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Sunday, June 30, 2013

Many Kids Missing Out on Healthy Lifestyle

From HealthDay News

June 25, 2013

Report finds only half exercise enough; only a third eat fruits and vegetables every day.

Only half of American youths get the recommended amount of exercise, and less than one-third eat the suggested amount of fruits and vegetables each day, according to a federal government study.

Researchers surveyed nearly 10,000 students aged 11 to 16 in 39 states, and found that only half were physically active five or more days a week and fewer than one in three ate fruits and vegetables daily.

"The students showed a surprising variability in eating patterns," study author Ronald Iannotti, of the prevention research branch of the U.S. National Institute of Child Health and Human Development, said in an institute news release.

"But most -- about 74 percent -- did not have a healthy pattern."

The students in the study also were asked to describe their body image, emotional health and general satisfaction with life. The researchers classified the participants' diet and exercise habits into three general categories: unhealthful (26 percent), healthful (27 percent) and typical (47 percent).

Youth in the typical group were least likely to exercise five or more days a week or to eat fruits and vegetables at least once a day. They were more likely to spend time watching television, playing video games or on a computer than those in the healthful group, but less likely to do so than those in the unhealthful group.

The participants in the typical group infrequently ate fruits and vegetables, but also infrequently consumed sweets, chips, french fries or soft drinks. They were more likely than those in the other two groups to be overweight or obese and to be unhappy with the appearance of their bodies.

Youth in the unhealthful group consumed the most sweets, chips, french fries and soft drinks, and also were more likely than the other groups to watch TV, play video games and use a computer more than two hours a day, according to the study, published in the Journal of Adolescent Health.

Despite the unhealthy foods they consumed, youth in the unhealthful group were more likely to be underweight and to report needing to put on weight. Youth in this group also were more likely to report symptoms of depression and poor physical health, such as backaches, stomachaches, headaches or feeling dizzy.

Nearly 65 percent of students in the healthful group exercised five or more days per week -- the highest rate of the three groups. They were least likely to spend time in front of a screen, most likely to report eating fruits and vegetables at least once a day, and least likely to consume sweets, soft drinks, chips and french fries. They had the lowest rates of depressive symptoms and the highest life satisfaction ratings.

All three groups could stand to improve their health habits, Iannotti said, whether by walking or biking between home and school or eating more fresh produce each day.

Children and teens should get one hour or more of moderate or vigorous aerobic physical activity a day, including vigorous-intensity physical activity at least three days a week, according to the U.S. Department of Health and Human Services' Physical Activity Guidelines for Americans.

More Information

The Nemours Foundation has more about kids and exercise.

Dr. Timothy Buie: "Evidence Insufficient to Support Gluten-Free Diet as Autism Treatment"

From lbrb - Left Brain Right Brain

By Matt Carey
May 24, 2013

Perhaps the most commonly cited alternative therapy approach for autism is the gluten free/casein free diet. The idea was promoted largely based on the “leaky gut” and “opiod excess” idea of autism. The basic idea was that the intestines of autistics are for some reason “leaky” and incompletely digested proteins from gluten (grains) and casein (milk) enter the bloodstream and act much like an opiod (drug) causing (somehow) autism.

Multiple research teams have looked for evidence of these “opiods” without success. But the idea that eliminating gluten and/or casein as an autism treatment.

Dr. Timothy Buie is perhaps one of, if not the, most respected gastroenterologists in the autism communities. He has recently written a literature review on the topic: The Relationship of Autism and Gluten.

Here is the abstract:

BACKGROUND:

Autism is now a common condition with a prevalence of 1 in 88 children. There is no known etiology. Speculation about possible treatments for autism or autism spectrum disorders (ASD) has included the use of various dietary interventions, including a gluten-free diet.

OBJECTIVE:

The goal of this article was to review the literature available evaluating the use of gluten-free diets in patients with autism to determine if diet should be instituted as a treatment.

METHODS:

A literature review was performed, identifying previously published studies in which a gluten-free diet was instituted as an autism treatment. These studies were not limited to randomized controlled trials because only 1 article was available that used a double-blind crossover design. Most publish reports were unblinded, observational studies.

RESULTS:

In the only double-blind, crossover study, no benefit of a gluten-free diet was identified. Several other studies did report benefit from gluten-free diet. Controlling for observer bias and what may have represented unrelated progress over time in these studies is not possible. There are many barriers to evaluating treatment benefits for patients with autism. Gluten sensitivity may present in a variety of ways, including gastrointestinal and neurologic symptoms. Although making a diagnosis of celiac disease is easier with new serology and genetic testing, a large number of gluten-sensitive patients do not have celiac disease. Testing to confirm non-celiac gluten sensitivity is not available.

CONCLUSIONS:

A variety of symptoms may be present with gluten sensitivity. Currently, there is insufficient evidence to support instituting a gluten-free diet as a treatment for autism. There may be a subgroup of patients who might benefit from a gluten-free diet, but the symptom or testing profile of these candidates remains unclear.


To paraphrase the conclusions: The evidence is not there for eliminating gluten from the diets of autistics. Perhaps some minority has a gluten sensitivity but so far there is no good test for this possible subgroup.

What Does It Mean To Be Intelligent?

From the Open Colleges Blog "InformED"

By Carrie Wible
June 25, 2013

Sighing loudly, Jimmy Thompson, the quiet student in the front row, is smoothing his hair back nervously with his left hand. His right hand is tapping his pencil, eraser-side down, on the desk rhythmically. His feet shift under the desk in an absentminded yet patterned restlessness; right ankle over left, left ankle over right, feet flat on the floor; lather, rinse, repeat.

He seems to be having difficulties with the math test.

In the last twenty minutes he has only written down his name, the date, and a pretty spot-on sketch of Master Chief from Halo in the margin. His fidgeting is causing other students’ attention waning from the test, and instead being focused on him. Hoping to help ease his frustration, you walk to his desk, bend down slightly, and whisper: “Are you ok? Do you need help with anything?” He looks up at you, defeated, and says the words no teacher wants to hear: “I’m just too dumb for this.”

