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Monday, January 22, 2018

What is Borderline Personality Disorder?

From the Child Mind Institute

By Caroline Miller
January 9, 2018

And why it's now being diagnosed and treated in teenagers.

Borderline personality disorder (BPD) is a diagnosis that has historically been difficult to understand, and even more difficult to treat successfully. The symptoms associated with it are a painful mix of emotional turmoil, unstable relationships and self-destructive behavior, including suicide attempts.

But new insights into the disorder, leading to new, more effective treatments, have made the prognosis for someone with BPD much more promising.

With the right support, most people with BPD can successfully learn to regulate their overwhelming emotions, stop self-destructive behavior and improve their lives.

“It used to be that receiving a BPD diagnosis felt like a life sentence of misery,” said Dr. Alec Miller, an expert in treating adolescents with BPD. “But research now shows that the chances of functioning better and even dropping the diagnostic label are very high.”

Another important change is that BPD is now diagnosed and treated in teenagers. Until recently mental health professionals were reluctant to give the diagnosis to anyone under 18, despite the fact that symptoms become prominent in adolescence, or even earlier.

Now, experts stress that treating BPD as early as possible leads to better long-term outcomes, as well as lowering the risk of dangerous or suicidal behavior.

What is BPD?

Experts call BPD a biosocial disorder, meaning that it starts with a biological (or temperamental) inclination which is exacerbated by the social environment. People who develop BPD are by temperament highly emotionally sensitive and reactive, feeling things more immediately and more intensely than most people. And once a powerful emotion is triggered, it takes them longer to return to their emotional baseline.

BPD develops when one of these emotionally vulnerable people is confronted with an environment that doesn’t validate her feelings — that is, acknowledge them, make her feel understood, and respond appropriately. In many cases, kids who develop BPD have been abused or neglected.

But the disorder can also come about in children whose ordinary, well-meaning parents minimize or discount their emotional reactions, which they find exaggerated or inappropriate.

The chronic sense of not feeling understood or supported leads people with BPD to feel painfully alone and disconnected, explains Dr. Blaise Aguirre, director of the borderline personality disorder unit at Boston’s McLean Hospital. Friends and family members don’t understand why people with BPD have huge reactions to small things.

For Dr. Aguirre, author of Borderline Personality Disorder in Adolescents, BPD is something like a peanut allergy; the reaction may not be typical of most people, but it’s no less real.

Emotional Dysregulation

When a child’s powerful feelings aren’t validated by the adults in her life, it becomes difficult for her to learn to manage them in a healthy way. Adults help us name and identify what we’re feeling; by soothing us they teach us how to soothe and calm ourselves down.

“Take a person with extremely strong, intense emotions, who is constantly told that she’s overreacting, she shouldn’t feel the ways she feels,” explains Dr. Jill Emanuele, clinical psychologist and director of the Mood Disorders Center at the Child Mind Institute. “As a result, she doesn’t learn how to regulate and modulate her emotions. “

People with BPD are often overwhelmed by intense anger and feelings of abandonment, emptiness, shame and self-loathing.

These feelings tend to destabilize relationships for people with BPD, who are hypersensitive to social cues from others, and more likely than others to interpret things negatively. Minor slights — or things misinterpreted as slights — are taken as evidence of abandonment, and the reaction can be swift and intense, causing rifts with friends, parents, partners. They go from “I love you” to “I hate you” in a heartbeat, Dr. Aguirre explains. Or they become so frantic asking for reassurance that they are loved — incessant texting, calling, begging, clinging —that they drive partners away.

Rifts with friends or breakups with partners are often the trigger for self-harm or suicide attempts, he notes.

Self-Destructive Behavior

Why does BPD lead to self-destructive behavior?

Without the skills to manage painful feelings in a more effective way, people with BPD often find unhealthy alternatives, including substance abuse, risky sex, reckless thrill-seeking.

Self-injury is very often one of these behaviors: Teenagers use things like cutting, scratching and opening wounds to alleviate emotions they find intolerable. “In fact it can work as an emotional regulation strategy,” notes Dr. Miller, cofounder and clinical director of Cognitive and Behavioral Consultants in Westchester and New York City.

“The problem is that if it works, they’re more likely to use it again to cope with negative emotions. To reduce self-harm we need to acknowledge what it’s doing for them, and try to give them some safer replacement strategies.”

One dangerous misunderstanding about BPD is that the emotional drama and the self-destructive behaviors, including suicide attempts, are manipulative pleas for attention.

“Historically, people with BPD have been viewed as purposely manipulative,” explains Dr. Emanuele, “using extreme measures to get things, gaming people around them. But that’s not it at all. These people are in intense pain, and feel they can’t get what they need.”

In fact, Dr. Aguirre notes, suicidal feelings are almost universal in people with BPD, and reflect a desperate need to escape extreme emotional distress.


