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Parents Who Spank, Swat, Switch: ‘On Point’ Takes On Corporal Punishment

Minnesota Vikings running back Adrian Peterson watches from the sidelines against the Oakland Raiders during the second half of a preseason game at TCF Bank Stadium in Minneapolis, on Aug. 8=. (Ann Heisenfelt/AP)

Minnesota Vikings running back Adrian Peterson watches from the sidelines during the second half of a preseason game against the Oakland Raiders in Minneapolis, on Aug. 8. (Ann Heisenfelt/AP)

Don’t miss this particularly point-filled On Point hour: “Kids, Discipline And The Adrian Peterson Debate.”

From the write-up:

Who ever imagined the National Football League would become the nation’s court of public opinion on how to live the domestic life. But here it is. First this season, Ray Rice and the terrible punch. Now, the Minnesota Vikings’ Adrian Peterson and the disciplining of children. Texas authorities have indicted Peterson for going too far with a switch, a branch, leaving welts and broken skin. Peterson says he disciplined his child the way he was disciplined, but he’s learned a lot and is re-evaluating his ways. Much of the country still spanks, swats, switches. Is it right? This hour, On Point: Corporal punishment, good parenting, and our kids.

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

Study: Bullying By Siblings May Double Risk Of Depression, Self-Harm

(Wikimedia Commons)

(Wikimedia Commons)

By Nicole Tay
CommonHealth intern

When I was growing up, I used to complain about the loneliness of being an only child. “I want an older brother like Mandy!” I would plead to my parents. I just wanted an older, cooler playmate; I never considered the potential downside.

Now, at 22, I’ve heard my share of horror stories; the sibling bullies who called my friends “butt face” or “stupid” or “brat;” the burnt Barbie dolls; the bag of caterpillars dumped on my poor friend’s head.

Is sibling bullying just a harmless rite of passage — or can it actually entail developmental repercussions?

A new study published today by the American Academy of Pediatrics targets that very question. After surveying more than 6,900 young people in the UK, researchers found that victims of frequent sibling bullying were twice as predisposed to depression, anxiety, and self-harm in young adulthood as non-bullied controls. This British-based study comes on the heels of similar findings in an American study last year. From the paper:

Of the 786 children who reported that they had been bullied by a sibling several times a week (55.3% female), depression was reported by 12.3% at age 18 years, self-harm occurred in 14.1%, and anxiety was reported by 16.0%.

And from the abstract: Continue reading

When One Twin Baby Lives But The Other Dies

(stitches1975 via compfight)

(stitches1975 via compfight)

By Dr. Karen O’Brien
Guest contributor

Never before in my obstetric practice have I taken care of so many twin pregnancies. What I witness in my own office is part of a nationwide trend: Over the last two decades, the twin birth rate in the United States rose 76 percent, from 19 to 33 per 1,000 births.

And never before have I taken care of so many twin pregnancies with complications.

The specific complication that has given me pause in the last year or two is the loss of one twin, either during or after pregnancy.

This doesn’t happen often, but I have taken care of a number of patients recently who have lost a twin during or shortly after pregnancy. And I’ve learned that though outsiders might see a glass half full, this experience is uniquely devastating, both emotionally and medically.

We must all understand that the life of one twin does not eradicate grief for the sibling who died.

The hope and anticipation of bringing home two healthy babies comes grinding to a halt. The joy of delivery is clouded by sibling loss.

As early as 18 weeks, Melissa’s identical twins showed signs of a complication called twin-to-twin transfusion syndrome, which occurs when one of the twins essentially donates blood to the other.

At 19 weeks, Melissa underwent surgery to try to correct the problem. Unfortunately, two days after the surgery, one of the twins passed away. Melissa remained pregnant for 13 more weeks and ultimately underwent cesarean section at 32 weeks.

She and her husband were able to hold the deceased twin for several hours after delivery. Her live twin did well; she spent a few weeks in the neonatal intensive care unit (NICU) and is now home and thriving.

Samantha’s twins were not identical, and were conceived through in vitro fertilization. At 14 weeks, we found that one of the twins, a boy, had several serious abnormalities. Even at that early gestational age, we knew that he would not live for long after birth, and might pass away during the pregnancy. The other twin, a girl, appeared normal throughout the pregnancy. Continue reading

Son, Mom, Psychiatrists Reflect On Finding Your Own Way With ADHD

Peter and Ellen Braaten (courtesy)

Peter and Ellen Braaten (courtesy)

Peter Braaten, now 20, still retains an indelible third-grade memory of being unable — simply unable — to stay seated in a reading circle. “And I just started walking around, because that’s what made me feel okay at the time. And the teacher said, ‘No, sit down, sit down.’ And I basically just couldn’t sit there, because I felt unsettled at the time. And I just couldn’t read, I wasn’t getting into it, so I kept pacing, kept pacing…”