What do you do?

If your first instinct is to agree with him, you might need to seek out a different profession. What Jimmy needs now is immediate positive feedback. He needs to be encouraged, and feel that he is worthwhile and understand it is okay to have different strengths and weaknesses than others. Unfortunately, this will be hard to do during a test. The best thing to do at this point is to tell him it is important to try, not to give up, and ask to see him after class for a pep talk.

When Jimmy does come dragging his feet to your desk after class, be prepared for a less than enthusiastic response to your pep talk. He is feeling bad about himself, frustrated, and possibly angry at you for giving the test in the first place. The hard part is knowing what to say to him to motivate him.

So what do you say?

Before you have a talk with Jimmy about his intelligence, or at least his (and yours!) perceived level of intelligence, you need to know what it is first. You might be thinking that it is easy to know who is intelligent and who is not, but therein lies the problem. While many educators and parents equate good grades and study habits with intelligence, doing so can be doing a disservice to many of your students and children.

Have you ever heard someone say: “She’s brilliant in math, but has no common sense”? Or perhaps: “He can’t find his way out of a paper bag, but he makes a mean tiramisu”? While the point of the comment is either to be disparaging or complimentary is unknown, it is an example of different areas and levels of intelligence.

What Do You Know?

If someone were to ask you right now to define the meaning of intelligence, what would you say? What if someone asked you why someone in your class is smart; would you know? Think about it for a second while all of the hundreds of ideas float around in your mind as you quickly try to define it. In a psychology course given at Mercer Community College in New Jersey, a PowerPoint presentation was shown asking students to define intelligence and theories regarding it.

It is actually pretty difficult to explain an individual’s perception of intelligence. You may also find it surprising that your friends and colleagues will define intelligence, or smart, differently than you do.

Intelligence is Unofficially Measured in Many Ways

This may be startling to some, but intelligence is judged subjectively. This can cause problems when conflicts arise. One person’s genius is another person’s average individual. Many people have never taken an IQ (Intelligence Quotient) test to find out their number, but that is probably a good thing. If we only went by IQ test numbers, then your IQ would have to be listed on your resume, or as this same article suggests, a CAT scan should be performed at every job interview.

This may actually sound like a good idea, especially of a co-worker you find to be lacking, but do not get too excited. While mandatory IQ testing and number revealing could potentially “thin out the herd”, this would not be a true indicator of what the person can actually do.

Intelligence is measured by those around you and also against the individual’s own knowledge of the world. Have you noticed how you are idolized by the younger students who think you know everything there is to know about everything? As far as they know, you do know everything!

Unfortunately, once they hit about twelve years old, you cease to have any grey matter left in your ancient brain, and the same elementary angels are now wondering how you got your shirt buttoned on your own.

It Is All Relative!

Thinking someone is smart or intelligent is not only subjective, but also relative. Someone who is not musically inclined will think the fifteen year old pianist next door is a musical genius. The fifty year old piano professor, however, will most likely be wincing at said fifteen year old’s murderous rendition of Beethoven’s “Moonlight Sonata” and remind himself to buy better ear plugs at the drugstore.

Pride can also factor in on measuring intelligence. Grandma deems her three year old twin grandsons the smartest toddlers in the history of time for blowing out the candles (along with a mild amount of spit) on their SpongeBob SquarePants birthday cake.

However, every time those same darling three year olds smacks mom in the head with a toy, their perceived intelligence levels go down as mom’s blood pressure rises.

But What Is Intelligence?

Over the years, intelligence has been defined, redefined, summarized, and defined again, but still no one person has the same exact definition or idea. There has even been a paper written called “The Collective Definitions of Intelligence” which include approximately seventy different definitions, or interpretations of what intelligence entails. Seventy! These seventy definitions were analyzed to find a simple informal definition. The one that is used by many comes from S. Legg and M. Hutter and it states: “Intelligence measures an agent’s ability to achieve goals in a wide range of environments.”

“The Collective Definitions of Intelligence” includes approximately seventy different definitions, or interpretations of what intelligence entails. Seventy!

Similarly, the Merriam-Webster Dictionary defines it as “…the ability to learn or understand or to deal with new or trying situations… the skilled use of reason…the ability to apply knowledge to manipulate one’s environment or to think abstractly as measured by objective criteria (as tests).”

The gist is the more intelligent the person, the more they are able to apply what they know to new situations. This sounds fair, but the question remains: how does one become intelligent?

The Bell Curve

Many ideas currently held about intelligence were brought forth in 1994 when the book The Bell Curve was published. It was written by a Harvard psychology professor named Richard Hernstein, and a political scientist named Charles Murray. Although controversial to many researchers, the book grew to popularity of epic proportions. Educators, policy makers, and the general public felt this book was an “aha!” moment and held the ideas and explanations near and dear to their hearts.

Conclusions gained from the book were that intelligence is genetic, IQ tests are accurate, and an individual’s IQ is not affected by living conditions, nurture, or the environment. The points the book also managed to get across were that IQ differences between the races were also genetic, and outside influences, educational or otherwise, did not affect the IQ of a person, or even out the IQ gap between different races.

Do not worry, all of those conclusions have been torn apart, analyzed, and reworked. Educators know very well how outside influences affect a student’s intelligence. If, in fact, it did not make a difference, what would be the point of interventions or initiating programs trying to give students a better chance and to help bridge the gap between races?

What if you learn best by bouncing ideas off another person, gaining important feedback, and there is no one around to do that for you?

The notion of living conditions or the environment not affecting IQ seems absurd when you think about it, but in fairness, it is not if you are coming from an “IQ is genetic” place. Think about where you learn best. Is it in a noisy, crowded, and littered area? It could be, there is no judgment here. But what if you had that type of environment and you learn best in a calm, quiet, clean atmosphere?

Conversely, what if you learn best by bouncing ideas off another person, gaining important feedback, and there is no one around to do that for you? This definitely will affect intelligence. If the tools are not there for a person to learn how to know what to do in different situations, how will they achieve this? The disparity of levels of intelligence has much to do with the conditions one lives in.

