adolescent health

RECENT POSTS

Sleep Alert: Bright Screens May Be More Disruptive For Tweens and Young Teens, Study Finds

If you’re the parent of a school-age child, you are probably thinking about sleep these days. More specifically, you may be wondering how you will possibly get your child back on a sleep schedule for school after a summer of late nights and mornings sleeping in.

Here’s one tip, based on a recent study on sleep led by researchers at Brown University: Get rid of bright screens at night. Especially if your child is a young teen or tween.

(Robin Lubbock/WBUR)

(Robin Lubbock/WBUR)

The study, published online in the Journal of Clinical Endocrinology & Metabolism, found that children between the ages of 9 and 15 in the early stages of puberty were particularly sensitive to light at night compared to older teens.

Researchers conclude: “The increased sensitivity to light in younger adolescents suggests that exposure to evening light could be particularly disruptive to sleep regulation for this group.”

From the Brown news release:

In lab experiments, an hour of nighttime light exposure suppressed their production of the sleep-timing hormone melatonin significantly more than the same light exposure did for teens aged 11 to 16 who were farther into puberty.

The brighter the light in the experiments, the more melatonin was suppressed. Continue reading

Opinion: It’s Time To Screen Teenagers At School For Risky Substance Use

By Dr. Eugene Beresin
Guest Contributor

Hearings are being held in the Massachusetts State House on a bill that would enable public school nurses to screen teens for the risk of substance use. This practice is strongly supported by the Children’s Mental Health Campaign and the Addiction Free Future Project, and part of a mission in five states to promote screening for teenagers at risk of substance use problems.

We favor broad screening as a way to reduce death and disability due to substance use that typically starts in the teen years. We understand that this screening will be totally confidential — like all substance use screening and discussions between teens and health care providers. However, parents are free to oppose the screening of their children just as they may prevent their children from receiving vaccinations.

The downside to screening raised by some is that it will bring additional costs to the state, including extra time for training and to administer the tests. In addition, some kids may feel discomfort being asked sensitive questions. However, the overall reduced costs of treatment are great. And most kids really are open to talking about substance use in a confidential setting.

There are certainly some people who do not feel school is a place for screening of any kind. But after looking at research on substance use disorder prevention, professionals at The MGH Clay Center for Young Healthy Minds, The MGH Recovery Research Institute and the Massachusetts Children’s Mental Health Campaign feel that the benefits of early screening far outweigh the financial cost and time factors involved. The risks of excessive substance use in teenage years is very dangerous to brain development and social functioning.

A new blog post by screening advocates John F. Kelly, Ph.D., founder and director of the Recovery Research Institute and associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and Courtney Chelo, behavioral health project manager at the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) lays out the details: Continue reading

Related:

Study: Sexual Minority Kids More Likely To Be Bullied — As Early As 5th Grade

A new study out of Boston Children’s Hospital paints a bleak picture of the social lives of many kids who identify as lesbian, gay or bisexual: As early as fifth grade, researchers report, these sexual minority youth are far more likely than their peers to be bullied.

This ongoing victimization (defined in the study as at least once a week over the course of a year) can have short-term consequences, of course, but can also lead to problems down the road. Those long-term troubles include, for instance, “anxiety, low self-esteem, depression, suicidal ideation, post-traumatic stress and negative school performance,” according to the study’s lead author, Mark Schuster, MD, PhD, chief of general pediatrics at the children’s hospital and professor of pediatrics at Harvard Medical School.

For the study, published in the New England Journal of Medicine, researchers interviewed over 4,000 fifth graders and followed up with the kids again in seventh and 10th grade. In an accompanying video Schuster offers this takeaway:

What we found is that the kids who were sexual minorities were more likely to report bullying in all three grades, in 5th grade, 7th grade and 10th grade, and this was true for the boys and the girls. What was particularly striking, in 5th grade, before most of these kids would even be aware of their own sexual orientation, their own identity, or the orientation of their peers, they’re already being bullied more…

That really stood out, and it suggests that these kids, by the time they’re in 10th grade they’ve been bullied and bullied and bullied over many years.

In this context, bullying is defined as “the intentional and repeated perpetration of aggression over time by a more powerful person against a less powerful person.” In the study, researchers suggest that screening for “bullying experiences” should become more commonplace:

“Our findings underscore the importance of clinicians routinely screening youth for bullying experiences, remaining vigilant about indicators of possible bullying (e.g., unexplained trauma and school avoidance), and creating a safe environment in which youth feel comfortable discussing their sexuality. Further research could determine the effectiveness of incorporating the experiences of sexual minorities into general school-based anti-bullying programs.”