Criteria for Diagnosing BPD

These are the criteria mental health professionals use to diagnose borderline personality disorder:

  • Frantic efforts to avoid abandonment, real or imagined
  • A pattern of unstable and intense relationships
  • An unstable self-image or sense of self
  • Dangerous impulsivity such as unsafe sexual encounters, substance abuse
  • Recurrent suicidal behavior, gestures or threats, or self-mutilating behavior.
  • Emotional instability due to high reactivity
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger
  • Transient, stress-related paranoia or severe dissociative symptoms

Diagnosing Teenagers

In the past, mental health professionals were reluctant to diagnose anyone under 18 with BPD, even though symptoms usually develop during the teen years. That was, in part, because emotional intensity and impulsive risk-taking are to some extent characteristic of adolescence itself. Typical teenage behavior, it was thought, could be confused with BPD.

But even if the behavior looks similar, the reasons for it are different in typical adolescents and those with BPD, Dr. Aguirre notes.

Typical teens experiment with alcohol and sex out of curiosity and impulsivity, while people with BPD use them to escape acutely painful feelings. They may seek out sexual encounters, for instance, because they feel abandoned, and crave closeness, rather than sex itself. They may take dangerous risks because “in that moment of desperation the need to change how they feel makes the behaviors feel like the right thing to do.”

Another reason for not diagnosing BPD in teens was to avoid labeling them with a severe illness that didn’t respond well to treatment. But as the treatment picture has changed, so has the aversion to diagnosis in adolescence.

One large study called the McLean Study of Adult Development, which followed BPD patients for 12 years, found that 74 percent of participants had no active symptoms after 6 years, and only 6 percent relapsed in the following 6 years.

Dr. Aguirre now calls BPD a “good-prognosis diagnosis,” and those who are treated while they’re still teenagers have even more optimistic outcomes.

Why Early Diagnosis is Crucial

If BPD is understood as a lack of emotional regulation skills, it’s crucial to get someone who develops symptoms into treatment as soon as possible, Dr. Aguirre says, “before patterns of maladaptive behavior have set in.”

This is particularly important as young people are developing their identity and sense of self, which is made incredibly difficult for young people with BPD symptoms. “When your environment doesn’t reflect back what your experience is,” Dr. Aguirre says, “it’s hard to know who you are, what your values are.”

Another reason experts urge earlier diagnosis of BPD is to lessen inaccurate diagnosis of more common disorders like ADHD, depression and bipolar disorder. Sometimes these are co-occurring disorders, but often they are misdiagnoses. As a result, these teenagers are given medications that aren’t effective, including mood stabilizers and antipsychotics.

“I’ve seen kids with BPD who were on extensive drug cocktails because the clinicians didn’t know what was happening,” adds Dr. Emanuele. “They’re just going after the symptoms. And no medication is going to correct the invalidation that these people feel.”

BPD patients who are admitted to Dr. Aguirre’s unit often come in “zombie-like,” he reports, because they are on so many medications. When they are discharged, he says, half are on no meds at all.


Treatment for BPD

There are a number of specialized psychotherapies that have been developed to treat BPD, but the gold standard treatment — the one with the most evidence for its effectiveness — is called dialectical behavioral therapy, or DBT. The reason it’s called “dialectical” is that it involves two things that might seem to be in opposition but are both important: the need for acceptance and the need for change.

First, a patient’s feelings need to be validated, or accepted without judgment, in order for her to learn more effective ways for her to manage and respond to them.

“It’s basically ‘I’m doing the best I can’ on the one hand,” explains Dr. Miller, “and at the same time ‘I need to do better’ on the other.”

Validation, which is the first step in DBT, means recognition and acceptance of another person’s feelings as being real. It doesn’t mean agreeing with the thoughts or feelings. When people feel accepted and understood, it has a calming effect and allows them to learn skills to regulate emotions and develop safer, more effective alternatives to the self-destructive behaviors they have been using.

“It’s essentially a skills-based approach which says that if our patients could do better, they would, but they’re lacking skills,” explains Dr. Miller, who is the author of Dialectical Behavioral Therapy with Suicidal Adolescents. “It’s so easy for us to tell people to stop problematic behaviors but it’s better to teach them new skills.”

DBT skills are very effective for getting patients to stop self-injury and suicidality, Dr. Aguirre notes. It’s tougher to change the self-loathing and self-hatred that can become fused with a borderline person’s identity.

He also notes that availability of DBT and other treatment for BPD is limited, which means that a lot of teenagers who should get treatment aren’t getting it. “The number of people with emotion regulation problems is outstripping the number of DBT providers,” he says, “and we know that because suicide rates in adolescents continue to go through the roof.”

Dr. Miller stresses the urgency of getting teens with BPD into treatment: “If you throw yourself into treatment, you can be a very successful, highly functional adult.”