Inherited Smarts

While many have believed in the past that “smart breeds smart” naturally, it is not necessarily true. It can be genetic, but to be able to actually measure the amount that is, is a test to be taken in the far, far future. You may often see well educated and intelligent parents having “smart” children, it could be argued that it was just as much environmental influences as genetic. After all, there are intelligent parents with children who are not as bright as they are, well, at least not yet.

Parents that went to college and who were motivated academically are more likely to do the same for their own children. The converse is also true, although many parents work hard so their children can achieve more than they had during their schooling years.

Disparity of IQ

Disparities can often be simply because those with lower socioeconomic status have fewer opportunities. Often lower SES families deal with poverty, poor living conditions, and an environment not conducive to learning. To gain data, this study followed almost 49,000 mothers and their children, numbering almost 60,000, all in different living conditions and SES from birth to age seven.

Often lower SES families deal with poverty, poor living conditions, and an environment not conducive to learning.

At age seven, the children were given the Wechsler Intelligence Scale for Children test. From this we were able to ascertain that the higher the SES, the less inhibiting environmental factors there were, and the IQ’s were higher than those with lower SES.

The Bell Curve Doesn’t Ring as Loud

Now that the findings of The Bell Curve have been corrected, it is time to get educators, parents, and policy makers to get on board. Hopefully, those still thinking the original findings are right are few and far between. Not to disregard the conclusions in their entirety, it was correct that tests can determine IQ, but not like people may think.

IQ Tests

IQ tests can provide a function, but the score should not be used as a defining factor of complete intelligence. These tests can be a predictor of future success, but not a guarantee. IQ tests actually measure two types of intelligence: fluid and crystallized. The intelligences work together, but where crystallized intelligence cannot affect fluid, the fluid intelligence can affect crystallized.

Fluid Intelligence

Fluid intelligence is monitored by the prefrontal cortex and measures ability to predict patterns, problem-solving, and learning. It can be affected by amount of working memory (where the thinking happens) and the ability to focus attention. Because this intelligence is learning-based, it remains level until middle adulthood, then begins to wane. Based on this definition, you can see where a student with ADD or ADHD can have lower scores, even if they are highly intelligent.

Crystallized Intelligence

Crystallized intelligence is monitored by many different parts of the brain and measures the knowledge about the world, and the understanding that things can change, be changed, added upon, and subtracted. It is also includes language, reading comprehension, and vocabulary. Crystallized intelligence is ever changing, and builds throughout one’s life.

Multiple Intelligences

While these two types of intelligence are measured, there are many different forms of intelligence. Dr. Howard Gardner, a name most educators are familiar with, developed the Theory of Multiple Intelligences in 1983. There are nine different intelligences that people have, and many have more than one.

They are: linguistic, logical-mathematical, music rhythm, bodily-kinesthetic, spatial, naturalist, interpersonal, intrapersonal, and existential intelligences. Everyone has something they are good at doing or learning, and it can be defined by one of the intelligences. Some people also have social and emotional intelligence.

If these intelligences could be measured formally, many people would have a much higher number on their IQ score. Think about someone in your class that struggles, then see if you can find what they are good at doing based on the list above. Put yourself, as an educator to the test, and see where you fall in the Multiple Intelligences.

Hopefully, one is interpersonal, which is dealing with others.

On Being Smart vs. Intelligent

As with intelligence, the word “smart” is heard, and the two are often interchangeable. The difference is that being smart is more about being adaptable. Do you know someone who is more successful than you (not narrowly defined by money) and never went to college? They may not be formally educated, but they were smart and did something right.

Someone can be book-smart and effortlessly regurgitate what they have read, while others learned how to fix cars and electrical devices by watching others. 

So, back to Jimmy…

Here comes Jimmy, shuffling his feet, dreading the talk with you about his test. What are you going to say? Not to be ominous, but this could be a defining moment for Jimmy. We all have one teacher we look back on fondly for something, and it is usually because of the way they treated us, believed in us, and made learning fun.

Remind Jimmy of what he can do, and do not focus on what he cannot do. [Read more about the right way to give student feedback.]

Point out Jimmy’s artwork to let him know you would appreciate it even more on a large piece of paper, rather than the test. Remind him of what a good artist he is, and ask what he feels he can do well. You may be surprised to find that this quiet, frustrated boy that cannot do his math problems, is more intelligent than you think.


Carrie Wible is an educator, writer, musician, and mother living in Northeast Ohio. She has a Bachelor of Arts degree in Music from Kent State University, a teaching certificate in grades 1-8 from Youngstown State University and a Masters in Teaching and Learning with Technology from Ashford University. Carrie has been teaching music lessons and has taught in the classroom for a combined total of 25 years. Connect with her @carriewible or +CarrieWible.

Saturday, June 29, 2013

Brain Imaging Alone Cannot Diagnose Autism

From ScienceDaily.com

November 1, 2012

"To diagnose autism reliably, we need to better understand what goes awry in people. Until its solid biological basis is found, any attempt to use brain imaging to diagnose autism will be futile."

In a column appearing in the current issue of the journal Nature, McLean Hospital biostatistician Nicholas Lange, Sc.D., cautions against heralding the use of brain imaging scans to diagnose autism, and urges greater focus on conducting large, long-term multicenter studies to identify the biological basis of the disorder.

"Several studies in the past two years have claimed that brain scans can diagnose autism, but this assertion is deeply flawed," said Lange, an associate professor of psychiatry and biostatistics at Harvard Medical School. "To diagnose autism reliably, we need to better understand what goes awry in people with the disorder. Until its solid biological basis is found, any attempt to use brain imaging to diagnose autism will be futile."

While cautioning against current use of brain imaging as a diagnostic tool, he is a strong proponent of using this technology to help scientists better understand autism.

Through the use of various brain imaging techniques, including functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and volumetric MRI, Lange points out that researchers have made important discoveries related to early brain enlargement in ASD, how those with autism focus during social interaction and the role of serotonin in someone with autism.