So how can parents help? In an interview Schuster offers this:

There are several things parents should be doing: creating an environment in the household where their kids feel comfortable being open with them, and an environment where the kids feel unconditional love. One of the places kids learn to bully is from watching adults around them; kids learn from their parents. So if a neighbor’s name comes up and he’s known to be gay and dad does the limp wrist thing, or mocks the neighbor, and the kid observes that, the kid learns it’s OK to mock based on who they are. It also sends a message that if there’s a gay child in the house who is not out, the message is that the kind of person dad is scorning or mocking is not just the neighbor but also the child, and that’s a terrible experience for a child, to feel that their own parent would reject them. Continue reading

Report: More College Freshmen Say They’re ‘Frequently’ Feeling Depressed

If you envision college life as an idyllic, carefree time filled with studies of classic literature and pondering the meaning of life at 2 a.m., think again. The reality of college today can be harsh.

For freshmen, in particular, navigating a new social, emotional and academic landscape can be extremely stressful. So it’s not terribly surprising that a new national survey of first-year college students finds, among other things, that more freshmen say they’re “frequently” feeling depressed.

According to the survey of more than 150,000 U.S. students conducted by researchers at UCLA, the emotional state of these young adults appears to be deteriorating:

In 2014, students’ self-rated emotional health dropped to 50.7%, its lowest level ever and 2.3 percentage points lower than the entering cohort of 2013. Additionally, the proportion of students who “frequently” felt depressed rose to 9.5%, 3.4 percentage points higher than in 2009 when feeling “frequently” depressed reached its lowest point. Self-rated emotional health and feeling depressed are very highly correlated…”

(Chrissy Hunt/Flickr)

(Chrissy Hunt/Flickr)

The survey suggests that students who say they’re depressed also tend to be more disconnected with college life in general:

Students who felt depressed more frequently reported behaviors reflecting disengagement. While these behaviors were not as widespread, students who were “frequently” depressed were about twice as likely to “frequently” come late to class (13.9%, compared to 7.2% for “occasionally” depressed and 5.5% for “not at all” depressed) and “frequently” fall asleep in class (14.1%, compared to 6.2% “occasionally” and 4.4% “not at all”). Further, more than half (56.6%) of the “frequently” depressed students reported that they were “frequently” bored in class, compared to 39.9% of those who reported being “occasionally” depressed and only 31.3% of those who were “not at all” depressed. They were also less likely to “frequently” engage with their classmates by studying with other students or working with other students on group projects.

I asked Steve Schlozman, associate director of The MGH Clay Center for Young Healthy Minds and an assistant professor of psychiatry at Harvard Medical School, for his thoughts on these findings. First he said, the word “depression” has become so ubiquitous in the popular vernacular that it’s not always clear in these kinds of surveys whether kids are describing clinical depression or simply the normal ebb and flow of emotional stress. Even so, he says, with regard to increased distress among college kids, “we are reaping what we sow.”

He explains further:

The pressure we put on high school kids to get into college and the pressure then that college follows up with is highly correlated with increased rates of emotional distress that can become full-blown depression. Also, the age of onset of depression is the exactly the age of onset of college — there’s a perfect storm of stressors. Finally, there’s a greater willingness to come forward, which is good. So, despite the fact that we’re using the word ‘depression’ a little more glibly, I’d rather have that and then rule out clinical depression through appropriate channels, like college health services, than miss cases that can lead to real suffering and possibly even death.

Continue reading

Gender Divide: Trans Youth Face Higher Mental Health Risk, Study Says

With the tragic death by suicide of transgender teenager Leelah Alcorn still in the news, Boston researchers are reporting that many transgender youth may be particularly vulnerable to a variety of mental health-related problems.

The new study published in the Journal of Adolescent Health found that transgender youth faced a higher risk of being diagnosed with a mental illness or related problem, compared to non-transgender teens.

Specifically, the study says:

Compared with non-transgender youth, transgender youth had an elevated probability of being diagnosed with depression (50.6% vs. 20.6%); suffering from anxiety (26.7% vs. 10%); attempting suicide (17.2% vs. 6.1%); and engaging in self-harming activities without lethal intent (16.7% vs. 4.4%).

Researchers suggest that primary care doctors should address gender identity more directly and routinely screen transgender adolescents for mental health concerns.

