Stay up to date with The Brown University Child & Adolescent Behavior Letter!

  • The latest information on child & adolescent behavioral health
  • Promising research findings and clinical studies 
  • New diagnosis and prevention techniques
  • Practical tips that you can implement immediately in your practice
Use discount code CABLW4 and SAVE 50% SUBSCRIBE NOW!

Other Products of Interest

The Brown University Child & Adolescent Psycho-pharmacology Update
This widely-hailed monthly newsletter fills the critical gap in information about children and adolescents' unique psychotropic medication needs. It delivers updates on new drugs, their uses, typical doses, side effects and interactions, and more. Read More
Mental Health Weekly
Stay up to date with the premier weekly publication on the mental health field. It delivers the latest news and research on behavioral health and provides analysis and implications for practice. Read More
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.

The presentation of autism in infancy is quite subtle, with more obvious signs and symptoms emerging over the first two to three years of life. The subtlety of presentation in early infancy suggests that young infants at risk for autism may be uniquely open to intervention. Yet these early developmental differences are difficult to detect, making it a challenge to screen for the risk for autism in early infancy. The gradual emergence of autism symptoms during development also makes diagnosis challenging in later infancy and toddlerhood. This article will provide a brief summary of recent research on early signs of autism followed by two case examples that highlight these issues.

Potential signs of risk for autism in infancy

Research strategies for identifying infant signs of risk for autism have included retrospective parent reports, examination of behavioral signs from early home videos, studies of babies at elevated risk for autism (specifically infant siblings of children with autism), and retrospective reviews of medical and research records of children after later diagnosis. Each of these approaches has strengths and weaknesses. Retrospective reports are challenged by the fallibility of memory, and medical record reviews are limited to information not initially planned for detection of autism risk. Studies of at-risk infants rely on an elevated recurrence rate in these infant siblings (approaching 20%), resulting in more efficient ascertainment of cases of autism in infancy, and allowing for prospective studies of autism as it emerges developmentally. Recent infant sibling studies have identified potential infant markers of autism, including poor social attention, diminished social responsiveness and eye contact, and poor or atypical affective signaling. But these findings have, for the most part, been very subtle, with few reliable findings reported in infants younger than 12 months of age. In addition, a limitation of this approach is that it is not known to what extent results from infant sibling studies will be applicable to the larger population of children with autism.

It is evident from this research that early disruptions in social relatedness associated with autism are not easily detected until the second year of life. And even then, the stability of formal diagnoses of infants in the second year of life has not been fully demonstrated. Thus, clinicians need to be cautious about very early diagnoses. One goal for clinical research is to develop more sensitive tests of risk for autism in infancy. However, it may be necessary to include methods that depart from traditional measures of social responses in order to identify early risks for autism. For example, some research groups (including our own) have turned attention to measures of motor development, stress responses, state regulation, and vocal production. Research on early biomarkers of autism in infancy has yielded some promising findings of differences in brain function using functional MRI and EEG methods. While promising, these approaches have not yet resulted in screening tools specific to autism in the first year of life. Indeed, caution must be taken not to overinterpret these findings without extensive longitudinal tests of sensitivity and specificity. A review by Dawson and Bernier (2013) provides an excellent summary of recent advances in this area.

Implications for clinical practice

Two composite case examples highlight the challenges of very early diagnostic work. These examples underscore the importance of longitudinal follow-up as a means to support the needs of children and their families, while also improving the accuracy of diagnostic impressions.

