Depression In New Dads: New Data And Awareness

You may be aware that rates of depression are high in women, and that depression can increase in new moms. But new data, drawn from a powerful longitudinal design, suggest that new dads are vulnerable to depression as well.

How vulnerable? Analyses of over 2 decades of prospective data collected on over 10,000 males in the National Longitudinal Study of Adolescent Health suggested that depressive symptoms in dads increase by as much as 68% following the birth of child (and extending out 5 years after). These were “resident” dads, meaning those living with the child.

Depression in dads, like mom, can compromise parenting. Depressed dads are more likely to be angry/hostile with a child, and less engaged in play and talk.

While the study does not go into the factors that predict which men are most likely to become depressed following the birth of a dad, the immediate takeaway is to promote awareness of signs of depression in men, and to encourage early intervention. As the symptoms of depression in men can differ somewhat from the typical signs in women, it’s useful to be aware of key signs of depression in dads.

There are many successful treatments for depression. As depression can be episodic (it can keep coming back over time), intervention is especially important in buffering against future increases in depressive symptoms. So if a new dad (or any dad) is showing potential signs of depression, it is well worth the time to seek out an evaluation and determine if a treatment plan is warranted.

Happy Dad and Baby via Shutterstock.com

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Mental Health Disorders: It's Not Your Fault
Mental Health Disorders: It's Not Your Fault
Mental Health Disorders: It's Not Your Fault

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School Stabbings

The emerging story of school stabbings at a high school in Murrysville, PA, will inevitably stir up debates about school violence, mental health, and gun control. For example:

  • The point will be made that it’s not all about guns at school. This is true – knives and other weapons can be used to cause harm. We need to understand how a range of weapons can be used by individuals who intend harm at schools.
  • The point will be made that we need to learn more about the factors that cause individuals to attempt mass murder. This is true. We need targeted research that will have, as an endpoint, strategies for identifying youth who may be on the verge of such behavior and routing them to interventions.
  • The point will be made that schools need to be better protected. This is true. Many schools have increased their security procedures and will need to continue to revisit them as necessary, and prioritize these initiatives.

What shouldn’t happen, however, is a myopic focus on just one issue and dismissal of the other issues – the kind of polarization that stymies progress. We can’t focus on just guns/knives/etc without thinking about mental health issues. We can’t just put all of our resources into the mental health angle without considering how we reduce access to weaponry in youth. School security is an ongoing concern because it is impossible to completely secure a school every second of the day, and as such we have to continue to refine how risk is minimized. There are of course other issues that should be examined and put into the mix. Serious public health concerns like school violence require at a minimum a multifactorial perspective and ideally a synergistic evaluation of many of the root issues.

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Stranded At Sea: Beyond Risk Taking?

A month long journey in a sailboat sounds like an exciting time for a kid. An adventure. And maybe a needed dose of risk taking in this age of perceived overprotection. But what about if that kid is 3 years old? How about 1 year old? Is this too risky?

It’s easy to say that it is when the baby gets sick, the boat gets stranded, and a massive rescue effort is necessary. The resulting storm over parenting seems to be landing on that conclusion.

What’s especially interesting is that this story may help illuminate what we mean by “safe risk taking.” I recently described an example of safe risk taking - the Noodle Forest exhibit at the Children’s Museum of Phoenix  (which is composed of densely packed, suspended pool noodles). The “risk taking” part was described as follows:

For a toddler, it can be a little disorienting making your way through the Noodle Forest. You do indeed get immersed in the noodles – you can’t see or hear much of anything else. You have to push your way through it and the noodles swing back at you. I’ve tried it myself and it is surprising how quickly you feel like you are, well, working your way through a Noodle Forest.

Of course, there is little physical danger, and a parent/guardian is nearby. The point of Noodle Forest is that it gives toddlers a chance to get out of a psychological comfort zone in a safe way. This is important, as kids’ play opportunities are not only getting limited in terms of opportunities, but also being compromised by safety concerns which can make playgrounds feel unchallenging. The point is to give kids chances to push themselves, not just physically, but psychologically, to try new things, things that might even seem a little scary, without putting them into situations that carry too much potential for harm.