Sari Reisner, a research scientist at the Fenway Institute who was the lead author on the survey, says gender affirming care by pediatricians can have a positive impact on a child’s future mental health outcomes:

“Gender affirmation is a very important part of a person’s identity. If a person is not being seen for who they are it can be very distressing. So pediatricians present a very important entry point into care and can get youth who need services to the right place.”

According to the study:

…it is recommended that primary care providers include gender identity as part of a basic patient history. Training programs and continuing education programs for primary care providers and mental health providers should include gender identity education.

Providers should familiarize themselves with community resources for transgender youth.

Patients with a transgender identity or history should be recognized as having higher risk for mental health concerns and should be carefully screened and evaluated.

Patients identified with co-occurring transgender identity and mental health concerns should be seen by a mental health provider who is qualified to provide evidence-based care with sensitivity to the diversity of gender identity and expression.

Continue reading

Persistent Stigma, Skepticism About Mental Illness Causes Real Harm

By Dr. Steve Scholzman
Guest Contributor

Profound misunderstanding about mental illness — its causes, its legitimacy and its treatment — permeate our culture. And the stigma that accompanies this lack of understanding hurts, a lot. Take this example — hardly original or rare.

Imagine a 15-year-old adolescent girl with fairly severe depression. She may be a classmate of your child, or the daughter of a friend. Let’s call her Sally.

Sally’s not so ill that she needs to be in the hospital, but she’s close. Her family and I — her psychiatrist — are doing our best to get her better as quickly as possible so she can get back to school. She’s been out now for about three days. Why? She literally lacks the capacity to think clearly. It’s all she can do to drag herself out of her bed and run a toothbrush across her teeth.

(Michael Summers/Flickr)

(Michael Summers/Flickr)

There’s a big family history of depression so Sally’s parents are both familiar with and frightened by her struggles.

“Can you call the school and ask them to give her more time on some work?” the parents ask.

“Sure,” I say, and I get in touch with the school administrator.

“Well,” I’m told by the very well-meaning administrator, “It IS a tough time of year. The other kids are getting through it somehow. I don’t see why she should get special treatment.”

“Because she has the equivalent of the flu,” I say. I like to use analogies at these crossroads.

“But the flu feels awful. Does she have a fever? Because if she does, she shouldn’t come to school…”

“No, she doesn’t have a fever,” I say. I try another analogy. “What if she had been in a car accident, God forbid?”

“Well, that’s pretty different, isn’t it?”

“How?” I ask.

“She’d be hurt,” I’m told. “This is an entirely different thing. You’ll need to get her pediatrician to call.”

I ask the pediatrician to call, and I can feel his discomfort over the phone. “I’m not very good at making this case,” he acknowledges. “It’s probably better if you just call them back.”

(I have to wonder whether he’d be so uncomfortable if I were a gastroenterologist asking him to call the school about a patient with ulcerative colitis?) Continue reading

New Pro-Circumcision Guidelines: Cutting Comments, Adolescent Choice

Preparing for a circumcision

Preparing for a circumcision (Cheskel Dovid/Wikimedia Commons)

Just days after the U.S. Centers for Disease Control and Prevention issued draft recommendations on male circumcision asserting that the health benefits outweigh the risks, more than 300 comments (and counting) have been posted on the agency’s website.

Surprise: The feedback overall reflects anger over mounting institutional support for what some call a “barbaric, outdated practice.” (The public comment period on the agency’s proposed recommendations ends on Jan. 16.)

Here are a few random comments:

When I was a little girl and discovered my little brothers had been cut, I was horrified for them and grateful I wasn’t born a boy.

The only benefit of infant circumcision is the fatter wallet of the circumciser. Wake up people! Condoms prevent sexually transmitted diseases, not circumcision. Males deserve the same protection from genital cuttings that females do. Shame on the CDC for condoning such a barbaric, outdated practice that nearly every other industrialized nation has refused to adopt!

Routine infant circumcision is morally wrong because it is non-essential cosmetic surgery performed on the body of a human being not yet old enough to give informed consent….

Your agenda clearly shows your primary purposes is for health insurance to pay for male genital mutilation. Please don’t continue to make the U.S. the continued laughing stock of the international medical community.

You get the picture.

The CDC stopped short of actually telling parents they must circumcise their baby boys; instead the agency offered guidelines — including a new recommendation that un-circumcised adolescent boys discuss the risks and benefits with their doctors — and laid out the latest research. Male circumcision, according to an AP report, can:

•Cut a man’s risk of getting HIV from an infected female partner by 50 to 60 percent.

