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Watching bullying can be toxic

School bullying is no laughing matter. Fortunately, schools and governmental agencies are recognizing that bullying victims often carry scars long after the event occurs. New information supports other prior research suggesting that students who merely observe bullying can be profoundly affected.

Research reported in December 2009, based on a study of over 2,000 students in England, has found that children who have observed bullying not only have a wide range of possible negative emotional consequences, but actually have more problems than do the bullied children themselves!

It is important to keep in mind that many children who observe bullying did not have evidence of sustained psychological consequences. However, many did. These symptoms of psychological distress included anxiety, depression, bodily symptoms, drug use, and other common markers of psychological upset.

Why would an observer of bullying suffer as much or even more than the victim? All we can do is to speculate about this, but some have wondered whether children who observe bullying are left with guilt feelings for not having intervened, or whether these children tend to worry that they will be next on the bully’s list.

Whatever the explanation, this study provides more evidence that bullying is indeed toxic to the victim, by-standing observers, and – don’t forget – the bullier himself who is dealing with his own problems in a psychologically and morally problematic way.

Perhaps you have some reasons to have thought about the topic of bullying. We invite you to contribute to a discussion on the topic.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary

School violence: Should the shrinks rush in?

Few things in our contemporary world terrify parents as much as the prospect of serious violence occurring in their school. It seems that hardly a year goes by without a shooting incident at a school somewhere or other. It has become customary for mental health professionals to come to a school in mass when such tragedy strikes. The mental health professionals typically meet with groups of children, providing opportunities for them to debrief and share reactions. Other types of services may also be provided. It is now expected that the shrinks will show up – but does it do any good?

For the first time, a group of researchers in Canada studied this question. (See Szumilas, Magdalena, Wei, Yifeng, Kutcher, Stan. Psychological debriefing in schools. Canadian Medical Association Journal (CMAJ) 2010.) It turns out that psychological debriefing that allows children an opportunity to express their reactions and recall the events if they wish does not help at all. In fact, there is some reason to even worry that in some situations, such an approach may interfere with a child’s effort to overcome the situation. There are some other kinds of interventions that show promise, but more research is needed to know if they will be of help.

Lucy Daniels Center clinicians believe that mental health assistance, properly applied, can have benefits – after all, that’s what we do ourselves. But, we are also aware that mental health professionals have their time and place, and that the people who can most help children at times of high stress are the people with whom they have the most loving and trusting relationships – their parents. The take-home lesson is that just sending in the shrink does not necessarily help!

We have discussed the ways that parents can help children at these times, and we would refer you to a past Ask Lucy Daniels column, or visit the Lucy Daniels Center Web site for a pdf version.

Perhaps you have some thoughts about violence in our schools, and the effect that it has on children. If so, please share them!

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary

How many children have mental disorders?

How many children experience mental disorders? Over the years, many studies have tried to answer this question. Such studies are always difficult and expensive. The best estimates in the field have been that somewhere about 10 to 15 percent of children experience substantial emotional interference in their development. If we include children who are having some clear emotional struggle but for whom the situation is not as serious, the best estimates have been that the percentage of affected children may rise to about 20 percent.

A recent and important study jointly conducted by the NIMH National Institute of Mental Health (NIMH) and the Center for Disease Control and Prevention (CDC) sheds important light on this issue. This study, reported in December 2009, was unusual in that information was collected from children as well as parents. Many thousands of children ages 8 to 15 were studied. Children were assessed for the presence of one or more of six conditions: generalized anxiety disorder (GAD), panic disorder, eating disorders (anorexia and bulimia), depression, attention deficit hyperactivity disorder (ADHD) and conduct disorder.

What were the results? In the past year, 13 percent of children appeared to have experienced one of these conditions. Less than half had received any form of medical or psychological attention for these problems!

All numbers always need interpretation. We interpret these results to indicate that the conventional wisdom about the incidence of significant emotional conditions in childhood has been on target and, if anything, has underestimated the incidence. For one thing, there are many more emotional conditions than just the six that were tracked in this particular study, and so this 13 percent figure does not include the children affected with these other emotional conditions. For example, among the children that we help at the Lucy Daniels Center are many with PTSD symptoms. Children with this problem would not have been counted in this particular study, unless they also had one of the other conditions.

Another reason we think there could be more than 13 percent of children burdened with emotional conditions is that emotional symptoms wax and wane. For example, some children with anxiety or depression have enough symptoms to reach the diagnostic threshold in a given year but not another. In other words, even within the six categories that were tracked, some children who are still struggling with a very significant problem would not have been counted.

Bottom line – the evidence continues to mount about the extent that our children experience limiting emotional conditions. Unaddressed, these problems will usually continue in some form in adulthood.

Do you have some thoughts about this matter of importance to all of us? If so, please share your comments.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary

This study was published online ahead of print on Dec. 14, 2009, in the journal Pediatrics. We have addressed related aspects of this topic, and you might be interested in our guidelines about when to seek professional help, or the many other Lucy Daniels Center articles on particular emotional conditions in the Carolina Parent archives or in pdf formats on the Lucy Daniels Center site.

Is autism on the rise?

Twenty years ago, autism was a rare condition that parents rarely thought about. Now, most parents know or know of a child diagnosed with autism. Their children may attend a school with a special classroom for autistic children. As many as 1 in 150 children are said to have this condition. Is it an epidemic?

