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Editor's Commentary
5/16/2014 12:00 AM
Autism in infancy
2/24/2014 12:00 AM

This article provides a brief summary of recent research on early signs of autism, followed by two case examples that highlight these issues.

Editor's Commentary
2/10/2014 12:00 AM
After decades of struggle, mental health parity became the law of the land in October 2008 with the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). The purpose of the mental health parity legislation was to eliminate discrimination by insurance companies in how they cover mental health and substance use disorders compared to medical and surgical coverage. Mental health professionals, patients, and their families were jubilant at this major civil rights victory, but once the celebrations died down, the realization set in that “the devil’s in the details” (i.e., the actual regulations that determine what the MHPAEA will mean on a day-to-day basis).
3/10/2014 12:00 AM

Social media is ever-present in the lives of children and adolescents and impacts the behavioral and mental health of children and adolescents, and as such it is important for parents and caregivers to be aware of the risks and benefits. Better understanding how and why adolescents interact with social media, as well as the associated risks and benefits, can help parents and caregivers engage in productive conversation and create strategies for responsible use.

Children and adolescents regularly use the Internet, cell phones, and video games to gather information and communicate with each other. This ability to interact with others is the unique feature of social media, which provides powerful new ways for teens to create and navigate their social environments. Teens’ use of social media occurs simultaneously with their developing identity, emerging sexuality, physical development, and moral consciousness. Social media is ever-present in the lives of children and adolescents and impacts the behavioral and mental health of children and adolescents, and as such it is important for parents and caregivers to be aware of the risks and benefits. Better understanding how and why adolescents interact with social media, as well as the associated risks and benefits, can help parents and caregivers engage in productive conversation and create strategies for responsible use.

Risks of Social Media

  • Risks to mental health. Many teens who are regular social media users report that they have many friends, get along well with their parents, and are happy at school. However, peer rejection and a lack of close friends are among the strongest predictors of depression and negative self-views. Teens who are the heaviest social media users report being less content and are more likely to report that they get into trouble a lot, are often sad or unhappy, and are often bored. Young women and girls tend to be at a higher risk for negative emotional and psychological consequences of social media interaction.
  • Cyberbullying. Use of social media also creates an opportunity for emotional distress from receiving threatening, harassing, or humiliating communication from another teen, or cyberbullying. Lesbian, gay, bisexual, and transgendered (LGBT) teens are the most likely to fall victim to this sort of bullying, followed by females. Individuals who are victims of cyberbullying are more likely to then perpetrate cyberbullying themselves. Cyberbullying is unfortunately quite common, can occur to any young person online, and can cause profound psychosocial outcomes, including depression, anxiety, severe isolation, and, tragically, suicide.
  • Text/picture messaging. While most teens use messaging responsibly, it is still an extremely powerful and private communication tool that can be used irresponsibly. With texting, teens cannot see the reaction of the person receiving the message, so their actions can be separated from the consequences. Any personal information, photos, or videos exchanged via text can quickly be provided to an audience other than the intended. It is important that teens know these messages can be even more lasting than a conversation or event in person. Sexting in particular is a concern for parents and teens, and 20% of teens have received or sent sexually explicit images or messages. Some teens who have engaged in sexting have been threatened or charged with felony child pornography charges, although some states have started characterizing such behaviors as juvenile-law misdemeanors.

Benefits of Social Media

  • Socialization and communication. Most teens use online networks to extend the friendships they already have from other areas of their life. Social networking sites provide a way for teens to experience connectedness and opportunities to learn from each other. Online exchanges can help foster a child’s individual identity, and unique social skills create relationships between individuals of different social and cultural backgrounds.
  • Support. Social media can provide a supportive environment to explore romance, friendship, and social status. Social networking sites can allow teens to find support online that they may lack in traditional relationships, especially for teens who are often marginalized, such as LGBT teens, those who are living with an illness or disability, or those who may feel physically unattractive or socially reticent.
  • Accessing health information. Teens also use online searches to gain answers to many of their health concerns easily and anonymously. Adolescents use social media to gather information about health topics that are hard to discuss with others, such as drug use and sexual health. The mobile technologies that teens use daily — namely, cell phones, instant messaging, and text messaging — have already produced multiple improvements in their health care, such as increased medication adherence, better disease understanding, and fewer missed appointments.
  • Peace of mind. Because children and adolescents usually have a mobile device or cell phone with them at all times, parents and children alike can feel a greater sense of comfort in independence.

Social Media and Privacy

When Internet users visit various websites, they can leave behind evidence of which sites they have visited. This collective, ongoing record of one’s Web activity is called the digital footprint. Most studies show that teens do care about privacy and engage in privacy-protecting behaviors, such as adjusting their profiles to private from public access, refusing to provide identifying information, and avoiding certain websites. However, most youth do not read websites’ privacy policies or may be unaware that their information is at risk of disclosure to third parties like advertisers. Though concerned about talking to people they don’t know online, teens appear to be less worried about posting information about themselves.

Recommendations for Parents

Parents and caregivers need to educate themselves about social media and the ways their teens may use it, as well as the common risks, to help them understand and navigate the technologies. Parents should be aware that 13 years is the minimum age for most social media sites because the Children’s Online Privacy Protection Act (COPPA), enacted by Congress, prohibits websites from collecting information on children younger than 13 years without parental permission.

Family discussions about Internet presence and social media can result in less risky online behaviors — many teens who say their parents have talked to them often about social media reported greater concerns about online safety and sharing of personal information and photos and more limited sharing of information/pictures via the Internet, lower incidence of public online profiles, and lower incidence of talking or meeting people they only know from online. Conversations reinforcing the idea that “what goes online, stays online” are important between parents and children. For parents and caregivers, discussing media content with their teens can be an effective strategy to reduce the amount of personal information disclosed — more so than prohibiting access, as teens often perceive monitoring as a violation of their privacy. Teens are more receptive to user-empowered strategies where they become the agent of their own protection or even some form of industry protection than policing by parents or caregivers.