Case example 1

A 30-month-old boy was referred by early intervention providers due to concerns about his slow language development. He was born at less than 30 weeks’ gestation with an appropriate birth weight for his gestational age. He had spent a significant amount of time in the special care nursery, but his course over that time period was relatively uncomplicated. There was no evidence of cerebral palsy or significant visual or hearing impairments. Motor milestones had been achieved on time, but he presented with mild to moderate delays in cognitive abilities and more significant impairments in language. Some aspects of his development were consistent with autism, including repetitive movements, limited eye contact, poor social pragmatic skills, and limited interest in social interactions. His physical activity level was high, and it was difficult (though not impossible) for parents or other adults to engage him in give-and-take social play. Thus, risk for autism appeared to be significant, and this resulted in an initial, although tentative, diagnosis. Doctors recommended continued early intervention, as well as strategies to individualize early intervention services. Subsequently, close follow-up revealed improvements in language and communication, reductions in the frequency and intensity of repetitive behaviors, an increase in playful social interactions with adults, and increased interest in other children. By 40 months of age, developmental delays remained present in the boy, but social communication and play now appeared to be appropriate in relation to his language and cognitive abilities, and an autism diagnosis was ruled out. This case highlights the need to account for overall developmental delays in the process of differential diagnosis. The longitudinal assessment allowed the clinician to offer continued support for the family in the face of diagnostic uncertainty, referral to services based on areas of impairment without presuming certainty in diagnosis, and ultimately an accurate diagnosis, at least with respect to autism.

Case example 2

A 20-month-old boy was referred due to specific parental concerns about the possibility of autism. Family history included an older brother with autism, another sibling with delays in language, and the question of autism in an extended family member. At the time of referral, this young boy had no evidence of spoken language, and in fact vocalized very little. He was able to complete basic problem-solving tasks that did not require verbal comprehension of commands but was not able to respond to verbal requests. During structured social interactions, he was affectionate and playful in response to his parents’ interactions. He sometimes looked at others in response to toys or actions that he enjoyed. His parents reported that he imitated some simple actions and facial expressions, demonstrated social enjoyment during simple games, and observed other children in a manner that appeared to indicate social interest. He sometimes flapped his hands when he was excited but not in ways that were more frequent or atypical than would be expected for his age. On the other hand, his social behaviors and skills were used inconsistently and were supported by his parents’ efforts to structure social interaction. This resulted in diagnostic uncertainty despite the strong family history. At the time of initial evaluation, the likelihood of a primary long-term diagnosis of a language delay appeared as likely as a diagnosis of autism.

Recommendations included referral to early intervention services as well as clinic-based, parent-mediated treatment to support this boy’s developing social communication skills and play. At the same time, his development was monitored during periodic follow-up visits. By the time of a formal reevaluation at 30 months of age, his language had improved to some degree, but his use of language was highly repetitive and not consistently directed toward others. Overall, social pragmatic skills had declined in relation to what would be developmentally appropriate for his age and language ability. Moreover, repetitive and stereotyped behaviors had increased, with relatively intense visual examination of objects becoming prominent and intruding upon play and social interactions. A diagnosis of autism was made at this time, and referral to intensive behavioral intervention was made. He returned for a follow-up visit after his third birthday, at which time his presentation continued to be consistent with a diagnosis of autism.

Summary

Behavioral signs of autism are likely to be present early in development but are quite subtle and difficult to detect in infancy. Current tests of early signs of autism in infants are not sufficiently sensitive, and the “noisiness” of normal development means that early tests do not yet have ideal specificity. This state of affairs means that clinicians need to be cautious when determining risk for autism during the infant period. Even in late infancy and toddlerhood, there is the need for caution in discussing diagnostic opinions with families. In fact, it is often necessary to communicate a degree of educated uncertainty to parents, and to rely on longitudinal observations to clarify diagnoses over time. Early diagnoses should be made when appropriate. But current best clinical practice should include a communication of the level of confidence of the long-term stability of early diagnostic impressions. At the same time, young children who show clear or emerging signs of autism need to be referred to appropriate early interventions. In this regard, recent advances in treatments targeting social communication and play skills have shown initially promising results (also briefly reviewed by Dawson & Bernier, 2013). Longitudinal monitoring of infants at risk for autism helps to ensure that accurate diagnoses are made as children move into the preschool age range, while also facilitating referrals to appropriate early interventions.