Dr. Emanuel adds that she’s seen many patients dramatically improve their lives. “Over the years, I have repeatedly seen DBT give participants the hope and reality of a ‘life worth living,’ ” adds Dr. Emanuel. “And that’s something they had not been able to imagine or experience before.”

Autism: Brain Circuit That Controls Social Behavior Identified

From Elsevier

January 11, 2018

A new study has identified a specific brain circuit that may lead to social impairments in autism spectrum disorders.

Researchers at Roche in Basel, Switzerland have identified a key brain region of the neural circuit that controls social behavior. Increasing the activity of this region, called the habenula, led to social problems in rodents, whereas decreasing activity of the region prevented social problems.

The study, which appears in Biological Psychiatry, suggests that social impairments characteristic of autism spectrum disorder may stem from alteration of activity in this circuit, and that tuning this circuit may help treat social deficits in the disorder.

"We are excited about this study as it identifies a brain circuit that may play a critical role in social reward, which is affected in autism," said senior author Dr. Anirvan Ghosh, who was the Head of Neuroscience Research at Roche and now serves as Head of Research and Early Development at Biogen. The findings provide clues as to what may be altered in the brain to lead to neurodevelopmental conditions like autism spectrum disorder.

Previous research has linked social function to the prefrontal region of the brain, but circuits that affect prefrontal control of social behavior were unknown. So first author Dr. Madhurima Benekareddy and colleagues activated the prefrontal region in mice and rats, and performed a brain-wide screen to find which regions responded. The screen identified changes in activity in regions related to emotional behavior, particularly in the habenula.

In the study, the researchers then used a combination of different techniques to map the connections from the habenula to the frontal area of the brain, and to precisely control the activity of neurons in these regions.

Turning up the activity of neurons in the habenula reduced how much the rats and mice socialized. Turning down habenula activity prevented the social deficits that could be induced by activating the frontal region.

According to the authors, an alteration of the normal activity range for the circuit may cause behavioral function in disorders such as autism spectrum disorder. "Understanding how altered brain function leads to social deficits could help develop novel targeted therapeutics for autism spectrum disorder," said Ghosh, such as by tuning the circuit to correct the altered activity.

The findings also have implications for diseases other than autism spectrum disorder, including schizophrenia and depression. The circuit incorporates brain regions involved in reward and pleasure, leading the authors to consider that social dysfunction may stem from reduced enjoyment in social interaction.

"It is interesting that the circuit implicated in social behavior in this study is also a circuit implicated in the biology of depression," said Dr. John Krystal, Editor of Biological Psychiatry. "Perhaps this circuit represents a pathway through which disruptions in social relationships contribute to negative mood states and depression."

Journal Reference
  • Madhurima Benekareddy, Tevye Jason Stachniak, Andreas Bruns, Frederic Knoflach, Markus von Kienlin, Basil Künnecke, Anirvan Ghosh. Identification of a Corticohabenular Circuit Regulating Socially Directed Behavior. Biological Psychiatry, 2017; DOI: 10.1016/j.biopsych.2017.10.032

Sunday, January 21, 2018

Former NFLers Call for End to Tackle Football for Kids

From CNN

By Nadia Kounang
January 18, 2018

Former football players are supporting a new education initiative, Flag Football Under 14."Please don't let your children play football until high school," one Hall of Fame player said.

Former pro football player Kevin Turner, shown here during a 1998 NFL game,
had the most advanced stage of CTE when he died in March at the age of 46.
Dr. Ann McKee of Boston University and the Concussion Legacy Foundation
said that Turner's CTE brought on amyotrophic lateral sclerosis (ALS),
also known as Lou Gehrig's disease.

CTE stands for chronic traumatic encephalopathy, a neurodegenerative disease associated with repeated head trauma. Scientists believe repeated head trauma can cause CTE, a progressive degenerative disease of the brain. Symptoms include depression, aggression and disorientation, but scientists can definitively diagnose it only after death.

Several former NFL players called Thursday for an end to tackle football for kids ages 13 and under.

Pro football Hall of Famers Nick Buoniconti and Harry Carson joined four-time Pro Bowl linebacker Phil Villapiano and researchers from Boston University to make the announcement. They're working with the Concussion Legacy Foundation to support a new parent education initiative, Flag Football Under 14, that pushes for no tackle football until the age of 14.

"I beg of you, all parents to please don't let your children play football until high school," said Buoniconti, 77, who has been diagnosed with dementia and probable chronic traumatic encephalopathy, a neurodegenerative disease.


"I made the mistake starting tackle football at 9 years old. Now, CTE has taken my life away. Youth tackle football is all risk with no reward."

Buoniconti helped the Miami Dolphins to three straight Super Bowl appearances, including two wins and an undefeated season in 1972, the only such season in all of NFL history. In November, he said he intended to donate his brain to research.

New York Giants legend Carson echoed Buoniconti's sentiments.


