adolescent health

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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

Pediatricians: Middle And High School Should Start No Earlier Than 8:30 AM

(eltpics/Flickr via Compfight)

(eltpics/Flickr via Compfight)

It’s one of the great joys of early parenthood: Finally being able to sleep until a reasonable hour — say, 6 a.m. Then, before you know it, you’re facing the opposite problem: Homeroom is just half an hour away, and your tween or teen remains an immovable lump beneath the covers.

As any parent who’s observed it would suspect, this is deep biology at work. Today, the American Academy of Pediatrics issues both an up-to-date explanation of research on adolescent sleep and a ringing call to the country’s schools to heed it and begin school later for “pathologically sleepy” older students. Sleep deprivation in youth is a common — “and easily fixable” — public health issue, the academy says in a policy statement.

From the press release, whose headline begins “Let Them Sleep:”

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” [statement lead author Dr. Judith] Owens said. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Many studies have documented that the average adolescent in the U.S. is chronically sleep-deprived and pathologically sleepy. A National Sleep Foundation poll found 59 percent of 6th through 8th graders and 87 percent of high school students in the U.S. were getting less than the recommended 8.5 to 9.5 hours of sleep on school nights.

This medical stance on sleep deprivation is not new; the research has been accumulating for many years. But the academy reports that about 40 percent of American high schools still start before 8 a.m., and only 15 percent launch the school-day at or after 8:30. Among middle schools, it says, more than one-fifth begin at 7:45 or earlier.

If schools are not shifting later as fast as pediatricians might like, that could be because, like virtually everything in education, it’s not as simple as it might seem.

‘Life is going on right now in hyperspeed for most of our young people.’

“Once you go deeper into the lives of kids today, things become more complex,” says Dr. Bob Weintraub, who was the headmaster of Brookline High School from 1992 to 2011 and is now a professor of educational leadership at Boston University. Based on the research, Brookline High shifted start times for most students to 8:30 during his tenure, he said, but such shifts do raise issues.

“One of the practical problems has always been for high school athletics and school activities,” he said; if school ends later, sports and other activities must start later, and outdoor sports are hindered when darkness descends. Continue reading

A Bittersweet Graduation For Patients At The Mass. Hospital School

Brian Devin, CEO of The Massachusetts Hospital School, speaks with student Miguel M. in the cafeteria after lunch. (Jesse Costa/WBUR)

Brian Devin, CEO of The Massachusetts Hospital School, speaks with student Miguel M. in the cafeteria after lunch. (Jesse Costa/WBUR)

By Gabrielle Emanuel

CANTON, Mass. — It’s lunch break and there’s a wheelchair traffic jam in the school hallway.

Friendly shouts of “Beep! Beep!” and “You’re blocking traffic” interrupt chatter about one kid’s new backpack and another guy’s birthday plans.

It’s a typical school scene, except a bunch of the kids are using computers to talk and others breathe through ventilators.

Like students across the country, many of these kids are getting ready for graduation. It’s a bittersweet time for graduates of all stripes, but perhaps nowhere is it more bittersweet than here.

All of the 91 students in these hallways are also patients. When they graduate – as about a dozen will this year – they’re not only leaving their friends and teachers, they’re leaving the hospital they’ve called home for years, and in some cases, a decade or more.

The campus’ main entrance is on a rural road in Canton, where a flashing sign reads: The Massachusetts Hospital School.

Brian Devin, the CEO, says that when cars zip past drivers often “think it’s a school where they teach people to work in hospitals.”

Devin says it’s a fair assumption, but completely wrong. This facility is part pediatric hospital, part elementary and secondary school. It serves children with severe disabilities — muscular dystrophy, cerebral palsy, brain injuries — and is run jointly by the state Department of Public Health and the Department of Education.

Children as young as 6 or 7 can be admitted to the hospital and they often stay at this lakefront campus until the kid’s clock strikes 22 years old, when it’s time to graduate and it’s time to go, regardless of whether there is another alternative place to go.

A Non-Institutional Hospital

As the hallway traffic starts moving, the students wheel themselves out into the brisk spring air. They race down covered ramps toward horseback riding lessons, speech therapy sessions and wheelchair hockey practice.

Those white ramps create a web that connects all the brick buildings on this idyllic, 160-acre facility.

“The kids are all over the place. They are not always with staff — we don’t want them to always be with staff,” Devin says. “We want them to be with themselves and with other kids as much as possible. There is no real institutional flavor.”