The bigger point, though, is that kids develop a sense of efficacy when they are the ones who control the experience. Being put in a situation that carries risk and potentially compromises heath and well-being isn’t safe risk taking – it’s simply risk. We as parents need to keep that in mind when we determine, for ourselves, our algorithm that computes what’s a “safe risk” for a kid and what’s being placed at risk.

SOS via Shutterstock.com

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Is Autism Being Overdiagnosed?

The latest prevalence estimate of Autism Spectrum Disorder (ASD) – 1 in 68 – reignites conversation that we may be overdiagnosing ASD. In part, to some the estimate just feels too high based on clinical and personal experience. And there is worry that we may be flooding an already overwhelmed evaluation and treatment system.

These concerns echo the debates that surrounded the changes in diagnostic criteria that were introduced in the DSM-5 in May 2013 which, to some, were implemented to protect against overdiagnosis of ASD, as I described last December:

The reformulation of the diagnostic criteria – which led to a discontinuation of the category of Asperger Syndrome in favor of a broad-based category of Autism Spectrum Disorder (ASD) – spurred concerns that many youth would no longer qualify for a diagnosis and hence have their intervention options limited. Others suggested that more precise diagnostic criteria are needed to ensure that ASD does not get overdiagnosed. While we await empirical resolution via publication of well-designed studies, it’s clear that the DSM-5 debate will stand out as an important time in which we wrestled (again) with the best way to be inclusive in diagnosis without expanding diagnostic criteria too broadly.

As a result of the changes in DSM-5, it may be that a few years from now we will see a “recalibration” of the prevalence of ASD. The speculations have been that about 10% of children now diagnosed with ASD will no longer meet criteria.

What do we make of these changing estimates in the prevalence of ASD, which have increased tremendously over the past decade and may, sometime in the near future, begin to decrease? This complex issue does not lend itself to a singular answer.  Considering a number of points may help to provide some perspective on how we discuss this question.

PREVALENCE RATES FOR DISORDERS CAN BE “HIGH”

While, as noted above, clinicians, researchers, and policy makers often attempt to interpret the rate of a disorder as a means of ensuring appropriate diagnostics without overdiagnosing, the fact is that there is no magic number or prevalence rate for a disorder. Consider the following:

  • Epilepsy is estimated to affect somewhere between 4-10 per 1000 people; and nearly 10% of the population will experience a seizure in their lifetime
  • Asthma affects almost 10% of children
  • More than 8% of the population is reported to have diabetes

The point? Disorders which can be validated biologically can affect large numbers of people in the population. This means that they are common disorders – not overdiagnosed conditions. The implication for ASD? Simply put, an estimated prevalence of “1 in 68″, in and of itself, does not necessarily imply overdiagnosis.

RATES CAN CHANGE OVER TIME

Part of the concern with the rate of ASD is that it has changed so much over the past decade. The estimates made by the Centers for Disease Control and Prevention (CDC) have gone from 1 in 150, to 1 in 110, to 1 in 88, and now to 1 in 68.  The rates of asthma have also gone up over the past decade, though not nearly as dramatically as those for ASD. A combination of factors have influenced this increased prevalence of asthma, including better recognition and diagnosis, changes in the definition of the disorder, and possibly increases in pathogens in the environment. The takeaway here is that an increase in prevalence over time is not a sufficient argument for overdiagnosis.

THE KEY CONCERN IS THE ROOT OF THE INCREASE OVER TIME

The crux of the debate about ASD is that we may be artificially increasing the prevalence. To consider this point, we need to focus on two two related factors that are primarily responsible for the dramatic changes in ASD prevalence.

First, there is much better screening, recognition, and evaluation. This is a positive step forward – early evaluation leads to early intervention. But as noted in the most recent CDC report, there are still children (primarily those in specific ethnic groups) who are not diagnosed at the same “high” rate as others. So simply lowering the bar for early evaluation is not necessarily a good step forward, and in fact may be counterproductive for many children in the population.

Second, there has been an increase in diagnosing “higher functioning” ASD, that is, ASD without a compromised cognitive level. This is where the conversation about overdiagnosis starts – and where the DSM-5 may lead to a reduction in prevalence over time. The sticky point is that as ASD, by definition, is recognized to occur along a spectrum of severity, it becomes hard to know where to draw the line. At what point would we be missing cases that could profit from intervention? At what point are we pathologizing normative variation in social functioning? There is where we need more informative data on the impact of interventions for those diagnosed and more pointed discussion.

