risk factors that seem to predict later relationship violence.

"It appears that it is not necessary to develop conduct disorder in order for early family lessons of coercive, aggressive conflict resolution within intimate relationships to generalize to youth's own intimate relationships," say the researchers. "Punishment from mothers may serve as a model for physical expression of anger. This acceptance of coercive, power-based norms as ways of regulating conflict may have direct implications for young adults' means of conflict resolution with partners, independent of a disruptive behavior disorder."

The study also finds that a history of physical abuse by a caretaker appears to directly increase the odds of using similar tactics of conflict resolution in adult close relationships. However, in looking at factors that may predict being on the receiving end of partner violence, the researchers say they were surprised to find that being the victim of child abuse was not a significant risk factor once exposure to violence between parents and harsh punishment were included. "Exposure to violence between parents, which probably begins when a child is young seems to pose the greatest independent risk for being the victim of any act of partner violence," say the authors.

"If families are targeted for intervention before children reach late childhood, patterns of excessive punishment may be prevented from becoming entrenched and later reproduced in adolescents' fledgling romantic relationships," the conclude.

Prevention programs should not just target boys, since no sex differences were found in predictors of partner violence. Both males and females who were abused as children or displayed conduct disorders as adolescents were found to be at risk for partner violence. "Preventing women's partner violence as well as men's may be necessary to prevent adverse consequences of partner violence for women."

Read more in Intelihealth

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Hyperactivity "Just High Spirits"

August 13, 2003

Teachers are "cynical" about the reported rise in disorders. Children diagnosed with behavioral disorders may simply need to be allowed to "let off steam", an expert has claimed.

Professor Priscilla Alderson, an expert in childhood studies at London's Institute of Education, believes conditions such as attention deficit hyperactive disorder and mild autism are being over-diagnosed. She said many children's problems were due to bad parenting, and psychologists looking to "make a quick buck".

Children were "cooped-up" at home, she said, and not given the opportunity to run off their extra energy in parks and playgrounds.

Teachers backed Professor Alderson's theory, with leaders saying the profession was cynical about the increase in the number of children suffering from behavioral disorders. The number of children in the UK registered with special needs, which covers conditions ranging from dyslexia to autistic spectrum disorders, has virtually doubled in the last decade to 1.4m.

Professor Alderson said many children were simply feeling restless and excitable. She said she had recently visited a school for children with special needs where 27 pupils had been diagnosed as autistic. But she told a national newspaper: "Of those, only two that I met displayed the lack of contact and absence of empathy which denotes true autism.

"Money is behind all this. Psychologists want the work and lower the diagnosis threshold accordingly. Special needs is an administrative device describing children who have extra needs from those provided for the average classroom. Playgrounds and parks are empty, because of the scare stories about abductions. But children need the space and freedom to play, run and climb--without that, they are restless and come to be seen as abnormally 'hyperactive'."

Professor Alderson concluded: "About eight children are murdered outside the home each year, compared with about 50 inside. Cooping up children inside homes is not going to do them any good."

Read more in BBC News (Health) Online

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Children with Bowel Disease Prone to Emotional Problems

August 13, 2003

According to a new study, more than one-third of children with mild inflammatory bowel disease (IBD) also suffered from psychological problems, such as symptoms of anxiety and depression. What's more, parents of children with the disease reported that their children had more problems socially than did parents of healthy children, said Laura Mackner, a study co-author and an assistant professor of pediatrics at Ohio State University.

The researchers compared the psychological health of 41 children with mild IBD to 27 healthy children in the areas of body image, self-esteem and behavioral, emotional, social, school and family functioning. The children with IBD had been diagnosed at least a year before the study began.

"The strength of family relationships, along with a higher self-esteem may play more important roles than having active IBD. Children with poor family relationship and lower self-esteem may be at greater risk of developing behavioral and emotional problems, even with mild IBD."

"We thought these patients would be doing pretty well in managing all aspects of their disease, given that they had had the condition for at least a year and that they only had mild symptoms at the time of the study," Crandall said. "We were surprised to find so many with psychological issues."

Mackner reported the team's findings at the annual meeting of the American Psychological Association.

Inflammatory bowel disease is really a group of chronic intestinal disorders, and the course of the disease is often unpredictable. Symptoms result from inflammation of the bowel, and may include abdominal pain, bleeding and diarrhea. Children diagnosed with IBD are often given a combination of medications, including drugs that affect the immune system, with side effects that range from mild to severe, such as vomiting, diarrhea, rash, hair loss, pancreatitis, bone loss and decreased white blood cell counts.

According to parental reports, more than three times as many children with mild IBD had significant behavioral and emotional problems as compared to healthy children. Such problems included being withdrawn, anxious or depressed. Similarly, teachers of children with IBD reported that these students had more attention problems and were absent from school one-and-a-half times as often as healthy children.

The researchers did find that children with IBD who had stronger family relationships and higher self-esteem also had better behavioral and emotional functioning. "In this case, the strength of family relationships, along with a higher self-esteem may play more important roles than having active IBD," Mackner said. "Children with poor family relationship and lower self-esteem may be at greater risk of developing behavioral and emotional problems, even with mild IBD."

"Research on adults with IBD has shown that patients with better coping skills and less psychological distress have fewer hospitalizations and visits to the doctor's office. While medication is necessary in controlling IBD, psychosocial interventions may help improve the course of the disease," the researchers concluded.

This story is based on an Ohio State University press release. The study had not yet been published at the time of writing.

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Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).

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