"I did not play tackle football until high school, I will not allow my grandson to play until 14, as I believe it is not an appropriate sport for young children," Carson said.

Villapiano is best known for his big plays for the Oakland Raiders. He said that witnessing how CTE ravaged his teammate and friend Ken Stabler is causing him to speak out about the dangers of tackle football for children under 14.

"At some point, those of us who have had success in this game must speak up to protect both football players and the future of the game, and supporting 'Flag Football Under 14' is our best way to do that," he said.

How CTE Begins

The players, along with researchers Chris Nowinski of the Concussion Legacy Foundation and Dr. Robert Cantu and Dr. Lee Goldstein of Boston University, pointed to studies that showed CTE can start early in life and without any signs of concussion.


A study co-authored by Goldstein and published Thursday in the journal Brain came to that conclusion. It found some changes in the brain occurred as early as 24 hours after injury.
Goldstein and his colleagues advocate for no tackle football before 14 because children's bodies, particularly their necks and upper bodies, aren't strong enough to counteract the bobbling of the head and shaking of the brain that occurs during tackles.

Dr. Julian Bailes, the director of neurosurgery and co-director of NorthShore University HealthSystem Neurological Institute and medical director for Pop Warner, said the concern over repeated hits is magnified in high school, after kids are 14.

"The real exposure to larger players, higher velocity hits and hundreds of hits starts in high school," he said.

Goldstein said parents should heed the warning that CTE can develop early -- and the focus on concussions doesn't reduce the risk.

"The NFL is setting a bad example by focusing on the concussion and while not focusing on the hits," said Goldstein.


The NFL and Dr. Allen Sills, it's chief medical officer, did not respond when asked whether the league is considering changing its CTE and concussion protocol because of the recent study.

"As highlighted in this recent study, repetitive hits to the head have been consistently implicated as a cause of CTE by this research group. How and why exactly this manifests, who is at risk, and why -- these are questions that we as researchers and clinicians are working to answer," Sills said.

Sills noted changes the NFL has made to reduce head-to-head contact over the years, including limiting how much players can wear their helmets off-season and limiting full-padded practices during the season. The NFL has also made grants and supported brain science.

Goldstein said concussions remain the red herring of CTE.

"We will never prevent CTE by focusing on concussions. Any meaningful prevention campaign has to focus on preventing all hits to the head, including sub-concussive impacts," said Goldstein.

And one way to do that, he said, is to limit overall exposure to hits by waiting to play tackle football.

Carson, the former linebacker, noted that "the game is more popular now."

"Parents should understand exactly what they are signing their kids up for," he said.

CNN's Kwegyirba Croffie contributed to this report.

A Tale of Two Social Styles: Classical and Jazz Socializers

From NESCA News & Notes

By Jason McCormick, Psy.D.
Senior Neuropsychologist

November 27, 2017

I work with a number of parents concerned about the quality of their child’s social life. Lamenting that their child has no true friends, many parents I see note that that their child doesn’t “hang out” with peers. However, when asked about how their child does spend time with peers, many parents report that their child is involved in several different structured after-school activities, such as a church youth group, scouting or a gaming club.

In other words, while not getting together with peers in less structured settings, these students often do, despite parent misgivings, have satisfying social lives.

I find it useful to think about socializers as lying in one of two camps: Jazz and Classical. Jazz socializers are all about improv. They’ll head downtown with a friend and see where the afternoon takes them, invite a friend over with no particular plan or agenda, or wander the mall in a herd. They care little about predictability and in fact relish spontaneity and surprise.

Classical socializers, by contrast, are most comfortable with structure. They crave predictability, wanting to know the specific parameters of a social activity, including the start and end times, the purpose, and the rules of engagement. Classical socializers, then, tend to do best with organized social activities.

It’s important to note that one type of socializing is not better than the other; it’s about match. I say that as many parents of Classical socializing children worry that their children will grow up to be friendless and alone. To those concerns, I observe that there are plenty of socially-satisfied Classical socializing adults: they have their book club the first Monday of every month, poker night every other Thursday, weekly chorus practice, and bar trivia on Wednesdays.

Thus, rather than trying cram to their Classical socializing child into a Jazz paradigm – which in fact runs the risk of leading to more social isolation due to anxiety stemming from the mismatch – I encourage parents to embrace the kind of socializer that their child is.

For parents of Classical socializers, that means supporting their child’s social satisfaction and growth through encouragement of their participation in a variety of structured after school activities (of course without over-scheduling).

In addition to giving their children a chance for a rich and rewarding social life now, participation in such activities serves as important practice and preparation for adult life, as in college and as adults in the working world, that is how Classical socializers will be most socially satisfied.

About the Author

Dr. Jason McCormick, a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE).

Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college.

As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

Saturday, January 20, 2018

How to Avoid Passing Anxiety on to Your Kids

From the Child Mind Institute

By Brigit Katz
January 16, 2018

Help yourself, and them, by learning techniques to manage stress in a healthy way.

