Tuesday, October 15th, 2013
Parents whose children face serious or life-threatening illnesses are likely to experience symptoms of post-traumatic stress, including anxiety and depression. These symptoms may, in effect, extend the traumatic effect the illness has on the whole family because it affects how parents treat siblings, their spouses, and other relatives. More on a new study about post-traumatic stress in kids and adults after a child’s injury from The New York Times:
Researchers who study parental stress tend to reach for the oxygen-mask metaphor: if you don’t breathe yourself, you aren’t going to be able to take care of your child.
“Parents need to feel well enough that they can then be there for their child, their other children,” said Nancy Kassam-Adams, a psychologist who is the director of the Center for Pediatric Traumatic Stress at Children’s Hospital of Philadelphia. “The hardest thing is self-care.”
Dr. Kassam-Adams is the lead author of a new review of post-traumatic stress in both children and parents after the children were injured, which concludes that about one in every six children, and a similar percentage of parents, experience significant, persistent symptoms. They may have intrusive and distressing memories and dreams, or continue to avoid people or places that evoke the circumstances of the injury, or struggle with mood problems, including depression. If untreated, this can damage the child’s emotional and physical recovery.
Research into the effects of parental stress developed as pediatric cancer treatment claimed more and more success stories, medical victories that gave children their lives back. Clinicians and social workers — and parents themselves — began asking questions about how to help families continue on with those triumphantly recovered childhoods.
It helped, in part, to tell parents that they’d been enlisted in a war, said Anne E. Kazak, a pediatric psychologist and co-director of the Center for Healthcare Delivery Science at Nemours Pediatric Health System in Wilmington, Del. Parents connected to this metaphor: “You’ve been part of the war on cancer, the battle fighting it,” she said.
Some of the strategies and insights gained from this body of research are already visible in most children’s hospitals: a place for parents to sleep, even in the intensive care unit; including parents in so-called family-centered rounds; a staff attuned to interpret a parent’s extreme behavior as a cry for help, rather than a source of irritation and extra work.
But what happens after children are out of the medical danger zone? Many parents continue to experience the physical symptoms of stress — the racing pulse, the dry mouth. They continue to flash back to the moment of the cancer diagnosis, the moment of the very premature birth, the moment of the accident.
“It’s my belief a parent who’s traumatized is always expecting the other shoe to drop, will always be scanning the horizon,” said Dr. Richard J. Shaw, a professor of psychiatry at Stanford.
Image: Mother holding infant’s hand, via Shutterstock
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Monday, September 30th, 2013
Up to a quarter of US kids may meet the criteria for a diagnosable anxiety disorder, according to new data from the National Institutes of Mental Health. Psychologist Lawrence J. Cohen, writing for Time.com, describes the situation:
Nowadays, there are still 10-20% with that reactive temperament, but the number of children with a diagnosable anxiety disorder has skyrocketed, up to 25% according to the National Institute of Mental Health. A report from the National Institutes of Health adds, “There is persuasive evidence from a range of studies that anxiety disorders are the most frequent mental disorders in children and adolescents….” These new numbers must be viewed skeptically, of course, because of the trend towards looser and broader definitions of mental illness. Many commentators have linked this trend to the influence of pharmaceutical companies on diagnosis and prescription patterns.
Despite these caveats, however, I believe that childhood anxiety is indeed on the rise at every level, from fears of monsters under the bed to phobias and panic attacks to severe anxiety disorders.
Last year I gave a lecture on childhood anxiety to parents at a public elementary school. I heard about children who couldn’t be in a different room from their parents, even to use the bathroom, children who were too afraid of the water to swim or even take a shower, and children who were too afraid of making a mistake to function well in the classroom.
Of course, these were parents who chose to attend a lecture on childhood anxiety, but many teachers have told me that they now have a number of highly anxious children in every class. What struck me most in this group was that none of these children was in therapy, and none had received an “official” diagnosis of an anxiety disorder (though I did give out a few business cards).
Image: Worried child, via Shutterstock
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Friday, September 20th, 2013
A genetic disorder that can lead to developmental delays, anxiety, and social awkwardness is misdiagnosed as an autism spectrum disorder (ASD) as much as 50 percent of the time, according to a new study by researchers at the University of California Davis. The mistake can lead to inappropriate treatment for the children, and may even worsen the symptoms of their genetic condition. More from Time.com:
About one in 2000 people are diagnosed with 22q11.2 deletion syndrome, which can lead to developmental delays, social awkwardness and anxiety, among other symptoms. Because those symptoms overlap with some of the hallmark signs of autism, researchers say that anywhere from 20% to 50% of children with 22q, as the condition is called, are misdiagnosed with autism.