Reference

Dawson G, Bernier R. A quarter century of progress on the early detection and treatment of autism spectrum disorder. Development and Psychopathology 2013; 25:1455–1472.

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).

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).

It’s been a long wait to find out. Despite considerable pressure (and ongoing discriminatory practices by insurers), the regulations — the Final Rule — were not released until November 8, 2013, over five years after the passage of the legislation. Better late than never, I guess. Now the challenge is to actually understand the regulations in the 200-page document and to translate them into something that is useful to patients and the public — as opposed to being of interest only to policy works. That will take some doing, but mental health parity carries many tangible benefits, along with its symbolic importance of ending government-sanctioned discrimination against a still-stigmatized segment of our society.

Simply put, most Americans who aren’t directly affected don’t understand either the problem of the lack of parity for mental conditions or the solutions provided by the MHPAEA and the Final Rule. They are neither “for” nor “against” it; they just don’t think about it. It’s a parallel scenario to the Affordable Care Act (ACA, or Obamacare): until the website’s problems became daily news, surveys showed that the vast majority of the population knew essentially nothing about the ACA. We have a major educational task facing us to make the details of mental health parity widely understood. The first step is to educate ourselves.

One of the major elements of the Final Rule emphasizes that non-quantitative treatment limitations (NQTLs) cannot be different for mental health or substance abuse disorders than for medical or surgical problems. Quantitative treatment limitations refer to numerical limits (usually dollars or days) like co-pays, days of treatment, lifetime limits, and so on; they are readily recognized if differentially applied. NQTLs refer to the cost-containment approaches that are not numerical and include managed care practices such as definitions of what is “medically necessary,” the review processes for authorization of care, the extent of preferred provider lists, and so on. An example of a discriminatory NQTL in action is the following scenario (encountered daily in every psychiatric emergency room): A mental health professional determines that an adolescent needs inpatient psychiatric hospitalization; he or she must present the case to a representative of the insurance company (often after waiting on hold for half an hour or more). The admission is denied as not medically necessary, leading to a lengthy appeal process. If the same patient had a medical illness and was recommended for admission, no such roadblocks would be encountered. The Final Rule no longer permits this discriminatory practice; the process hurdles must be the same for both psychiatric and medical disorders.

For the first time, the Final Rule mandates disclosure of insurance companies’ procedures for approving and denying care. Thus, it will be possible to see the criteria that are applied in making a determination of medical necessity. The Final Rule allows a patient or provider access to the processes, strategies, evidence base for the decision, and other factors that are behind medical necessity determinations for both mental health and medical/surgical benefits. This transparency also applies to individual claims that are being appealed. It is long overdue.

Two other implications come to mind as highly relevant once true parity between mental health/substance use disorders and medical/surgical disorders is established. The first is that the need would seem dubious for a separate, parallel mental health insurance system to be carved out from the rest of medical insurance as is now the case. Eliminating the “mental health carve-out” that has been in place since the 1980s would be a big step toward eliminating dualistic, mind-separated-from-body thinking. That clearly does not reflect the way human beings are wired, and it is a substantial impediment toward establishing integrated care in the medical homes of the future.

The second implication of parity is that, in combination with the Affordable Care Act increasing the number of insured Americans, the elimination of discriminatory practices will lead to a huge increase in the number of patients seeking mental health services. Given that only one in four or five children with mental health problems currently receives any treatment at all, the demand for services can be expected to intensify the most for children and adolescents. Access issues, already a substantial problem, will be magnified by inadequate numbers of mental health professionals in the workforce. However, establishing parity won’t happen overnight, just like with other expansions of civil rights, so if we’re smart, we will grow the workforce simultaneously. I’m always an optimist.

Psychopathy and Lizzie Borden
12/9/2013 12:00 AM
One of the most famous murderesses in U.S. history was Lizzie Borden, born in 1860 in Fall River, MA. She committed a double parricide on August 4, 1892. This psychohistorical case analysis examines the degree of psychopathy in Lizzie to promote an understanding of her homicidal motivation. Psychopathy is a personality disorder with such characteristics as callousness, egocentricity, impulsivity, and lack of remorse.