The Massachusetts Hospital School’s ultimate goal is to cultivate as much independence as possible for these children. Continue reading

Navigating The Senior Prom: Tips To Help Parents Cope

From left: Zack Beresin, Sophie Manning and Glennon Beresin (Zack's twin sister) before their senior prom (Courtesy of Gene Beresin)

From left: Zack Beresin, Sophie Manning and Glennon Beresin (Zack’s twin sister) before their senior prom (Courtesy of Gene Beresin)

By Drs. Steve Schlozman and Eugene Beresin
Guest contributors

The recent fatal stabbing of a 16-year-old girl in Connecticut have understandably cast a dark shadow over prom night.

Attacks like the one in Connecticut are rare, but these events receive massive attention and can thus obscure the more common tribulations characteristic of the spring dance.

In no way do we want to make light of the seriousness of recent events, but we also do not want to miss the opportunity to explore the more common hand-wringing of this yearly ritual.

So, consider the following scenario:

It’s late afternoon on the day of the prom. Your son ambles downstairs in his tuxedo, silently seeking approval. Your younger daughter giggles: “What’s that thing he’s wearing?” she asks.

“That’s a tuxedo,” you say.

“I know what that is, Daddy, but what’s that big black belt?”

“It’s a cummerbund,” you reply.

But you are wrong, according to your daughter’s analysis. “It’s morantic,” she says. “I think he looks morantic.”

That’s how she says romantic. It usually cracks up your son when she says this, but not today.

“No,” you respond. “You look very distinguished.”

He’s still not pleased. He’s 18, after all, and not ready to be distinguished.

And as his date arrives, you have this sinking recollection: they are preparing themselves for a night that can’t possibly live up to expectations.

Then you start to worry about the sharp turn that can separate the glamour of the dance itself from the potential debauchery of the post-prom festivities. No dress-up clothes then, no contrived formalities…just hanging out with friends and staying up all night, with possible cut-loose celebrations (read: sex) or unfettered over-indulgence (read: drugs).

For all those parents out there who are planning to launch their own kids into this great Western tradition, we would like to opine from our vantage points as child and adolescent psychiatrists, and as former prom attendees, and, for at least one of us, as someone who has seen four kids attend proms. Here are a few tips:

1. Don’t use the “S” word

When your daughter emerges in her prom dress, don’t fuss. Tell her that she looks great, or that she looks beautiful, but don’t say sexy. Continue reading

What Teens Say Teens Should Know About Sexually Transmitted Diseases

(Planned Parenthood)

(Planned Parenthood League of Massachusetts)

By Joey Boots-Ebenfield
Guest contributor

I’ve gotten used to hearing myths and misinformation when I talk about sex with fellow teens.

And I talk about sex often in my role as an 17-year-old peer educator with the Planned Parenthood Get Real Teen Council (GRTC) — a year-long high school sexual health program for 10th-12th graders who are trained to facilitate sex education workshops and serve as resources for peers, families and communities.

If teens are uncomfortable talking about topics related to sex and sexuality, or don’t have a trusted source of information about their health, it’s easy for all kinds of misinformation to spread. And of course, there’s the Internet, where bad information is often rampant, so it’s not always a reliable place to find accurate health information.

The subject of sexually transmitted diseases (STDs) is no exception. I’ve heard some pretty interesting misconceptions about what STDs are and what it’s like to get tested. One myth is that STDs have obvious symptoms, like localized pain or some other physical sign.

In fact, this is quite the opposite! STDs often show NO symptoms. This myth is especially dangerous because it means that someone can have an STD and not even know it. As a result, many STDs go untreated, which can cause cause some pretty nasty complications. Continue reading

Coerced Sex Common For Teen Boys And Young Men, Study Finds

A few nights ago, unable to wind down, I was searching for something to watch and stumbled across the film “Adore.” It’s about a pair of lifelong friends (grown women) who end up having affairs with each other’s young, hunky, 19- or 20-year-old sons. My first reaction was the same as one Netflix commenter:

“…if this had been two pals and each other’s teen daughter; well, you get the point. The movie would not have been made, or if so, it would have had an entirely different hue-to say the least. DOUBLE STANDARDS.”

Or, as A.O Scott wrote in his New York Times review:

“It is worth noting that the same movie about a couple of dads sleeping with each other’s 20-year-old daughters would need, at a minimum, to confront the ickiness of the situation. Really, such a movie would be unlikely to make it into theaters, in spite of the commonness of real-life relationships between older men and younger women.”