"Brain scans have led to these extremely valuable advances, and, with each discovery, we are getting closer to solving the autism pathology puzzle," said Lange.

"What individuals with autism and their parents urgently need is for us to carry out large-scale studies to find reliable, sensitive and specific biological markers of autism with high predictive value, that allow clinicians to identify interventions that will improve the lives of people with the disorder."

Autism and autism spectrum disorder (ASD) are terms regularly used to describe a group of complex disorders of brain development. This spectrum is characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors, whose criteria have been revised in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The prevalence of ASD in the United States has increased 78% in the last decade, with the Centers for Disease Control estimating that one in 88 children has ASD.

Never Leave A Child Alone During A Meltdown

From the Boston.com Lifestyle Blog "Child in Mind"

By Dr. Claudia M Gold
September 11, 2012

Controversy is brewing over the recent New York times op ed: A terrifying way to discipline children, in which Bill Lichtenstein describes his five-year-old daughter being held in a seclusion room at a Lexington school when her behavior was out of control. A Globe headline asserts in response: Account of putting pupil in isolation disputed.

Of course, I do not know what actually happened.

However, I do know that a very commonly held belief among parents is that one should leave a child alone, or "ignore" him, when he is having a meltdown. Yet all of the best of developmental science tell us that this approach is completely wrong.

"... a very commonly held belief among parents is that one should leave a child alone, or "ignore" him, when he is having a meltdown. Yet all of the best of developmental science tell us that this approach is completely wrong."

When I work with families who are struggling with a child's out-of-control behavior, I explain that in the middle of a meltdown, a child feels completely helpless. If left alone, he will feel not only frightened, but also abandoned. At such a moment, the cortical centers of the brain responsible for rational thought are not functioning properly.

These types of severe meltdowns are common in children who have experience early trauma, at the time when the higher cortical centers of the brain were not yet fully developed. Stress of a seemingly minor nature can lead the rational brain to in a sense go "off-line."

The child will have access only to the lower brain centers that function more instinctively.

I recall working with the parents of a four-year-old child who had been adopted from another country. There he had lived on the street with his mentally ill mother, from whom he had been separated at one year of age and placed in an orphanage. His adoptive parents where both horrified and overwhelmed by what they interpreted as "anger."

He would scream at them, spit at them, kick and hit them. Not only would they get angry in return, interpreting his behavior as "defiant," but they would send him to his room, saying, "I'll be back when you can calm down and behave nicely."

When I explained that during a meltdown he was developmentally more like a newborn than a four- year-old, their approach to him completely changed. Rather than react in anger, they would ask calmly, "Do you need a hug?" Or they would try to hold him. If he were too out-of-control to allow physical contact, they would take him to a place where he was physically safe, and speak to him reassuringly until he began to calm down.

Not only did the tantrums subside, but his parents began to learn to recognize when he was about to descend into what they now understood as a lower center of brain function. They would try to engage him when the thinking part of his brain was still working.

Similar mechanisms are at play in a child who has not had this kind of severe trauma. Frequent meltdowns are common in the setting of sensory processing problems and developmental problems such as speech and language delay (as apparently was the case for Rose, the child described the New York Times piece.)

When a child is repeatedly abandoned both physically and emotionally in the middle of a meltdown, that experience in itself may be traumatic. In such a situation frequency and intensity of meltdowns often worsens.

Parents often feel that holding a child in this way is counter intuitive. "Won't I teach him that he can get whatever he wants? " they often ask. But the opposite is true. When a child feels held and understood, with time he learns to manage these difficult moments on his own.

Discipline, both in the home and in the school setting, should be founded in contemporary developmental science. This science tells us that when we aim to see the world through the child's eyes, and approach his behavior from a stance of empathy and understanding, he learns to regulate emotions, think clearly, and manage himself in a complex social environment.

About Dr. Claudia M. Gold

Claudia Gold, M.D. is a pediatrician with a long-standing interest in addressing children’s mental health needs in a preventive model. Currently, she runs the Early Childhood Social-Emotional Health program at Newton-Wellesley Hospital. Previously, she had practiced general pediatrics for 20 years.

Gold is a graduate of the UMass Boston Infant-Parent Mental Health Post-Graduate Certificate Program, and serves on the faculties of the Brazelton Institute and the Berkshire Psychoanalytic Institute. She is the author of Keeping Your Child in Mind: Overcoming Defiance, Tantrums and Other Everyday Behavior Problems by Seeing the World through Your Child’s Eyes. You can visit her website HERE.



Friday, June 28, 2013

Anxiety Linked to Chest Pain in Children

From ScienceDaily.com

November 16, 2012

Psychological factors can have as much or more impact on pediatric chest pain as physical ones, a University of Georgia study found recently.

UGA psychologists discovered pediatric patients diagnosed with noncardiac chest pain have higher levels of anxiety and depression than patients diagnosed with innocent heart murmurs - the noise of normal turbulent blood flow in a structurally normal heart.

The UGA research was done in collaboration with Children's Healthcare of Atlanta and Emory University.


"The fact that these psychological symptoms are higher in noncardiac chest pain patients suggests the psychological symptoms may be playing a role in the presentation of chest pain," said Jennifer Lee, a doctoral candidate in the UGA Franklin College of Arts and Sciences, and the study's lead author.

The results of the study, which were published November 5 in the Journal of Pediatric Psychology, show a statistically significant increase in anxiety and depression among patients who are later diagnosed with noncardiac chest pain when compared to patients diagnosed with innocent heart murmurs. Lee said it is not clear if the anxiety is a cause of the pain or if pain caused the anxiety in the sample group.


"The higher levels weren't so high as to cause a clinical diagnosis on their own, but when you contrast the two groups, there were statistically significant differences," said study co-author Ronald Blount, a psychology professor in the Franklin College.

The study included 129 patients ages 8 to 18. The group completed surveys prior to diagnosis. All patients were essentially in the same situation-sitting in a cardiology office awaiting their unknown medical diagnosis.