Parricide is the murder of a parent by a child. It is a rare crime, accounting for only 2% of U.S. homicides (FBI’s “Crime in the United States,” 2010). Fathers are the most likely victims. The majority of adult parricide offenders suffer from a psychotic illness and are driven to kill by delusions. In contrast, most child parricide offenders kill parents in the context of severe child abuse.

One of the most famous murderesses in U.S. history was Lizzie Borden, born in 1860 in Fall River, MA. She committed a double parricide on August 4, 1892. This psychohistorical case analysis examines the degree of psychopathy in Lizzie to promote an understanding of her homicidal motivation. Psychopathy is a personality disorder with such characteristics as callousness, egocentricity, impulsivity, and lack of remorse.

The Psychopathy Checklist-Revised (PCL-R) is a widely used tool to assess psychopathic traits in research and clinical settings (Hare, 2003). The PCL-R is a 20-item instrument (range 0–40) scored on a 3-point scale (0, 1, or 2) using information gathered through clinical interviews and collateral data. A cut-off score of 30 indicates a full-fledged psychopathic personality.

Lizzie’s level of psychopathy was examined using the PCL-R. Would this finding point to a coldhearted, greedy killer who dispatched of her parents to seize a substantial inheritance (now the equivalent of about 60 million dollars), or an abused, frightened daughter who could no longer endure her father’s and stepmother’s alleged maltreatment?

Historical background

Historic Fall River lies just across the Taunton River from Rhode Island, on the northeastern shore of Mount Hope Bay. The Borden family contributed greatly to Fall River’s industrial development, with diverse interests in textiles, ironworks, printing, cabinetry, and steamship transportation. In the nineteenth century, Fall River was briefly the most important textile manufacturing city in the country.

Lizzie Andrew Borden’s wealthy and respected father was Andrew Borden. He was described as a miserly, cold man who allowed the family few luxuries. Lizzie’s natural mother died of “uterine congestion” and “spine disease” when Lizzie was age two. The father soon remarried to Abby Borden. Abby reportedly lacked compassion for her stepdaughter, and Lizzie disliked her from the beginning.

Over the years, Lizzie and her older sister, Emma, grew in their resentment toward Abby, whose influence over the family fortune and its eventual disbursement upon Andrew’s death had grown. Meanwhile, Lizzie was implicated in having stolen money, jewelry, and other items from Abby.

At the time of the murders, Lizzie was a 32-year-old spinster still living at home. Lizzie was the first to find her father’s bloodied body on a downstairs sitting-room couch. She alerted the family servant, Bridget Sullivan. The stepmother was found a short time later on her bedroom floor in a similar state. They had been bludgeoned to death with a hatchet-like weapon: the father sustained 10 blows to the head and the stepmother 18 to the head and neck. A poem by New Hampshire poet Alexander Beard described the scene:

His head was by a hatchet hacked

Which took away his life,

And in her room in the same plight

They also found his wife.

The crime quickly garnered national attention. Lizzie was prosecuted, and suggested motives included financial gain, long-harbored resentment toward her miserly father and cold stepmother, and possibly even sexual abuse by her father (no substantiated evidence of the latter exists).

The circumstantial evidence against Lizzie was overwhelming. For example, Lizzie tried to buy deadly poisons (arsenic and prussic acid) shortly before the homicides. Abby had gone to her physician the day before she died and complained that she and Andrew had been violently ill and may have been poisoned. Also the day before, Lizzie told a friend she was concerned something bad might happen to her parents. In the aftermath of the killings, Lizzie burned a dress in the kitchen stove and explained it had been ruined by paint stains. Part of an axe was found in the basement.