On a recent afternoon, J.D. Bailey was trying to get her two young daughters to their dance class. A work assignment delayed her attempts to leave the house, and when Bailey was finally ready to go, she realized that her girls still didn’t have their dance clothes on.

She began to feel overwhelmed and frustrated, and in the car ride on the way to the class, she shouted at her daughters for not being ready on time. “Suddenly I was like, ‘What am I doing?'” she recalls, filled with anxiety. “‘This isn’t their fault. This is me.’ ”

Bailey has dealt with anxiety for as long as she can remember, but it has become more acute since the birth of her second daughter, when she began to experience postpartum depression. She knows that her anxiety occasionally causes her to lash out at her daughters when she doesn’t really mean to, and she can see that it affects them.

“You see it in your kids’ face,” Bailey says. “Not that they’re scared, but just the negativity: ‘Oh my God, my mommy’s upset.’ You’re their rock. They don’t want to see you upset.”

Taking Cues from You

Witnessing a parent in a state of anxiety can be more than just momentarily unsettling for children. Kids look to their parents for information about how to interpret ambiguous situations; if a parent seems consistently anxious and fearful, the child will determine that a variety of scenarios are unsafe.

And, there is evidence that children of anxious parents are more likely to exhibit anxiety themselves, a probable combination of genetic risk factors and learned behaviors.

If you feel yourself becoming overwhelmed with anxiety, try to take a break.

It can be painful to think that, despite your best intentions, you may find yourself transmitting your own stress to your child. But if you are dealing with anxiety and start to notice your child exhibiting anxious behaviors, the first important thing is not to get bogged down by guilt.

“There’s no need to punish yourself,” says Dr. Jamie Howard, director of the Stress and Resilience Program at the Child Mind Institute. “It feels really bad to have anxiety, and it’s not easy to turn off.”

But the transmission of anxiety from parent to child is not inevitable. The second important thing to do is implement strategies to help ensure that you do not pass your anxiety on to your kids. That means managing your own stress as effectively as possible, and helping your kids manage theirs. “If a child is prone to anxiety,” Dr. Howard adds, “it’s helpful to know it sooner and to learn the strategies to manage sooner.”

Learn Stress Management Techniques

It can be very difficult to communicate a sense of calm to your child when you are struggling to cope with your own anxiety. A mental health professional can help you work through methods of stress management that will suit your specific needs. As you learn to tolerate stress, you will in turn be teaching your child—who takes cues from your behavior—how to cope with situations of uncertainty or doubt.

“A big part of treatment for children with anxiety,” explains Dr. Laura Kirmayer, a clinical psychologist, “is actually teaching parents stress tolerance, It’s a simultaneous process—it’s both directing the parent’s anxiety, and then how they also support and scaffold the child’s development of stress tolerance."


Model Stress Tolerance

You might find yourself learning strategies in therapy that you can then impart to your child when she is feeling anxious. If, for example, you are working on thinking rationally during times of stress, you can practice those same skills with your child. Say to her: “I understand that you are scared, but what are the chances something scary is actually going to happen?”

Try to maintain a calm, neutral demeanour in front of your child, even as you are working on managing your anxiety. Dr. Howard says, “Be aware of your facial expressions, the words you choose, and the intensity of the emotion you express, because kids are reading you. They’re little sponges and they pick up on everything.”

Explain Your Anxiety

While you don’t want your child to witness every anxious moment you experience, you do not have to constantly suppress your emotions. It’s okay—and even healthy—for children to see their parents cope with stress every now and then, but you want to explain why you reacted in the way that you did.

Let’s say, for example, you lost your temper because you were worried about getting your child to school on time. Later, when things are calm, say to her: “Do you remember when I got really frustrated in the morning? I was feeling anxious because you were late for school, and the way I managed my anxiety was by yelling. But there are other ways you can manage it too. Maybe we can come up with a better way of leaving the house each morning.”

Talking about anxiety in this way gives children permission to feel stress, explains Dr. Kirmayer, and sends the message that stress is manageable.

“If we feel like we have to constantly protect our children from seeing us sad, or angry, or anxious, we’re subtly giving our children the message that they don’t have permission to feel those feelings, or express them, or manage them,” she adds. “Then we’re also, in a way, giving them an indication that there isn’t a way to manage them when they happen.”


After J.D. Bailey lost her temper at her daughters on their way to dance class, she made sure to explain her reaction, and then focused on moving forward. “I said, ‘I’m sorry. Mom is a little stressed out because I have a lot of work going on. Let’s listen to some music,’ ” Bailey recalls. “We cranked up the music in the car, and it changed our mood.”

Make a Plan

Come up with strategies in advance for managing specific situations that trigger your stress. You may even involve your child in the plan. If, for example, you find yourself feeling anxious about getting your son ready for bed by a reasonable hour, talk to him about how you can work together to better handle this stressful transition in the future.