"We are highlighting that psychology has a part in these symptoms," Blount said, "and screening for psychological, as well as medical factors, is one implication we foresee coming from this investigation."
Chest pain can indicate serious medical conditions that require a doctor's evaluation. In adults, chest pain is often linked to a cardiac problem. In children, however, less than 2 percent of patients receive a cardiac diagnosis for their pain.

The Sibley Heart Center at Children's Healthcare of Atlanta is one of the world's largest pediatric heart centers, seeing 2,500 new patients with acute chest pain each year.

"We know up front that 99 percent of these patients will not have a heart complication at all. The trick is, it is not zero, and I cannot miss the one patient with heart disease because the consequences could be catastrophic," said Dr. Robert Campbell, chief of the Sibley Heart Center and division director of the department of pediatrics at the Emory University School of Medicine.

The study also observed that noncardiac chest pain patients have a higher level of functional disability-or the inability to participate in everyday activities like running across a football field or making it through a day without a nap. They also spent less time at school and were less involved in extra-curricular activities.

"These symptoms are believed to be psychological manifestations of stress. Sometimes your brain doesn't tell you that you are stressed out, but your body does."

"These kids also report greater levels of physical symptoms with unclear causes, like joint pain, stomach aches, head aches," Lee said. "These symptoms are believed to be psychological manifestations of stress. Sometimes your brain doesn't tell you that you are stressed out, but your body does, so you will experience symptoms like these."

Pediatric patients with noncardiac chest pain also reported higher levels of anxiety sensitivity, a fear of experiencing physical symptoms and additionally fearing that those symptoms are related to a catastrophic health issue.

"Psychological functioning is heavily related to pain," Blount said. "Pain is a sensory experience, but your attention to one thing or another and your emotions can impact your experience of pain. And how debilitating the pain is for you can be determined by psychological and social factors. That is what we were interested in looking at."

Previous studies have shown reducing emotional symptoms can lead to better coping ability with pain, Lee said. "A goal with these patients would be to create a clearer, more comprehensive picture of what is going on and determine a better way to help these kids and adolescents."

Campbell said the UGA research helps him serve the majority of his patients who leave his office with a clean bill of health but unexplained chest pain.

"Most importantly what we've learned is that after a physical evaluation of the patient, we take the time to sit down with the family and find out what they are most worried about, so we can address their psychological issues," Campbell said.
"We've learned to pay attention and to be confident and reassuring. I need to make it clear to my patients and their parents that I'm not saying you are not having pain, but that the pain is not caused by your heart."

America’s Epidemic of Psychiatric Over-Diagnosis

From The Daily Beast

By Jesse Singal
June 21, 2013

More and more people are being diagnosed with depression or ADHD, but is that an illusion? There is an epidemic in America, but it’s not an epidemic of psychiatric disorders—it’s an epidemic of over-diagnosis that’s making billions for pharmaceutical companies and the doctors prescribing these drugs.

The next time you’re in a crowded room, look around. A scary percentage of the people in the room with you are suffering from a mental disorder.

Prescription drugs are overused to treat normal
behavior, according to psychiatrist Allen Frances.


Or at least that’s what we’ve been led to believe, that the United States has a crisis on its hands when it comes to mental illness. The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), the most recent edition of the bible for psychiatric diagnosis, offers up the current "official" view on what the establishment believes separates the normal from the disordered. Both it and its predecessors have received heaps of criticism for turning the everyday highs and lows of human experience into diseases.

In Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, Allen Frances, a semi-retired psychiatrist who served as the chair of the task force behind the DSM-IV, uses the release of the DSM-5, the methodology behind which he calls “egregiously reckless,” as a springboard to offer up a stinging rebuke of the explosive rate of psychiatric diagnosis in the U.S.

According to Frances, the U.S. is experiencing a dangerous moment in which political and financial forces are pushing people to think of themselves as abnormal, and “the counterbalancing forces pushing normal don’t remotely counterbalance and aren’t nearly forceful enough.”

In other words, there are many people who profit from the idea that a staggering proportion of Americans are mentally ill, and these groups are powerful, well organized, and politically effective. The argument that things aren’t that bad—that the hysteria over attention-deficit hyperactivity disorder or autism is a bit overblown and not backed up by empirical literature—is much harder to make. Given a screeching demagogue and an evenhanded, mild-mannered technocrat, people will always be more drawn to the former.

Frances, like historian Edward Shorter, the author of How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown, believes in psychiatry when it is done correctly. The right medication prescribed in the right dosage at the right time can save a life. But we’ve convinced ourselves that a variety of merely human experience—temporary bouts of sadness or excitement or distraction—are in fact pathologies that need to be blasted at with drugs.

The companies that make these drugs are all too happy to help agitate us into a state of hypochondria, and more or less make up certain “diseases” by dint of their influence within the medical establishment. The media, meanwhile, eagerly laps up new and exciting mental afflictions, reporting on them credulously.


130620-singal-normal-embed
Political and financial forces are pushing people
to think of themselves as abnormal.

Two quirks often convince people that drugs work when they do not. The first is that most people naturally return to their baseline state after experiencing a short period of, say, depression or mania. The second is the placebo effect, which will often cause anything presented as medication to “work.”

If I visit a psychiatrist because I’ve been feeling pretty sad for a week, and I’m prescribed an antidepressant, I may decide that the medication “works” because I soon return to my standard level of happiness. In this case psychiatry has taken a normal part of the human experience—feeling crappy for a little while—and pathologized it, potentially leading me to become dependent on a drug that may have dangerous side effects.

Frances's book is full of examples like this—of powerful antipsychotics given to 3-year-olds, of doctors prescribing dangerous combinations of drugs at the hint of a disorder. His preferred approach upon encountering someone who might have a problem—“watchful waiting”—is antithetical to the current trend in psychiatry, where the automatic response to any perceived problem is to prescribe, prescribe, and prescribe some more.