Notwithstanding abundant incriminating evidence, several factors hampered the prosecution’s case. There were no eyewitnesses. The murder weapon was never unequivocally identified. A mysterious stranger was invoked as the perpetrator. Perhaps most importantly, women from respected families in the Victorian era who taught Sunday school did not kill people, especially their parents. Furthermore, the trial judge did not allow Lizzie’s earlier conflicting stories or her attempt to buy poison into the trial as evidence. The jury reached a verdict, also depicted in Beard’s poem:

No evidence could her convict

The jury did agree,

That it was all by far too weak

So Lizzie was set free.

This outcome brings to mind Fall River's official motto, “We'll Try.” Although Lizzie was found not guilty, little doubt remains that she was culpable.

Methods

Historical sources related to Lizzie Borden’s life, her family, and the Bordens’ financial dealings; police reports of the murder scene and investigation; and court inquests, proceedings, and testimony were reviewed. The PCL-R was scored using all information noted and then compared with female population norms.

Reliance solely on independent data (i.e., no clinical interview) can be used to score the PCL-R. Research indicates that outcomes are similar for PCL-R scoring with and without a personal interview provided sufficient and reliable collateral data is available.

Results

Lizzie scored a 10 on the PCL-R (T-score = 38), placing her at the fifteenth percentile for incarcerated female offenders.

Table 1. Borden’s Score on the Psychopathy Checklist-2

PCL-2 Item

Criteria Case Examples

Score

1. Glibness/Superficial Charm

Not supported by data.

0

2. Grandiose Sense of Self-Worth

No evidence.

0

3. Need for Stimulation/Proneness to Boredom

No evidence.

0

4. Pathological Lying

Lizzie changed her story multiple times throughout the inquest and trial, and attempted to rework the facts to appear consistent. Three years prior, Lizzie was suspected by police of having stolen jewelry, money, and other items from her family’s home, but she denied it. The case was dropped without explanation by Borden’s father shortly after it was reported.

1

5. Cunning/ Manipulative

Lizzie stole from her stepmother and then blamed an intruder who no one else witnessed (Lizzie, her sister, and a servant were home at the time of the alleged thievery). She engaged in shoplifting to fulfill her own psychological needs, and possibly to bring shame to the family.

1

6. Lack of Remorse or Guilt

She repeatedly appeared to lack remorse when suspected of and caught shoplifting while growing up. During the trial, she was composed, emotionally distant, and lacking in signs of guilt.

2

7. Shallow Affect

She was observed to consistently demonstrate a limited range of affect as a child, as an adolescent school girl, and during the trial.

2

8. Callous/Lack of Empathy

Lizzie showed no empathy and limited emotion immediately after the crime and during the trial.

1

9. Parasitic Lifestyle

Lizzie never married and lived at home, repeatedly asking for increasing funds from her father and stepmother.

1

10. Poor Behavioral Control

No evidence.

0

11. Promiscuous Sexual Behavior

No evidence.

0

12. Early Behavioral Problems

No evidence.

0

13. Lack of Realistic, Long-Term Goals

No evidence.

0

14. Impulsivity

No evidence.

0

15. Irresponsibility

No evidence.

0

16. Failure to Accept Responsibility For Own Actions

Lizzie blamed others for her stealing, manufactured alibis for her illegal actions, and took no responsibility for the murders.

1

17. Many Short-Term Marital Relationships

No evidence.

0

18. Juvenile Delinquency

No evidence.

0

19. Revocation of Conditional Release

No evidence.

0

20. Criminal Versatility

Lizzie stole from her father and stepmother, repeatedly shoplifted, killed a pet cat, and committed a double murder.

1

Discussion

Lizzie’s PCL-R score of 10 places her in the mild range of psychopathic traits (mild defined as a score of 10–19). Her score is elevated compared to community female norms (<5), and slightly above the average score (9.2) for survivors of physical and sexual abuse (Hare, 2003). However, Lizzie’s score falls well below mean PCL-R scores for incarcerated female offenders (typically falling in the 19–24 range), and the mean PCL-R score for convicted female murderers (19.2). Considering the brutality of Lizzie’s supposed crimes, her score is not as elevated as would be predicted based on these comparison populations.