Additional Resources for Parents

Following are some resources for further research and information:

12/9/2013 12:00 AM

In the wake of Typhoon Haiyan, which recently devastated the Philippines, the importance of recognizing the traumatic impact of natural disasters on the mental health of children and adolescents is brought freshly to mind in addition to concerns for children’s physical health and safety. Survival quickly becomes the top priority and “survival means not only that we address children’s health, education and psychological well-being, but that we make sure their safety is given top priority,” according to Tomoo Hozumi, the United Nations Children’s Fund (UNICEF) representative in the Philippines. Hozumi further explains that recovery efforts in the Philippines are currently aimed at establishing a safe place “for children to begin the process of recovering from the loss of loved ones and the total upheaval in their lives,” but this is just the first step in the recovery process.

Natural disasters and trauma are of course not unique to any one corner of the world. Natural disasters and traumatic events can happen anywhere, and parents should be aware of the special psychological needs of children in relationship to such events. In order to deliver the most effective and necessary care as parents and guardians to children who have suffered such traumas, we will take a step back from the immediate crisis in the Philippines and examine the effects disaster and trauma have on children in a more universal sense. The following handout is designed to help parents recognize a disaster and the resulting trauma, and provide some strategies for mental health support.

What is a disaster?

A disaster is a significant calamitous event that generally involves injury or loss of life and destruction of property. A disaster can affect both small and large populations and is typically outside the scope of normal human experience. It is widely accepted that the psychosocial effects in children after disaster are influenced greatly by the nature of disaster itself, the level of exposure to the disaster, the extent to which the children and those around them are personally affected by the disaster, and the individual characteristics of children, including their age and stage of development. In addition, children are uniquely affected by disasters because they are afflicted not only by the trauma of the event but also by their parents’ fear and distress. Parents are often suffering from the psychological effects of the disaster or traumatic event themselves, but it is important to understand that a parent or guardian’s reaction to a traumatic event has a significant bearing on the experience of the child.

What should parents look for?

Traumatic reactions in children can vary in degree and intensity based on the developmental stage and age of the child, but here are some general indicators of the traumatic impact that can result from a disaster event:

  • Avoidance: Children may try to avoid reminders, activities, thoughts, and feelings related to a traumatic event. Children may withdraw from social events and interactions, block out or forget details of the traumatic event, or appear numb or unable to express a wide range of emotional responses.
  • Re-experiencing: Children may show evidence of reliving aspects of the event or of having recurring images and thoughts of the traumatic event. Children may engage in role-playing or acting out of the trauma-related event, have nightmares of the disaster or trauma, or display a distressed reaction to reminders of the trauma.
  • Heightened agitation: Children may show agitation and elevated responsiveness to reminders of the event. Symptoms of elevated responsiveness include sleep problems, nervousness, irritability, crying, anxiety, appetite changes, and inability to concentrate.

What should parents do to help prevent trauma from disasters?

Preparedness is a key in offsetting some of the short- and long-term effects of experiencing a traumatic event. Natural disasters in particular can be unpredictable, so having a general emergency plan in place with a family evacuation plan, designated meeting place, and communication strategy can be a great way to mediate a child’s anxiety before the disaster takes place. Identify evacuation routes and prepare an emergency kit so that children know there is a definite plan in place for a disaster. Practice and review your evacuation plan — predictability goes a long way in creating a sense of stability and familiarity in the emergency situation in the wake of a disaster. All of these preparations will also benefit the emotional and psychological state of the adults involved in disaster situations, too. As previously mentioned, the traumatic impact of a disaster on a child is directly related to the impact of the disaster on the parents or guardians, so any advance measures are an opportunity to make sure that you as a parent are prepared to handle a disaster situation to the best of your ability, in turn creating a better experience for your child.

In the event of a natural disaster, be sure to maintain your routines and normal activities, providing your child with as much of a safe and predictable environment as possible. Ask your child to help — giving children the opportunity to help out will build their sense of usefulness and control during stressful times. This could be volunteering in the disaster-stricken community or household, but be mindful of any negative reactions to disaster-related stimuli or situations. Be patient and calm with your child. Provide clear and factual (and age-appropriate) information regarding the traumatic situation while limiting media coverage of the event, both prior to and post. Sensationalized and graphic content may elicit feelings of fear, anxiety, and uncertainty in children prior to disaster, and children may re-experience these same negative feelings when confronted with media coverage after the event.

How can parents help children cope?

Parents can play a significant role in helping children cope with the trauma of a natural disaster. Encouraging a child to take up a new hobby or continue a commitment to an existing hobby will serve as a distraction from the events of a natural disaster. Writing in a journal or maintaining contact via mail, email, or phone with close friends to share feelings and experiences while continuing a normal sense of connectedness can assist in positive adjustment and coping. Social events are a good opportunity to facilitate this communication, too. Volunteering money, time, or resources can help children create a sense of accomplishment and purpose that assists with personal recovery.

Of course, seek professional help if your child is having difficulty coping. Parents and school professionals should pay close attention to children’s feelings and behaviors. The process may be a gradual one, but children should be able to slowly resume family and social activities. If you see your child struggling with this readjustment, do not hesitate to seek professional help and consultation.

Sources: UNICEF, American Academy of Pediatrics, NYU Child Study Center, www.AboutOurKids.org.

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  • Meet the Editor

    Gregory K. Fritz, M.D.
    Managing Editor

    Dr Fritz is a professor of psychiatry and director of child and adolescent psychiatry at the Brown University School of Medicine, where he conducts research and teaches.
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