•Reduce their risk of genital herpes and certain strains of human papillomavirus by 30 percent or more.

•Lower the risk of urinary tract infections during infancy, and cancer of the penis in adulthood.

Studies have not shown that circumcision will reduce an HIV-infected man’s chances of spreading the AIDS virus to women. And research has not found circumcision to be a help in stopping spread of HIV during gay sex.

The guidelines say circumcision is safer for newborns and infants than for older males, noting the complication rate rises from 0.5 percent in newborns to 9 percent in children ages 1 to 9, according to the CDC. Minor bleeding and pain are the most common problems, experts say.

CDC officials are recommending doctors tell parents of baby boys of the benefits and risks of circumcision…

These are the first federal guidelines on circumcision, a brief medical procedure that involves cutting away the foreskin around the tip of the penis. Germs can grow underneath the foreskin, and CDC officials say the procedure can lower a male’s risk of sexually-transmitted diseases, penile cancer and even urinary tract infections.

I asked circumcision expert Marvin Wang, co-director of the newborn nurseries at Massachusetts General Hospital (and someone who has performed thousands of circumcisions), about the new CDC draft recommendation, and he offered this thoughtful analysis:

First a little history:

For decades, the American Academy of Pediatrics (AAP) (which produces the majority of research-based policy for U.S. pediatric care) has led a relatively neutral stance on male neonatal circumcision, as the literature has shown that there is a relatively small health benefit by performing circumcision (there is huge debate on how one interprets the numbers on this, but overall, that conclusion is true). However, a game changer that tilted the balance towards claiming health benefits came in 2005-2007, when three separate World Health Organization clinical trials were performed in Africa demonstrating that circumcision among adult men in Sub-Saharan African settings reduced the acquisition of HIV by 50%.

With that, the AAP changed its recommendations in 2012 to reflect these studies. Their statement basically said that, yes, we know that there are health benefits now – enough to encourage parents to strongly consider circumcision for the newborn. However, the decision still lays with the parents, balanced by their beliefs (which may be influenced by religious, social or familial reasons). There are other tenets to the statement, but let’s just focus on this one topic, as this is most relevant to the recent CDC statement.

In light of the infectious disease issues involved, the medical community had been told that the CDC would make their recommendations regarding circumcision at about the same time as the AAP’s release. So, with this week’s statement, you are basically seeing a reaffirmation of the 2012 AAP statement. We don’t really see anything new. The health benefits touted in the CDC report have all been discussed before in the literature.

The only potentially new issue here is a topic that the 2012 AAP statement neglected: The idea of encouraging un-circumcised adolescents to discuss the option with their physician. Continue reading

When You’re Dealing With A Stressed-Out High School Junior: 5 Tips

By Steve Schlozman, MD
Guest Contributor

(Miguel Angel/Flickr)

(Miguel Angel/Flickr)

Sometimes things are so obvious we fail to take notice.

For example, if I tell you that high school students who plan on attending college are under a lot of pressure, your response might sound like, well, a 17-year-old:

“Duh,” you might say, “What else is new?”

This is not new, of course, but the pressure continues to get exponentially worse. Students from all walks of life are increasingly overscheduled, academically burdened and socially overwhelmed. We pile all this stuff on top of the already treacherous waters of adolescence, and it’s no wonder kids feel emotionally battered.

I started thinking more about this when a friend of mine from high school called about his 9th grade daughter.

“She’s 14,” my friend said, “And they’re telling her in the fifth week of school about college. Did we worry about college in 9th grade?”

No way.

I used to think that the pressure on high school teens was largely a regional issue. I was raised in the Midwest, so of course things weren’t quite so high-stress compared to here in Boston. But my friend was calling from Colorado, and this is therefore not a regional issue. What is clear, is that this pressure is not good for our kids.

Let’s look at some of the data:

•According to the Department of Education, there are around 2,675 nonprofit four-year undergraduate colleges in the United States.

•Although the number of students in high school continues to slowly decline, the number of students applying to college is steadily increasing. In 2011, there were about 20.4 million students enrolled in college, and that number is projected to reach about 23 million by 2020.

•One out of four teenagers submitted college applications in 2011, at an average of around $40 per application

•In 2001, the typical college admitted around 71 percent of its applicants. By 2011, this number dropped to around 65 percent. I could go on. The common application increases the overall number of applications that students complete, schools look to college acceptance rates as a means of measuring their success and they therefore pass this pressure onto their students, and students themselves are more and more led to view the junior year of high school as something akin to academic and extracurricular boot camp. I’ve seen students get freaked out even before the first week of 11th grade.