But Saving Normal is about a bigger, broader story than simply blaming the drug companies and the media. Rather, the culprit here is a variety of interlocking factors. Complex systems lead to massive over-diagnosis. Take, for example, the sudden and recent “explosion” of ADHD among the nation’s youths. Frances lists six factors that contribute to the “epidemic”:

"Working changes in DSM-IV; heavy drug-company marketing to doctors and advertising to the general public; extensive media coverage; pressure from harried parents and teachers to control unruly children; extra time given on tests and extra school services for those with an ADHD diagnosis; and finally, the widespread misuse of prescription stimulants for general performance enhancement and recreation."

So while Frances does direct a fair amount of his ire at the drug companies, it’s not just about Big Pharma steamrolling everyone, effectively forcing drugs down their throat. Your kid is falling behind in school, so don’t you want to do anything you can to help? All your colleagues are prescribing their patients a drug that works wonders to promote concentration, so do you really want to be the only doctor in the building who isn’t a part of this exciting new pharmacological breakthrough?

The current state of affairs rose up organically out of many individual decisions influenced by inadequate regulation and skewed incentives for the people who manufacture, advertise, and prescribe these drugs.

Frances, having been immersed in various psychiatric bureaucracies, has the eye for how multifaceted, interdependent systems function. But he is a better commentator than a reporter, and the reader gets the sense that he or she is in an airplane, and the captain keeps pointing out landmarks 40,000 feet down, only the most prominent features of which are visible. Frances rarely gets into specifics, but he does give some, well, prescriptions.

He argues that it is a mistake to allow drug companies to advertise directly to consumers, which is not the norm in the developed world outside the U.S. But Congress and federal regulators aren’t ever likely to take up the issue, which would open up all sorts of constitutional issues.

He also argues that the practice of diagnosing criminal suspects claiming to be mentally ill should be curbed except in the clearest cases. “Bad should usually trump mad,” he writes. But there’s a consensus among reform-minded observers of the criminal-justice system that offenders are dangerously under-treated for mental disorders.

America's diagnosis is clear. We have convinced ourselves that we are a sick, troubled people, and the result has been endless, largely harmful prescription-writing—and endless profits for the drug companies. The first step toward getting out of this mess is to understand just how many of our psychiatric maladies are pure fictions.

Thursday, June 27, 2013

Autism & Wandering: An Infographic on the Prevalence of Wandering and How to Keep Your Child Safe

From The Friendship Circle Blog

June 27, 2013

Wandering.

The constant fear parents with an autistic child will always have. Every week there is another news story of a child gone missing, and sometimes the results are tragic.

A recent study by the
Kennedy Krieger Institute has shown just how common it is for kids with autism to wander, and an article by Autism Beacon tells you how you can keep your loved ones with autism safe.

An infographic that shows the study's results and some ways to prevent wandering:


Lawmakers Should Fully Fund Special Education

From The Boston Globe

By Steven M. Rothstein
June 21, 2013

Massachusetts is known for its commitment to education, and that’s something to be proud of. Nothing of value comes cheap, however, and continuing to fund our educational system is an ever-increasing challenge during these turbulent economic times.

With that in mind, now take a moment to consider our students with disabilities. They have added struggles in their lives and in school, but with access to highly skilled teachers and educational technologies, they have a real opportunity for hope and achievement.

As our leaders on Beacon Hill continue their work on the FY’14 budget, we urge them to consider the students at special education schools in Massachusetts. After years of inequality between state spending on regular education versus special education, it is time to restore funds for special education schools that prepare students with complex needs for adult life.

Whether studying science, math, reading and writing, or social skills, children with special needs learn best from highly trained professional educators. Many times, those specially trained teachers are not available in the regular school systems.

Providing expert education and learning tools is, indeed, costly. For that reason, the budget line item called the “special education circuit breaker account” was established in 2004. This line item provides tuition reimbursements from the state to school districts to help pay for the cost of sending public students with complex learning needs to specialized private schools. (State funds cover only a portion of the cost. At Perkins, private donations make up the rest.)

These schools deliver not only high-quality, but also cost-effective special education services to the Commonwealth. A recent cost comparison shows that Massachusetts special education school costs are actually 35 percent lower than that of public schools and collaboratives, after differences in staff compensation, length of the school year and hidden costs to taxpayers are considered.

Parents and families of students at specialized schools have high hopes and dreams for their children’s futures. They do not ask for exceptional privileges for their children, but they rightfully expect them to get an even chance to learn and realize their potentials. Every year of school is critical for all of our children.

We thank the Senate Ways and Means Committee for increasing the special education circuit breaker account. This brings us one step closer to providing the highly trained teachers and cutting edge technologies necessary to meet the ever-changing needs of children enrolled in specialized schools.

The Senate Ways and Means Committee proposed budget released in mid-May increases the special education circuit breaker account by $22.4 million to $252.8 million or 10.7 percent over the FY’13 appropriation. That is still below the $261 million recommended by the Massachusetts Department of Elementary and Secondary Education in order for school districts to receive full reimbursement.

All those whose lives are touched by a child who requires the special education services the circuit breaker fund provides anxiously wait and hope for that account to be fully funded during the Conference Committee deliberations currently underway. These children can thrive with the kind of education specialized schools offer. Beyond a moral obligation, the state has a legal obligation outlined in the Education Reform Act of 1993.

Now, we look to the Budget Conferees to work together to equalize the funding for special education with general education, or Chapter 70, by advocating to increase the funding for the special education circuit breaker account to the Senate allocation of $252.8 million. This will ensure that the account is adequately funded to provide the financial support to cities and towns so vital to students who attend specialized schools, such as Perkins.

Fully funding the circuit breaker provides the opportunity that fuels the dreams of these students who are striving to become productive members of society, to live as independently as possible and to contribute to our economy with meaningful jobs.

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Steven Rothstein is president of Perkins School for the Blind in Watertown.