(Dustin Hoffman, Anne Bancoft in "The Graduate"; Movie-Fan/flickr)

(Dustin Hoffman, Anne Bancoft in “The Graduate”; Movie-Fan/flickr)

The film isn’t about sexually coercion; but it is about boundary breaking, and I thought of it again reading this new study on the pervasive, but largely unexamined problem of sexual coercion among boys and young men.

The study, published in the journal Psychology of Men and Masculinity, found that coerced sex is fairly common for teenage boys and college-age men and can lead to psychological distress and risky behavior, such as sexual risk-taking and alcohol use.

From the American Psychological Association news release:

A total of 43 percent of high school boys and young college men reported they had an unwanted sexual experience and of those, 95 percent said a female acquaintance was the aggressor…

“Sexual victimization continues to be a pervasive problem in the United States, but the victimization of men is rarely explored,” said lead author Bryana H. French, PhD, of the University of Missouri. “Our findings can help lead to better prevention by identifying the various types of coercion that men face and by acknowledging women as perpetrators against men.” Continue reading

Third Teen Suicide In Newton: What Can You Say?

Newton South (Wikimedia Commons)

Newton South (Wikimedia Commons)

Tonight at the Newton South High School auditorium, school officials and mental health experts will try to offer some guidance on how to talk to children about suicide and how best to support kids and families reeling from the news of a third teen suicide in this community since the start of the school year.

Tonight’s gathering comes after reports that 17-year-old Roee Grutman, a popular Newton South junior, committed suicide earlier this month. (According to the state Executive Office of Public Safety & Security, Grutman’s death was a result of “asphyxia by hanging.”)

Grutman’s death follows two other suicides: Katherine Stack, a Newton South sophomore, took her own life in October, shortly after Karen Douglass, a Newton North senior, also committed suicide.

At a memorial service for Grutman last night, hundreds of classmates and family members gathered to remember the “bright, articulate, compassionate” young man, The Boston Globe reports:

“One after another, the speakers at Monday’s service told of a young man who lit up a room when he walked in, and despite his schedule busy with honors classes and sports, always had time for a friend.”

According to parents in the Newton South community, many children are still in shock (as are their parents and teachers) and struggling to comprehend the string of suicides in general, and in particular, the death of a boy who appeared to be so well-adjusted, socially connected and stable.

“I think the kids are beside themselves,” said Elizabeth Knoll, whose 17-year-old daughter, Anya Graubard, is also a Newton South junior and was friends with Roee. “My daughter was gray and pale and tightlipped for the last two days.” (Knoll says Anya gave her permission to be named here.)

Knoll said in Newton — where many kids have been classmates since the age of 4 — Grutman’s out-of-the-blue suicide is particularly excruciating. “No one among his family or friends…could see anything like this coming,” Knoll said. “It’s impossible to make any sense of it.” Continue reading

Pet Study: Cute, Furry And (Possibly) A Catalyst For Better Adolescent Behavior

Pets, if you haven’t already noticed, are no longer simply pets. They are political (ban the puppy mills!); they are personal therapists; they are leading blog protagonists (see: My House Rabbit) and for some, they are prized surrogate children.

Now, it turns out, pets may have yet another dimension: they might contribute to more positive adolescent behavior (and you thought that was impossible). Indeed, a new study led by Tufts researchers finds that young adults caring for animals may develop deeper social connections and other positive traits such as empathy.

Here’s more from the Cummings School of Veterinary Medicine at Tufts news release:

girlanddogs

Young adults who care for an animal may have stronger social relationships and connection to their communities, according to a paper published online in Applied Developmental Science.

While there is mounting evidence of the effects of animals on children in therapeutic settings, not much is known about if and how everyday interactions with animals can impact positive youth development more broadly.

“Our findings suggest that it may not be whether an animal is present in an individual’s life that is most significant but rather the quality of that relationship,” said the paper’s author, Megan Mueller, Ph.D., a developmental psychologist and research assistant professor at the Cummings School of Veterinary Medicine at Tufts University. “The young adults in the study who had strong attachment to pets reported feeling more connected to their communities and relationships.”

Mueller surveyed more than 500 participants, aged 18-26 and predominately female, about their attitudes and interaction with animals. Those responses were indexed against responses the same participants had given on a range of questions that measure positive youth development characteristics such as competence, caring, confidence, connection, and character, as well as feelings of depression, as part of a national longitudinal study, the 4-H Study of Positive Youth Development, which was led by Tufts Professor of Child Development Richard Lerner, Ph.D., and funded by the National 4-H Council.