Maybe you can come up with a plan wherein he earns points toward a privilege whenever he goes through his evening routine without protesting his bedtime.

These strategies should be used sparingly: You don’t want to put the responsibility on your child to manage your anxiety if it permeates many aspects of your life. But seeing you implement a plan to curb specific anxious moments lets him know that stress can be tolerated and managed.


Know When to Disengage

If you know that a situation causes you undue stress, you might want to plan ahead to absent yourself from that situation so your children will not interpret it as unsafe. Let’s say, for example, that school drop-offs fill you with separation anxiety. Eventually you want to be able to take your child to school, but if you are still in treatment, you can ask a co-parent or co-adult to handle the drop off.

“You don’t want to model this very worried, concerned expression upon separating from your children,” says Dr. Howard. “You don’t want them to think that there’s anything dangerous about dropping them off at school.”

In general, if you feel yourself becoming overwhelmed with anxiety in the presence of your child, try to take a break. Danielle Veith, a stay-at-home mom who blogs about her struggles with anxiety, will take some time to herself and engage in stress-relieving activities when she starts to feel acutely anxious.

“I have a list of to-do-right-this-second tips for dealing with a panic, which I carry with me: take a walk, drink tea, take a bath, or just get out the door into the air,” she says. “For me, it’s about trusting in the fact that the anxiety will pass and just getting through until it passes.”

Find a Support System

Trying to parent while struggling with your own mental health can be a challenge, but you don’t have to do it alone. Rely on the people in your life who will step in when you feel overwhelmed, or even just offer words of support. Those people can be therapists, co-parents, or friends.

“I am a part of an actual support group, but I also have a network of friends,” says Veith. “I am open with friends about who I am, because I need to be able to call on them and ask for help. ”

You can also look for support on blogs, online forums, and social media. JD Bailey runs a site called Honest Mom, where mothers can post essays about mental health and parenting. “I write about mental health to connect with other moms and help them not feel so alone,” Bailey explains.

“I get email and Facebook messages from readers, and the most common comment is, ‘I felt so alone until I found your site.’ And yes, writing about depression and anxiety helps me, too!”

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Segregation, School Funding Inequalities Still Punishing Black, Latino students

From the Associated Press
via NBC News

By Associated Press and Ariel Jao
January 12, 2018

The U.S. Commission on Civil Rights says inequality and segregation persist in American schools. Their study found that low-income, black and Latino students too often end up in schools with crumbling walls, old textbooks and unqualified teachers. The commission calls for boosting federal education spending, changing school funding models and investing in housing.

The U.S. Commission on Civil Rights published a report Thursday titled Public Education Funding Equity: In an Era of Increasing Concentration of Poverty and Resegregation, which confirms what educators have known for a long time now -- that educational resources and outcomes have a lot to do with a child's particular neighborhood.

Residential segregation causes a disparity in educational opportunity because it creates higher-income communities, with predominantly white school districts that have more local tax revenue for their schools, compared to fewer dollars and resources for school districts in low-income, minority neighborhoods.

The Chair of the U.S. Commission of Civil Rights, Catherine Lhamon said, “low-income students and students of color are often relegated to low-quality school facilities that lack equitable access to teachers, instructional materials, technology and technology support, critical facilities, and physical maintenance,” in the Letter of Transmittal of the briefing report.

The inequitable spending results in achievement gaps among predominantly Black and Latino students.

A study in “The Nation’s Report Card: Trends in Academic Progress” (2012) found that in 2012, students who did not participate in the National School Lunch Program scored an average of 37 points higher on the NAEP reading test than students receiving free lunch, and an average of 24 points higher than students receiving reduced-price lunch.

Schools with a majority of Black and Latino high school students have less access to high-rigor courses than predominantly white schools. For instance, the authors said, 33 percent of high schools with high black and Latino enrollment offer calculus, compared with 56 percent of high schools with low black and Latino student populations. Nationwide, 48 percent of schools offer the rigorous math course.

There is also a lack of courses in STEM (Science, Technology, Engineering and Math) as well as Advancement Placement (AP) courses. This is a major factor in why Blacks and Hispanics are still heavily underrepresented in the STEM workforce relative to their shares in the U.S. workforce as a whole, according to Pew Research.


In addition to academics, there are disparities in the quality of athletic programs and extracurricular program offered to low-poverty and high-poverty schools. Fatima Gross Graves told USCCR in her testimony that, “while heavily minority schools typically have fewer resources and provide fewer spots on teams compared to heavily white schools, they also allocate those fewer spots unequally, such that girls of color get less than their fair share.”

When exploring the disparities in teacher salaries, the USCCR briefing report finds that the highest teacher salaries are reported in wealthy, suburban districts which serve predominantly white students.