This case study has several notable limitations. No clinical interview was possible (allowing for exploration of Lizzie’s inner life, developmental experiences, antisocial attitudes and behaviors, etc.). Additionally, the data used for psychohistorical analyses can be hindered by documentation limitations and the passage of time. Furthermore, some of Lizzie’s transgressions possibly went undocumented; her father’s community standing allowed him to financially rescue her from being held responsible for her stealing and shoplifting behaviors. Thus, Lizzie’s PCL-R score may be falsely low. It is also possible her PCL-R is accurate. Not all women who kill have elevated levels of psychopathy, and only 10 percent of female killers are true psychopaths.

Posterity will likely never know exactly what events transpired in the Borden household that ultimately culminated in this parental massacre. We do know that Lizzie and Emma inherited their father’s fortune. Lizzie bought a Fall River mansion in which she and Emma lived for a time. The Fall River community, however, largely rebuffed Lizzie despite her acquittal. Several years after the murders, Lizzie was again accused of shoplifting. Further leakage of her psychopathic traits? Lizzie never married. Some speculated she was homosexual, while others postulated the pathological father-daughter relationship alienated Lizzie from men.

Noteworthy is the timing of the murders, which is consistent with Lizzie’s motive having been financial. The stepmother was killed an hour or two prior to the father. Had the reverse occurred, based on estate law, a substantial part of the Borden fortune would have gone to the stepmother’s family. Instead, the bulk of the fortune went to Lizzie and her sister. Andrew Borden was technically a widower when he died.

We conclude with the proposition that the convergence of Lizzie losing her mother at the tender age of two, emotional alienation between her and the victims, escalating family conflict, potent financial interests, and Lizzie’s psychopathic personality traits are sufficient to explain the Borden tragedy.

References

Hare, RD. The Hare psychopathy checklist–revised (2nd ed.). Toronto, Canada: Multi-Health Systems; 2003.

Kent, D, Flynn, R, Caso, A. The Lizzie Borden sourcebook. Boston, MA: Brandon Publishing; 1991.

Rebello, L. Lizzie Borden: Past and present. Fall River, MA: Al-Zach Press; 1999.

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.

Parent's Guide
9/9/2013 12:00 AM
The most recent analysis on sleep in ADHD found that children and/or their parents reported bedtime resistance, sleep-onset difficulties, night awakenings, difficulties with morning awakenings, sleep breathing problems, and daytime sleepiness significantly more than healthy comparison individuals. “Sleep problems” refers to nonspecific sleep-related complaints (e.g., sleep-onset difficulties) that may be caused by several mutually exacerbating conditions. For example, prolonged sleep onset may be due to such things as behaviorally based insomnia, circadian rhythm sleep disorder, or restless legs syndrome. Although there is no sleep problem specific to ADHD, the most commonly reported is “difficulty falling asleep.”
The most recent analysis on sleep in ADHD found that children and/or their parents reported bedtime resistance, sleep-onset difficulties, night awakenings, difficulties with morning awakenings, sleep breathing problems, and daytime sleepiness significantly more than healthy comparison individuals. “Sleep problems” refers to nonspecific sleep-related complaints (e.g., sleep-onset difficulties) that may be caused by several mutually exacerbating conditions. For example, prolonged sleep onset may be due to such things as behaviorally based insomnia, circadian rhythm sleep disorder, or restless legs syndrome. Although there is no sleep problem specific to ADHD, the most commonly reported is “difficulty falling asleep.”
  • LOGIN HERE

    Username: Password:
  • Content Directory

    CABL subscribers can now log in to browse all articles online!
    Browse Content
    Free Content
  • Free E-Alerts

    Sign up and get concise news updates on the child and adolescent behavioral healthcare world—emailed directly to you. It's FREE, so try it today!
    Send
  • Subscription Formats

  • 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.
Copyright © 2000-2013 by John Wiley & Sons, Inc. or related companies. All rights reserved.