This this kind of systemic stress is not good for anyone. A 2008 study found that the increased rate of academic dishonesty on high school campuses stemmed, at least according to some students, from the increasingly high achievement bar that the students themselves experienced. This of course does not excuse cheating, but it is worth noting that both cheating and academic and social pressures seem to have grown in concert with one another. Continue reading

Study: Aerobics Plus Resistance Training May Be Best Against Teen Obesity

obese kid

A new study published online in JAMA Pediatrics finds that a combination of aerobic workouts plus resistance training offers the best hope for teenagers battling obesity.

From the abstract:

Aerobic, resistance, and combined training reduced total body fat and waist circumference in obese adolescents. In more adherent participants, combined training may cause greater decreases than aerobic or resistance training alone.

Here’s more from The New York Times coverage of the study, which found that “diet without exercise accomplishes little:”

Canadian researchers put 304 obese teenagers on a diet with a daily energy deficit of 250 calories (measured from their resting energy expenditure). Then they assigned them randomly to one of four groups for 22 weeks: aerobic training on exercise machines like treadmills, resistance exercise using weight machines and free weights, combined aerobic and resistance training, and a diet-only group with no exercise… Continue reading

When Teens Talk Of Suicide: What You Need To Know

By Gene Beresin, MD and Steve Schlozman, MD
Guest Contributors

Here’s the kind of call we get all too frequently:

“Doctor, my son said he just doesn’t care about living anymore. He’s been really upset for a while, and when his girlfriend broke things off, he just shut down.”

Needless to say, situations like this are terribly frightening for parents. Kids break up with girlfriends and boyfriends all the time; how, parents wonder, could it be so bad that life might not be worth living? How could anything be so awful?

For clinicians like us who work with kids, these moments are at once common and anxiety-provoking. We know that teenagers suffer all sorts of challenges as they navigate the murky waters of growing up. We also know that rarely do these kids take their own lives. Nevertheless, some of them do, and parents and providers alike must share the burden of the inexact science of determining where the greatest risks lie.

Suicide has been in the news lately with a flurry of new research and reports and, of course, the high profile death earlier this summer of Robin Williams.

But suicidal behavior among teenagers and kids in their early 20s is different and unique.

So let’s look at a couple of fictional — yet highly representative — scenarios.

depressed

Charlie, a 16-year-old high school junior was not acting like himself. In fact, those were his parents’ very words. Previously a great student and popular kid, Charlie gradually started behaving like a different person. He became more irritable, more isolated and seemed to stop caring about or even completing his homework. Then one morning, just before before school, he told his mother that he wished he were dead.

Myths: Common But Distorted 

There are countless other examples. Sometimes kids say something. Sometimes they post a frightening array of hopeless lyrics on Facebook. And most of the time — and this is important — kids don’t do anything to hurt themselves. Morbid lyrics and even suicidal sentiments are surprisingly common in adolescence. Still, this does not mean for a second that we take these warning signs lightly. In fact, there is a common myth that asking about suicide perpetuates suicide. There is not a shred of evidence in support of this concern, and in the studies that have been done, the opposite appears to be true. Kids are glad to be asked.

We have to ask. It’s really that simple. But, we ask with some very basic facts in mind. Suicidal thinking, and even serious contemplation of suicide, is, as we mentioned, very common among high school students. In the Center for Disease Control Youth Risk Behavior Surveillance Survey distributed every two years to about 14,000 high school kids in grades 9-12, students are queried about a range of high-risk behaviors, including suicide.

The Underlying Mood Disorder

In 2013, 17% of teens reported seriously considering suicide, and 8% made actual attempts. Each year in the United States, about 15 in 100,000 kids will die by suicide, making suicide the third leading cause of death in this age group. Additionally, we have no idea how many deaths by accidents (the leading cause of death) were, in fact, the product of latent or active suicide.

The greatest risk factors for a teenager to die by suicide include the presence of some mood disorder (most commonly depression), coupled with the use of drugs, or other substances, and previous attempts.

Although research suggests that girls attempt suicide more often, boys more often die from suicide. Add these risk factors together, and it turns out that Caucasian boys are at highest risk.

Some of this is also driven by a still immature brain. Impulsive behavior is notoriously common in teens, and in many cases, it looks as if the act of suicide was the result of a rash and sudden decision. Continue reading