Districts that serve the highest proportion of low-income students and students of color are populated by about twice as many teachers lacking credentials and experience.

Education Department spokeswoman Liz Hill said the commission’s findings underscore the need for reform through the promotion of charter schools, voucher programs and other forms of school choice. These are key goals for the Trump administration and Education Secretary Betsy DeVos.

“This is further proof that too many children, simply because of where they live, are forced to attend schools that do not provide an equitable education,” Hill said in a statement. “Secretary DeVos has made clear her mission is to ensure every child has the opportunity to attend a school that offers an excellent education that meets their individual needs.”

But the answer, say the authors of the report as well as many education experts, is to try to level the playing field when it comes to public school funding, so that the amount of local tax dollars does not dictate the quality of the school district.

“Money matters. If you don’t have it, you cannot spend it,” said Bruce Baker, a professor of education at Rutgers University. Baker said that states should do a better job in raising education funding and in equalizing spending among school districts. He also called for a greater federal role in making sure that less affluent states that need additional education funding get it.

“Having federal money can help states that cannot help themselves and federal pressure can encourage states to do the right thing, to raise enough resources and put them where they are needed.”

But Eric Hanushek, a fellow at the Hoover Institution of Stanford University, disagrees.

“Money is not the secret recipe,” Hanushek said. “How much is spent on schools is not as important as how the money is spent.” For instance, he said, simply increasing the salaries of all teachers in a high-need school district won’t have as much of an impact as identifying high-performing teachers and increasing their salaries.

Friday, January 19, 2018

Repeated Head Hits, Not Just Concussions, May Lead to a Type of Chronic Brain Damage

From NPR's Health Blog "Shots"

By Tom Goldman
January 18, 2018

We live in an age of heightened awareness about concussions. From battlefields around the world to football fields in the U.S., we've heard about the dangers caused when the brain rattles around inside the skull and the possible link between concussions and the degenerative brain disease chronic traumatic encephalopathy.

A number of high-profile NFL stars have developed CTE, and parents are increasingly worried about how concussions may affect their children who play sports. The injury even has become part of popular culture, thanks to the 2015 film "Concussion."

But now a high-powered team of researchers says all that focus on concussions may be missing the mark.

It's Really About Hits

A study published online Thursday in Brain, a journal of neurology, presents the strongest case yet that repetitive hits to the head that don't lead to concussions —meaning no loss of consciousness or other symptoms that can include headaches, dizziness, vision problems or confusion — cause CTE.

"We've had an inkling that subconcussive hits — the ones that don't [show] neurological signs and symptoms — may be associated with CTE," says Dr. Lee Goldstein, an associate professor of psychiatry at the Boston University School of Medicine and the lead investigator on the study. "We now have solid scientific evidence to say that is so."

And this evidence, he says, leaves researchers "terrifically concerned."

"The concussions we see on the ballfield or the battlefield or wherever — those people are going to get attention," Goldstein says, "because it's obvious they've had some sort of injury. We're really worried about the many more people who are getting hit and getting hurt — their brain is getting hurt — but are not getting help because we can't see the evidence on the outside that their brain is actually hurt. It's a silent injury."

Translating Goldstein's concern to the football field, Chris Nowinski, who heads the Concussion Legacy Foundation, says, "We see the hard hits all the time, where a guy pops up and smiles and [signals] a first down, and [we think], 'OK, that hit was fine.' But what this study says is: No, that hit probably wasn't fine, and that poor guy can't feel the damage that's happening in his brain right now."

Tracking Hits to the Head Instead

Goldstein says about 20 percent of known cases of CTE had no record or report of concussion.

"It suggested that maybe concussion isn't the index or metric that we should be following," he says. "Rather, maybe it's something about the hits and number of hits that might be important. That's what we wanted to nail here."

The study was seven years in the making and involved researchers from Boston University, Cleveland Clinic, Harvard Medical School, Lawrence Livermore National Laboratory in California, Ben-Gurion University of the Negev in Israel and Oxford University in the U.K.

The researchers analyzed human brains — from teenagers and young adults who had been exposed to mild head impact but died from another cause soon after. They found early evidence of brain pathology consistent with what is seen in CTE, including abnormal accumulation of tau protein.

CTE is a neurodegenerative disease characterized by that kind of abnormal accumulation around small blood vessels in the brain. The disease can cause brain cell death, cognitive deficits and dementia.

The researchers also conducted experiments that re-created sports-related head impact and military-related blast exposure on laboratory mice.

"It took us many years to do this," Goldstein says. "We see in our animals — even after a small number of hits, even one — very early evidence of pathologies associated with CTE."

And, they noted, the brain pathology was unrelated to signs of concussion in the mice, such as altered arousal and impaired balance. Goldstein says the scientists nailed what they wanted to — strong evidence linking head impact to CTE, independent of concussion.