Ellen Braaten, PhD, Peter’s mother and the chief child neuropsychologist at Massachusetts General Hospital, is an expert on Attention Deficit Hyperactivity Disorder, but that doesn’t mean it was easy to cope with it in her son. She recalls the “humbling” experience of going to IEP — Individual Education Program — meetings with school staff as a parent rather than an expert: “Peter has seen me in IEP meetings where I’ve had to yell at them…”

They share their experiences in the podcast above with Dr. Gene Beresin, director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital, and the Center’s associate director, Dr. Steve Schlozman, who treated Peter. One central message from the podcast, Dr. Beresin says: “As with every psychological problem, we all have to find out what works for us. Because what works for one person is not necessarily what works for all. There are no magic bullets. No platitudes. No simplistic answers.” But Peter is now earning all A’s in community college, helped in part by academic coaching and regular exercise. The post below supplements the podcast above.

By Peter Braaten, Ellen Braaten and Gene Beresin
Guest contributors

Peter:

One of the most difficult things for me about being diagnosed with ADHD (especially at such an early age) was understanding this as a helpful push in the right direction. It was very hard for me to appreciate what a “diagnosis” means. Does it just mean a guide for treatment? Well, that might be fine for a doctor, but in my experience it is not good guide for others. In some ways, it significantly influences the ways others view you. Some understand what it means, while others don’t — some adults around me did not even believe it exists or just seemed to disregard it.

‘I have gotten in trouble more times than days I’ve lived on this planet.’

Context is what I find difficult with this diagnosis. It is really something that affects every aspect of your life, which is why it is so hard for other people (teachers, parents, etc.) to understand what it means for an individual to have ADHD. A diagnosis in itself does not inform others around you what tasks are easy or difficult. It does not differentiate effort levels. So for me, some activities have been pretty easy to accomplish, while others are very hard, if not impossible, without some kind of coaching. And the amount of energy that it takes me to do different projects is highly variable. But only I know this, and a teacher, parent, friend might not know what I am going through — they are not living my life.

We live in a world where results are everything. Too often I have been told to just ‘try harder.’ Well, ‘trying hard’ just doesn’t cut it anymore – it is not so simple if you have ADHD, and especially if you have problems with organization in some tasks. I have gotten in trouble more times than days I’ve lived on this planet because I complete 85% of an assignment, task, or any kind of job. And then when I just cannot do the rest, others around get angry, frustrated, or don’t understand. And worse, I get really down on myself! Continue reading

Work-Family Crunch: Parents Resort To ER To Get Kids Back Into Daycare

(Bob Reck via Compfight)

(Bob Reck via Compfight)

Some of the tension between work and family is inevitable. If your child comes down with the flu on the very day you’re supposed to give a major presentation, there’s just no way you can be everywhere you’re needed at the same time.

But a study just out in the journal Pediatrics shows that the discrepancy between the sick-child policies at many daycare centers and accepted medical wisdom could often make the work-family crunch harder than it has to be. (Meanwhile, a day-long White House “summit” today is looking at ways to ease that crunch for American parents, from promoting more flexible work schedules to paid maternity leaves.)

From the study’s press release:

Substantial proportions of parents chose urgent care or emergency department visits when their sick children were excluded from attending child care, according to a new study by University of Michigan researchers.

The study, to be published June 23 in Pediatrics, also found that use of the emergency department or urgent care was significantly higher among parents who are single or divorced, African American, have job concerns or needed a doctor’s note for the child to return.

Previous studies have shown children in child care are frequently ill with mild illness and are unnecessarily excluded from child care at high rates, says Andrew N. Hashikawa, M.D., M.S., an emergency physician at  C.S. Mott Children’s Hospital. This is the first national study to examine the impact of illness for children in child care on parents’ need for urgent medical evaluations, says Hashikawa.

In the study, 80 percent of parents took their children to a primary care provider when their sick children were unable to attend child care. Twenty-six percent of parents also said they had used urgent care and 25 percent had taken their children to an emergency room.

“These parents may view the situation as a socioeconomic emergency,” Dr. Hashikawa says.

He got interested in this topic, he told me, when he was a med student working in an ER, and one night, a family brought in children who looked fine, they just had a little bit of red in their eyes. “And it was midnight, and I asked them, ‘Why are you here?’ I was just so curious. And they said ‘Well, I’ve got to work, I’m not going to get paid, and I really need a doctor’s note for both my work and for my daycare so I can send them back.'”

A bit more of our conversation, lightly edited:

How much does daycare keep kids out unnecessarily?