Transforming Autism Research: Reflections on IMFAR, RDoC, and DSM-5

From Cracking the Enigma

By Jon Brock
June 23, 2013

“In many scientific problems, the difficulty is to state the question rightly; once that is done it may almost answer itself.”
          -- Jacob Bronowski

A year, it seems, is a long time in autism research. In May 2012, the International Meeting for Autism Research (IMFAR) in Toronto was all about DSM-5 and the proposed changes to autism diagnosis contained therein. Up for discussion were the abolition of Asperger syndrome as a distinct condition, the introduction of a new (and still mysterious) diagnosis of “social communication disorder”, and the feared exclusion of many people from autism-specific support and interventions.

Those concerns have not gone away. But 12 months later, at IMFAR 2013 in San Sebastian, the DSM-5 debate was notable by its absence. People had apparently agreed to disagree. And the manual had long since gone to the printers.

Discussion turned instead to comments by Thomas Insel, director of the National Institute of Mental Health (NIMH). In a blogpost entitled "Transforming Diagnosis", Insel announced that the institute would be “re-orienting its research away from DSM categories”. “Patients”, he argued, “deserve better”.

Insel's proposed solution is a new research framework -Research Domain Criteria or RDoC. The aim of RDoC is to make connections across different levels of analysis, from genes and neurotransmitters through to brain circuits and behavior. But rather than basing research on existing diagnostic categories, RDoC focuses on broad constructs such as ‘social communication’, ‘cognitive control’, or ‘anxiety’ that cut across existing diagnostic boundaries.


As Insel pointed out, the DSM’s great weakness is “a lack of validity”. This doesn’t mean that it's useless or a waste of time. The key point is that there’s little independent evidence to suggest that people who are diagnosed with the same condition really do belong together - and should be treated differently to people with other diagnoses. We don’t know that their symptoms have the same underlying cause, and we can’t say that their outcomes will be similar, or that they should be offered the same interventions.

These issues were front and centre in the opening address of IMFAR 2013. Focusing on the problem of “comorbidity”, Christopher Gillberg noted that people with autism often meet criteria for several other DSM diagnoses, including ADHD, specific language impairment, and developmental coordination disorder. These, Gillberg argued, are not discrete syndromes, so it is inappropriate to research them separately or to diagnose one condition without considering the implications of the others.

The Kursaal Centre, San Sebastian. Venue for IMFAR 2013.

Daniel Geschwind's keynote address on Day 2 raised similar problems with the validity of autism. Reviewing the latest in autism genetics, Geschwind noted that, according to current projections, autism is linked to upwards of 1000 different genetic variations. Although these appear to converge on a smaller number of pathways, most of the genetic risk factors discovered so far also increase the likelihood of other, supposedly unrelated disorders.

Like so many other conditions in the DSM, autism is a mess.

Insel's comments, arriving just days before DSM-5’s publication, were widely seen as a final blow to the DSM’s credibility and a major snub to its publishers, the American Psychiatric Association. Media coverage spoke of a civil war within psychiatry. But the reality is that the aims of RDoC actually align closely with those of the APA.

Back in 2002, in a document entitled “A Research Agenda for DSM-V”, Dennis Charney and colleagues stated:

“It is our goal to translate basic and clinical neuroscience research relating brain structure, brain function, and behavior into a classification of psychiatric disorders based on etiology and pathophysiology. It is possible, even likely, that such a classification will be radically different from the current DSM-IV approach."
It soon became clear, however, that this radical new approach to diagnosis was not ready for primetime. As Insel noted, the controversy surrounding DSM-5 belies the fact that the changes from DSM-IV have been relatively modest. In the case of autism, the reworking of diagnostic criteria may yet have profound consequences in terms of who receives interventions and services. But conceptually, little has changed. Seventy years after it was first identified, autism is still diagnosed in terms of the collection of behavioral symptoms that also define the condition.

In the absence of reliable alternatives, clinicians will continue to rely on the DSM. But researchers do not have the same excuse. Holding up the current diagnostic criteria as the ‘gold standard’ for research makes it impossible to discover better alternatives.

Writing for the Dana Foundation in 2011, DSM-5 panel member, Steven Hyman, concluded:

“... it is critical that the scientific community escape the artificial diagnostic silos that control so much research, ultimately to our detriment.”
Lynn Waterhouse reached a similar conclusion in her 2012 book, Rethinking Autism:
“The only viable scientific path… requires researchers to abandon the use of the diagnosis of autism as a basis for research.”
Last year on my journey home from Toronto, I spent the flight reading Jacob Bronowski’s “The Common Sense of Science”, a 1951 history of science that I’d picked up for a few dollars in our local second hand bookstore. I took it with me for no reason other than that it fitted neatly into my hand luggage. But the ideas seemed particularly relevant in the light of the drama and intrigue of the IMFAR meeting.

According to Bronowski, the first step towards scientific understanding is to “order” things into groups, as he put it, “not of identical things, but of things which seem to be or behave alike”. This “ordering” process is necessary if we are to generalize our narrow scientific observations towards a broader understanding of the world. Initially, the “throwing into groups” has to be intuitive, but these intuitions must be tested. If the evidence doesn’t fit, then we should be prepared to refine or even abandon our intuitions and (literally) regroup:

“We order by likeness, and we choose those likenesses which we first judge and then find to have significance.” [emphasis added]
Since Kanner, the idea of a discrete condition, “autism”, has made intuitive sense to researchers and clinicians alike. We could metaphorically throw a wide range of people into that group because, although they were different from one another in many ways, they seemed to have something essential in common. What was learned about one sample of autistic people could, we assumed be generalised to others. However, as more evidence has come in, the concept of autism as a coherent entity has been found wanting. This is the “validity” issue that so undermines the DSM.

Insel’s bet is that the “domains” of RDoC do have validity, that they will map better onto underlying biological mechanisms and, crucially, that they will provide clearer insights into appropriate treatments and interventions for individuals. RDoC represents an alternative “ordering” of the human mind. But like the DSM, it needs to be empirically tested, refined, and, if necessary, rejected.

After all the controversy surrounding DSM-5, RDoC represents a fresh start, and a much-needed reframing of the scientific problem. At present, however, it’s little more than a statement of intent, describing how research could and perhaps should proceed. The goals are long term. And while the idea of looking beyond DSM categories is a welcome move, there’s no guarantee that RDoC will succeed in its primary objectives of linking behavioural symptoms back to their underlying biological origins.