Young adults who cared for animals reported engaging in more “contribution” activities, such as providing service to their community, helping friends or family and demonstrating leadership, than those who did not. The more actively they participated in the pet’s care, the higher the contribution scores. The study also found that high levels of attachment to an animal in late adolescence and young adulthood were positively associated with feeling connected with other people, having empathy and feeling confident. Continue reading

Young Girls Afraid To Gain Weight And Get Fat, Study Finds

mikebaird/flickr

mikebaird/flickr

A smart, health-conscious mom I know just drew the line: she’s going to stop reading “Grain Brain” — the compelling, controversial, potentially crazy-making new book that details the evils of carbs in general and grains in particular. She, and so many others, initially loved the book, which argues that carbs, even the whole grain variety, can “destroy” your brain and “cause demential, ADHA, anxiety” and more.

The problem, says this mom (beyond the what-can-I-possibly-pack-the-kids-for-lunch-with-no-grains dilemma), is that all the chatter about “bad foods” around her daughters might possibly increase their chances of developing an eating disorder.

This rang true to me as I came across this recent U.K. study on eating disorders in early adolescence.

Researchers from University College London Institute of Child Health and the London School of Hygiene and Tropical Medicine found that “six in 10 13-year-old girls, compared to four in 10 boys the same age, are afraid of gaining weight or getting fat.” And it got worse when the young teenage girls got a bit older, notes the report, published online in the Journal of Adolescent Health.

The bottom line results, according to the study of more than 7,000 13-year-olds: “Extreme levels of fear of weight gain, avoidance of fattening foods, and distress about weight and shape were common among girls.”

Here’s more from the study, according to the news release:

•One in three girls (34%) and one in five boys (21%) were upset or distressed about weight and shape

•One in two girls (53%) and four in 10 boys (41%) avoided fatty foods

•A quarter of girls (26%) and one in seven boys (14.5%) had restricted their food intake (by fasting, skipping meals or throwing away food) in the previous three months Continue reading

Will They Ever Leave? What It Takes To Nudge Millennials Out Of Nest

How do young adults who successfully move out overcome adversities? According to a new study, it all boils down to peer support. (ibm4381/Flickr)

How do young adults who successfully move out overcome adversities? According to a new study, it all boils down to peer support. (ibm4381/Flickr)

Truth be told, my position in life is somewhat confusing. While I’m no longer a teenager, at 21 I can’t say I feel all that adult-like. I’ve finished one degree, but I’m not ready to commit to any one career. I recently moved into my first apartment, though I have no idea where I’ll be living 10, five or even two years from now. According to developmental psychologists, these are all indicators that I am in my emerging adulthood.

But what exactly is “emerging adulthood”? It’s the period of life between adolescence and full-fledged adulthood, between the late teens and late 20s, where people explore their options before committing seriously to a career, home, or family. And according to experts, it’s happening later and later. Dr. Jeff Arnett of Clark University, who coined the term “emerging adulthood” in 2000, points to the fact that North Americans are delaying adopting a permanent residence until reaching their 30s.

The reasons are complex and diverse, Arnett says: they include a shift in the economy that necessitates more education, a rising marriage age and, more nebulously, an increased sense of personal freedom over the past several decades. All this makes conventional adulthood “a less attractive destination,” he says. (I’ll say.) And then there’s the job market, which makes the decision to move out even more complicated.

This doesn’t mean that today’s young adults aren’t feeling the itch for independence, however. Some friends of mine who remained at home after college say they “would’ve preferred to have gone elsewhere,” and cite being “treated like a child” by parents as both a positive reason why they stayed at home and a negative — why they didn’t want to be there. Fortunately, my parents conveyed confidence in my ability to live on my own. In moving out, I benefitted greatly from knowing my parents had my back, should I need financial or emotional support.

For foster-care children, the lack of a parental support system presents a huge issue. Professor Varda Mann-Feder knows this problem intimately, after having spent decades working with foster children as they transition into adulthood. But there may be good news for emerging adults in foster care: a new study headed by Mann-Feder and her colleagues at Concordia University shows that peer support systems could be even more important than parental support in facilitating the transition to independent living.

While parents played an important role in how confidently participants experienced the transition — particularly based on parents’ willingness to provide a financial safety net — Mann-Feder found that Millennials “much preferred to turn to their friends for help if they needed it,” and “benefit greatly from watching their peers who have already moved out.” Conversely, young adults who opted to stay in their childhood home pointed to friends who were doing the same. Because they tend to model their peers, “when, how and where a young person moves is to a large degree determined by what their friends are doing,” says Mann-Feder. Continue reading