Still, Concussion is Part of the Picture

While the study downplays the role of concussions in the ultimate development of CTE, the familiar symptoms — headaches, fogginess or problems with concentration, memory, balance and coordination, even without a loss of consciousness, are still important signs the brain has been hurt.

"I want to be very clear on this," Goldstein says. "This is in no way to minimize concussions."

Nowinski, from the Concussion Legacy Foundation, is a former high school and college football player who says that even now, at 39, he deals with symptoms of acute post-concussion syndrome, including lingering headaches, sleepwalking and nausea during intense exercise.

"We're not taking concussions out of the equation," Nowinski says. "Concussions are still very bad." They can still cause acute brain injury that leads to long-term symptoms, he says, independent of whether they spark a neurodegenerative disease.

"We still have to respect and address [concussions], even more than we have in the past."

Pushing the Science Ahead

Dr. Julian Bailes isn't a household name. Not like, say, actor Alec Baldwin. But the two are linked on this issue — Baldwin played Bailes in the movie Concussion. Bailes chairs the department of neurosurgery at NorthShore University Health System in the Chicago area; he wasn't involved with Goldstein's study, but followed the work and calls it "good science."

"It's a comprehensive study," he says, "and I believe it adds a lot to our knowledge and the medical literature concerning this topic." Bailes says the work dovetails with findings he and others published in 2013.

"We've known for a few years that it's not just the known or diagnosed concussions that may increase risk for [CTE]," Bailes says. "It's probably the exposure. It's how many hits to the head that have occurred and at what velocity and what extent."

He notes the first case of CTE for an NFL player, discovered by his colleague Dr. Bennet Omalu, was the late center Mike Webster who "played football 27 years and never had a known or diagnosed concussion."

Bailes thinks the study published Thursday adds to the evolving narrative about head impact and the long-term consequences. "It certainly adds to our science and our understanding," Bailes says. "And hopefully it adds to greater protection, greater safety and the ability for all ages to enjoy contact sports."

The NFL Players Association agrees, saying in a statement:

"We stood firm against an [expanded] 18-game schedule and insisted on changes to the work rules in 2011 to limit contact of all types to protect players, and this study reinforces we made the right decision. We have been in close touch with the researchers at Boston University, who are also members of our Mackey-White Health and Safety committee, and we will review this study carefully to consider future changes to improve the health and safety of our players."

Delay Start of Tackle Football for Kids?

Still, Goldstein and Nowinski aren't so sure young kids should be playing contact sports at all.

"The longer you play, and the earlier you start playing, you'll suffer more head hits [and put yourself at] greater the risk for CTE," Goldstein says. "That's what all the evidence [in the study] was suggesting."

He and Nowinski believe student-athletes shouldn't play tackle football until high school.

But Bailes disagrees.

For the past seven years, he has served as the volunteer chairman of the medical advisory committee for Pop Warner, one of the oldest and largest youth football organizations in the U.S.

Bailes doesn't believe the study offers evidence that early exposure to head hits makes a football player more likely to develop CTE. Six years ago, he notes, Pop Warner became the first football organization at any level to legislate against having head contact drills in practice.

Since that time, from the NFL on down, Bailes says, there has been a marked reduction in styles of practice or techniques that lead to gratuitous head contact. And new rules at all levels have helped eliminate egregious open-field head hits or head targeting, he says.

Urging kids to play flag football until high school wouldn't actually provide the solution people seek, Bailes says. High school is when the real risk to student-athletes begins.

"That's where the players become man-sized and run fast and have high velocity collisions and hundreds of them a year," Bailes says. As to the question of where to draw the line in terms of what age kids should start playing tackle football — "this study doesn't answer that," Bailes says. "There's been no answer to that question."

It's an individual choice, he believes; parents and kids need to consider the risks and benefits.

Bailes thinks playing football before the age of 14 or 15 can have many benefits.

And, he notes, everything is relative.

"There are about 10 people who drown every day in the U.S.," he says, citing statistics from the Centers for Disease Control and Prevention, "and we're not calling to outlaw swimming."

Brain Injuries That Transcend Football – and Sports

The debate over when or even if kids should play tackle football will continue as the science of head injury evolves.

Both Bailes and Goldstein are a big part of that evolution. Right now, CTE can only be diagnosed after death, but both scientists are working, independently of each other, on a test intended to detect CTE in living brains. Such a test would help determine how widespread the disease is and, beyond that, how to develop treatment.

In the meantime, Goldstein hopes his study finds applications not just in football, but in other sports, like soccer and lacrosse, where contact and collisions include hits to the head.

And beyond sports, Goldstein says, hits to the head affect the most vulnerable segments of society. He has a long list.

"Intimate partners who are having repetitive head injuries," he notes," domestic violence victims, homeless, children at risk, people in our prison systems. [With] all of these people, we need to take the focus off concussion and find out if they have injured brains."