Identifying risk genes and their immediate relevance to neural function is likely to be the easy part. The greater challenge will come in working out how these differences interact with other genetic and environmental risk factors, such that some individuals develop into autism, whereas others have completely different outcomes. Given the complexities, both known and unknown, that are yet to be addressed, it seems essential that any biological approach to autism is complemented by research with more immediate benefits to the autism community.

For me, the highlight of IMFAR 2013 was Maureen Durkin's keynote address on the final morning, focusing on the discrepancies in autism diagnosis across countries, cultures, and social classes. In her closing remarks, Durkin emphasized an important distinction - between the current emphasis on autism as an impairment and the alternative view of autism as a disability. Practical strategies for assisting people with sensory and physical disabilities often have the indirect consequence of increasing social participation. It follows, Durkin argued, that research on autism should address similar practical solutions that might lead to greater inclusion of people with autism in society.

DSM-5 has been a long and painful process. Only time will tell if the changes represent a net improvement on DSM-IV. But the debates generated within the scientific community and beyond have served an important purpose, laying bare the questionable assumptions that underpin contemporary autism research.

Whatever your views on the specifics of DSM-5 and RDoC, Dr Insel was certainly right about one thing. There is room for improvement. We can do better. Autistic people deserve better.

Reference

Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D., Quinn, K., Sanislow, C., & Wang, P. (2010). Research Domain Criteria (RDoC): Toward a New Classification Framework for Research on Mental Disorders. American Journal of Psychiatry, 167 (7), 748-751 DOI: 10.1176/appi.ajp.2010.09091379

Further Reading

About Jon Brock

Jon Brock is a research fellow at the ARC Centre for Cognition and its Disorders at Macquarie University in Sydney, Australia. His research focuses on cognitive and neural mechanisms involved in developmental disorders including autism, Williams Syndrome, and Down Syndrome. Publications can be downloaded here.

As well as authoring Cracking the Enigma, Brock has also written for the Simons Foundation Autism Research Initiative, the Thinking Person's Guide to Autism, and The Conversation.

Wednesday, June 26, 2013

A Letter Blaming Scapegoating Special Education for Teacher Lay-Offs

Submitted by A (Justifiably) Upset Parent
June 25, 2013

The following letter was sent recently via email to families residing the North Andover, MA school district. One concerned parent of a special education student who received and passed it along reported that she felt that it painted a bulls-eye on her child's back.

"Today has been a very difficult day for our school district community. As you may already have heard, a number of teachers have received “pink slips” or reassignment letters.

The reason behind this situation is that we have identified a large potential shortfall of about $670,000 that will impact next year’s approved budget, due to the most current costs for Special Education. As you know, while we are unable to predict the number of students who will be moving into the district and who will need special services, the district is obligated by law to cover those costs.

Unfortunately, the costs have been trending upward since the development of the budget in the spring, having the potential to drain an already tight budget for next year. While we are hopeful that there may be some financial resolve, at this time we need to address our budget liabilities per any contractual obligations. If we had not notified teachers by June 15, we would have been obligated to their employment.

As we progress during the remaining weeks and into the summer, we will make further decisions regarding any adjustments or recalls of staff, who will be notified as soon as any changes may occur.

The unfortunate part is that the personal feelings of hurt and uncertainty of our caring teachers cannot be denied or avoided. I simply ask that we be as supportive as we can of all involved, and I hope that we can be constructive as possible as we move forward."

Sincerely,

Kevin Hutchinson, Ed.D.,
Superintendent, North Andover Public Schools

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We hope that Superintendent Hutchinson is as concerned about the feelings of his students in special education and as constructive in his efforts to provide them with the Free Appropriate Public Education to which they are entitled as matters of law and justice. Given the choice, would he turn back the clock? 

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A Rebuttal from EducationNext

Blaming Special Education?

By Jay P. Greene and Marcus A. Winters

Following anecdotes about expensive and unreasonable-sounding private placements, news stories often segue into reports of the total cost of special education—not private placement costs per se. Perhaps special education as a whole is the legitimate target of complaint.

This claim also appears at odds with the facts. It is true that special education enrollments have been increasing at a rapid rate, but that doesn’t mean special education costs are rising faster than the resources available for regular education. To estimate the relative burden of providing special education services over time, we use information on the cost of these services by disability type reported by the Special Education Expenditure Project. We know the number of students in each disability classification over time from the U.S. Department of Education’s Digest of Education Statistics. If we multiply the number of students in each disability category by the cost of services in each disability, we can estimate the total cost of special education services.

Of course, we only have information on the costs per disabled student from a recent study, and it is possible that the cost of serving students in each disability classification has increased in real terms over time. To adjust for this, we assume that the change in the real cost of special education services is commensurate with the change in student-teacher ratios. Making that adjustment, special education services cost roughly $17.7 billion in 1977, when federal protection for special education began; spending almost doubled to $34.3 billion by 2003 as the number of students in special education increased by 76 percent.

The near doubling in special education costs is not attributable to a rise in rare and expensive disabilities. Media reports often emphasize the growth in students with autism but their numbers remain very small, less than 0.3 percent of enrollment. The total cost of special education services for autism does not exceed 0.45 percent of all spending. Severe disability categories like mental retardation, which are costly to serve, have actually experienced a decline in enrollment. The bulk of special education cost increases comes from explosive growth in the specific learning disability (SLD) category, which is among the least costly to serve. Students in this category grew from 796,000 in 1977 to 2,848,000 in 2003.

Still, the large cost increase doesn’t mean that special education is taking away more resources from general education. Total revenue for public education also nearly doubled between 1977 and 2003, adjusted for inflation. Special education costs constituted roughly the same share of total public school revenue (8.3 percent) in 2003 as in 1977. While special education does consume more money over time, the relative financial burden of special education on public education has not increased because public schools are also receiving significantly more money.