That can have serious implications for these patients, since behavior-based treatments designed to alleviate the social deficits of autism may actually exacerbate anxiety among those with the 22q genetic disorder. If left untreated, children with 22q can be at higher risk of developing other mental health disorders like schizophrenia later in life.
To tease apart the differences between children with 22q and those with autism, the researchers, based at the University of California Davis MIND Institute, recruited a small group of 29 kids from a website the study called Cognitive Analysis and Brain Imaging Laboratory (CABIL). The scientists noticed that parents of children with the genetic disorder often commented that while their kids were diagnosed with autism, they seemed different from other children with the developmental disorder. “It’s quite clear that children with the [22q] disorder do have social impairments,” said study author Tony J. Simon, a professor of psychiatry and behavioral sciences at the MIND Institute in a statement. “But it did seem to us that they did not have a classic case of autism spectrum disorder. They often have very high levels of social motivation. They get a lot of pleasure from social interaction, and they’re quite socially skilled.”
So the team gave the children two of the gold standard tests for diagnosing autism — the Autism Diagnostic Observation Schedule (ADOS) and the Social Communication Questionnaire (SCQ) — to see if they indeed showed signs of autism.
Only five of the children had elevated scores on the ADOS test, and four out of the five had anxiety. None of the 22q children had scores high enough in both tests to classify them as having autism.
Image: Child with pediatrician, via Shutterstock
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Tuesday, August 13th, 2013
Chronic stomach pain suffered by children but without medical explanation may be an indication of an anxiety disorder, according to new research published in the journal Pedaitrics. More from Reuters:
By the time kids with stomach pain reached age 20, just over half had had symptoms of an anxiety disorder at some point, most often social anxiety, researchers found.
Anxiety tended to start in early childhood, around the same time as the chronic stomach problems.
Past studies suggest between eight and 25 percent of all youth have chronic stomach pain, researchers noted. When there’s no clear medical cause for the pain – such as inflammatory bowel disease or celiac disease – it’s known as functional abdominal pain.
“It’s very prevalent, and it’s one of the most common reasons that children and adolescents end up in their pediatrician’s office. It’s one of the most common reasons kids are missing school,” said Dr. Eva Szigethy, head of the Medical Coping Clinic at the Children’s Hospital of Pittsburgh Inflammatory Bowel Disease Center.
One small study of children with that type of pain found they were at a higher than average risk of anxiety disorders as young adults.
To build on those findings, Lynn Walker from the Vanderbilt University School of Medicine in Nashville, Tennessee, and her colleagues followed 332 children who visited a doctor for unexplained stomach pain between age eight and 17.
For comparison, they also tracked 147 youth from the same area schools without stomach problems.
When participants were 20 years old, on average, the researchers interviewed them in person or over the phone about symptoms of anxiety and depression. At that point, four in 10 of those with a history of stomach pain still had a gastrointestinal disorder.
Based on the interviews, Walker’s team found 51 percent of people with stomach pain as children had ever had an anxiety disorder and 30 percent currently met the criteria for a diagnosis.
In comparison, 20 percent of people in the no-stomach pain group had ever had an anxiety disorder and 12 percent currently had one.
“What was striking was the extent to which anxiety disorders were still present at follow-up,” Walker told Reuters Health.
Image: Boy having stomach pain, via Shutterstock
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Thursday, July 25th, 2013
The children of parents on active military duty are vulnerable to long-term emotional strain, according to a new study from a research nonprofit called Child Trends. As many as a half million American children face the elevated risk for emotional problems, particularly anxiety issues. Further, if parents return from active duty with mental health struggles of their own, children face additional risk. The Huffington Post has more:
David Murphey, the author of Child Trend’s study “Home Front Alert: The Risks Facing Young Children in Military Families,” told the Washington Post that this particular group of children is facing emotional obstacles that could develop into more serious long-term issues.
“We’re concerned that children exposed to stressful events, particularly traumatic stressful events, will have difficulty learning to cope with emotions, to do well socially and academically, and even have problems with their physical health,” he said. “As these younger children grow up, we can expect there will be at least a subset of them that will face very substantial problems.”
Murphey explains the delicate nature of these young children’s mental development in a recent Child Trends video.
“It could be the accumulation of those stresses as well as a single overwhelming stress that can lead to really lasting changes in the developing brain that can have negative implications for development further down the line,” he said.
Image: Military family, via Shutterstock
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