Let’s look at a very different example – potential changes in how high blood pressure is being diagnosed in those 60 years of age and older. New guidelines have suggested that the target blood pressure for determining treatment is 150/90, as opposed to 140/90. The result would be that millions of adults over 60 would no longer be “required” to take medication for high blood pressure. This is a current controversy in medicine and it is being debated. The point here is that the biomedical and health sciences have to make these kinds of decisions for many disorders, and that controversies continue to arise. In other words, these are not simple issues, and they are not resolved easily. We continue to gather more information and bring more opinions to the table to come up with our best practices – and this same principle applies to the current and future conversations about ASD.

SO IS ASD BEING OVERDIAGNOSED?

Right now, this is an important question to ask, but rather than demand an answer, we need to gather more informative data and have more informed discussions that go beyond the prevalence rate. We have these discussions frequently about attention-deficit hyperactivity disorder (ADHD), and they continue. We worry that too many kids are being arbitrarily diagnosed with ADHD and that we may artificially inflate rates of ADHD by making inappropriate demands of toddlers and young children. The concern with ADHD is that we may be preventing kids from being kids, slapping them with inappropriate labels, and giving them medications that are not needed.

The concern with ASD is somewhat different. We are not over-medicating youngsters who are receiving a diagnosis of ASD, particularly those who are “high functioning.” We are offering behavioral interventions to improve social and cognitive skills. What we need to know is if some kids who would receive these kinds of interventions don’t need them or don’t profit from them. That’s essentially the tipping point in the argument described above about how to define high blood pressure. We should move beyond the prevalence rate and begin to look more closely at the efficacy of interventions and if there are better ways to define which kids can be best served by a diagnosis.

But what we don’t want to do is arbitrarily decide that the prevalence rate is “too high” and that we need to lower the bar for screening and evaluation. That would be a big mistake and undermine all the progress made to date in early surveillance and early intervention. Whatever the “true” prevalence rate is (and it will be a moving target), what we do know is that many young children can profit from early intervention and that we need to keep momentum going on understanding more about the causes of ASD, how to best diagnosis it, and how to develop even more powerful interventions.

Autism via Shutterstock.com

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Early Signs of Autism
Early Signs of Autism
Early Signs of Autism

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Safe Risk Taking For Toddlers

While there is a growing consensus that kids need to take risks, the conversation often focuses on “danger” versus “safety.” Not all risk taking ventures for kids involves potential danger. Rather it’s more about the idea of exploration and getting outside of a comfort zone.

NOODLE FOREST: NOT YOUR EVERYDAY NOODLES via childrensmuseumofphoenix.org

Consider a terrific exhibit/experience at the Children’s Museum of Phoenix – the Noodle Forest, comprised of lots of pool noodles. Check out the description from the museum’s website:

Oodles of noodles suspended from above offer sensory immersion in a unique and engaging environment. A thick forest of textural delight awaits visitors as they navigate this unfamiliar yet stimulating terrain. The Noodle Forest is guaranteed to activate the senses and inspire the giggles.

Here’s the thing. For a toddler, it can be a little disorienting making your way through the Noodle Forest. You do indeed get immersed in the noodles – you can’t see or hear much of anything else. You have to push your way through it and the noodles swing back at you. I’ve tried it myself and it is surprising how quickly you feel like you are, well, working your way through a Noodle Forest.

So it’s somewhat “risky” for some kids because it’s different and perhaps even a little challenging psychologically. But it’s physically safe and kids know that a parent is waiting for them once they get through it. This is an excellent balance of sensory stimulation combined with experiencing something a little different that pushes a toddler a little and makes them feel like they did something cool.

The Children’s Museum of Phoenix has many other exciting exhibits and exhibitions. Some especially promote creativity and fine motor development. Some push kids a bit more to get out of their comfort zone. This is the kind of risk taking play that toddlers need.

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You Know You Have A Toddler When¿
You Know You Have A Toddler When¿
You Know You Have A Toddler When¿

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