No one knows the answer for sure. What we do know is that we have changed the definition of autism from what it was 20 years ago or more, and we now include many children within the “autistic spectrum” who would not have received this diagnosis years ago. From that standpoint, we are comparing today’s apples with yesterday’s oranges. We also know that awareness among professionals and parents is immensurably higher now than in prior years –we have many more apple-pickers than we had. There is no controversy among professionals and others about these two factors. There is controversy about whether the change in the diagnostic criteria and the greater awareness sufficiently accounts for the greater incidence of autism. It is for this reason that there is a search for possible additional explanations, such as the misguided concerns about a relationship between autism and childhood vaccinations.

A recent study in California, while not resolving the question whether there is an actual increase in incidence of autism or not, does strengthen the case that greater awareness is an especially important factor. In a very carefully designed and conducted study published in the online Journal Autism Research this month, the researchers found that 10 areas in California had an especially high incidence of autism. These areas were associated with more educated parents and the presence of an autism center. It does indeed seem that more education and awareness, by parents and in the community (professionals in the vicinity of an autism center tend to be more knowledgeable about the signs of autism) make an important difference.

We will have more to say on the important topic of autism in subsequent postings. Meanwhile, won’t you contribute your own thoughts? Perhaps you have had some experiences or points of view, or questions that you would like us to address at some point.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary

ADHD medication & children's cardiac health

About 7 percent of American children are receiving medication for ADHD. Aside from all the controversies about the diagnosis and treatment, this is the current reality. In the last several years, a small—thankfully, very small—number of children receiving one of the standard ADHD first-line medications (psychostimulants) have experienced effects on their heart, including sudden death. Because this tragic event is so rare, controversy remains among medical professionals about whether cardiac health is indeed affected by psychostimulants, or whether there is a similar incidence of cardiac events in the untreated pediatric population.

Although there are a bewildering number of products for ADHD, the front-line treatments fall into two main, very closely chemically related groups: the psychostimulant called methylphenidate (for example, Ritalin); and the psychostimulant known as amphetamine salts (for example, Adderall). A July 2009 study in the Journal of Pediatrics addresses one question of great importance to parents and physicians: Is either methylphenidate or amphetamine salts safer? Although this study did not provide the final answer, its analysis of Emergency Room visits between 1994 and 2004 for children receiving Medicaid in Florida did not show any differential in the risks associated with the two main classes of medication.

So what’s a parent to do when the medical experts can’t agree among themselves? The Lucy Daniels Center believes that the American Heart Association (AHA) struck a very sensible note with its guidelines, which have been endorsed by the Academy of Pediatrics. The AHA recommends that pediatricians and family physicians obtain a thorough cardiac history and perform a routine physical cardiac exam assessment of all children. If patient history, family history, or physical exam is suggestive of cardiac disease, further evaluation is advised, and careful thought should be given to the benefits and possible risks of using psychostimulants.

On the other hand, if there is no reason to be concerned about cardiac health on the basis of history and exam, the AHA does not recommend routine ECG’s or additional cardiac evaluation but recognizes that a pediatrician or family physician might still recommend further evaluation. The bottom line: if your child is taking psychostimulant medications, be sure that you and your child’s physician have addressed these issues of cardiac health.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary

Parenting special needs children gets easier

Parents of special needs children face special challenges, whether the children’s special needs are physical, developmental, or emotional. Marriages feel the strain, and parents often struggle to maintain their own emotional well being.

A 2008 study from the University of Chicago and the University of Wisconsin is the first to study, over time, the physical and mental health of parents of children with developmental and mental health special needs. According to the report of the research in Science Daily, “Research suggests that, over time, parents learn to adapt to the challenges of caring for a disabled child. As these parents age, the study shows, their health more closely mirrors the health of parents with children who don’t have disabilities.”

There is encouragement here for parents who face such challenges: It is rough at first, but things generally settle down. In our own work with parents of special needs children, we have consistently seen that staying connected with loved ones and friends, making sure that a marriage receives the attention it needs, taking time to take care for yourself, and relying upon sources of spiritual meaning all contribute to good outcomes for parents in trying situations.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary

Explaining emotions pays off!

We’ve known for a long-time that children who have close, loving relationships with their parents in their early years are more likely to relate in a caring and successful way with friends. A 2008 study in Child Development further supports this common observation and provides insight into effective parenting.

Children in the study had the most successful social relationships when parents consistently explained the emotional reasons for actions and interactions. Children benefited when their parents offered detailed explanations that helped them understand themselves and others.

The study looked at several indicators of successful social development in early childhood, including what researchers called a “hostile attribution bias” at 4 ½ years and again in the first grade. Interviewers might pose questions such as, “John throws a ball and it hits you in the back,” and if a child interpreted the peer's behavior as intentional, it indicated a hostile attribution bias. The researchers also evaluated children’s language ability, and mothers and teachers reported on children’s general peer competence in first grade and the quality of their relationships with their closest friends in third grade.

This study reminds us that parents should provide a rich emotional dialogue with their children. If a 1-year-old hits when frustrated, it is helpful to say, “You can’t hit even though you are angry.” If a 2-year old is sad when dropped off at school, an appropriate response would be: “I know you are sad and that is why you don’t want Mommy to leave, but Mrs. Smith is here to help you to feel better and have a good day.”

For more on this topic, browse Ask Lucy Daniels columns in CarolinaParent.com’s archives. Read tips on Raising Considerate Children, or visit the Lucy Daniels Web Site for a pdf version.

Parents can also find advice and reading recommendations to help support attachment at our Lucy’s Book Club, lucysbookclub.org. In particular, take a look at our first list of books, Topic one: Feeling strong with your love, which can be directly accessed through lucysbookclub.org/page/former-booklists.

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood in Cary