There are different ways to look at it…A Maryland study showed that for every one appropriate exclusion (from daycare) approximately five or six were inappropriate exclusions. I did a study from a daycare provider standpoint: If we gave you a hypothetical scenario, how many of these kids would you send home that probably didn’t need to be excluded? It seemed that 57% of kids would be unnecessarily excluded at that point.

The American Academy of Pediatrics has guidelines on when children should actually be kept home, right? Continue reading

Unraveling My Childhood Asthma: Did Motherhood Cure It?

By Sarah Baker
Guest contributor

I recently started singing lessons — a rather mind-blowing pursuit, since for much of my life, singing was out of the question. How can you sing when you can’t even breathe?

At 18 months old, while my dad, mom, older brother and I were driving from Virginia to San Francisco for my father’s new Naval deployment, I started wheezing. The asthma attack landed me in the hospital.

Emergency room visits and hospital stays punctuated my childhood and early adulthood. I could have been a tour guide of any Intensive Care Unit: “Over on the right is a shot of adrenaline, or epinephrine — try that first. If that doesn’t work, try the nebulizer on the left and IV over there.” These visits became so routine that as I got older, I often told the doctors and nurses what medicines I needed: Prednisone. Albuterol. Theophylline. These were the mainstays, but there were many others over the years. I took them in such large doses that one time they made my blood toxic.

Circa 1970: The author, center, with her brother and mother, shortly before the discovery of her mom's fatal brain tumor.  (Courtesy)

Circa 1970: The author, center, with her brother and mother, shortly before the discovery of her mom’s fatal brain tumor. (Courtesy)

Emergency was a word my family understood. My mother was diagnosed with a brain tumor when I was 3 years old; she was 28. For five years, until her death, she battled her disease in and out of the hospital, too. I went to Bethesda Naval and she went across the state to Johns Hopkins in Baltimore. I don’t remember ever seeing her hospital nor do I recall her ever seeing mine.

A Motherless Child’s Stress

Asthma is a disease of the respiratory system. It is serious business. Seneca, the Roman philosopher and Stoic dedicated an essay to it, called “Asthma,” in which he said that of all the ailments he’d suffered, asthma was the worst of them all. “Doctors have nicknamed [asthma] ‘rehearsing death,’ he wrote.

But asthma also has a powerful psychological or psycho-social component; with symptoms potentially exacerbated by emotional stress. As a child, I never realized it, but looking back I see it clearly: for all my suffering, asthma distinguished me. Got me noticed. In a childhood of disorder — marked by my mother’s death, and family chaos and constant moving — my own illness provided order. It wasn’t until the birth of my first child that my symptoms truly ceased. Continue reading

Mom’s Memo To Schools: Please, Make These Random Half-Days Stop

May I share with you the delights of my children’s April school schedule? They get out at 12:40 because of parent-teacher conferences on these days sprinkled through the month: Tues., April 1; Weds., April 9; Tues., April 29. Oh, yes, and just when you thought it was safe, one more on May 7. (Plus they’re off April 18-25 for spring vacation.)

That’s in addition to our new regular Friday early dismissals at 1:40. When we got word of that, one mother I know said to the superintendent, “You must really hate parents.”

I don’t think the administration hates us, but I do think that perhaps we haven’t spoken up loudly enough about the logistical stress these half-days create. And they’re common around the state, from year-round early-release Tuesdays in Newton to April half-Wednesdays in Westwood.

They’re an old tradition. Many of us remember the joys of occasional half days from our own school years. You know, back when our mothers were mostly housewives. Now, virtually all mothers work, and I venture to say that virtually all working parents wish that all our public schools provided universal, affordable after-school care.

(Photo: Rachel Zimmerman)

(Photo: Rachel Zimmerman)

Or at the very least, reliable after-school care on random half-days. At our school, a team of mothers has created a “half-day matinee,” gathering all the children who need looking after for a movie that runs until the normal 2:30 dismissal time. But their altruistic efforts are in danger of being overwhelmed by demand: More than 200 children have been coming to the movies this month, straining even their heroic volunteer powers.

“First-world problems,” you may say, and I’d agree but go a step further: This is specifically a first-world middle-class problem. Continue reading

Marathon Reflection: How To Raise Secure Children In An Insecure World?

Police clear the area at the finish line of the 2013 Boston Marathon as medical workers help injured following the explosions. (Charles Krupa/AP)

Police clear the area at the finish line of the 2013 Boston Marathon as medical workers help the injured following the explosions. (Charles Krupa/AP)

One year ago, on the day of the Boston Marathon bombing, Dr. Gene Beresin shared advice on how to talk to children about the frightening event. Here, a year later, he and Dr. Paula Rauch, a fellow professor of psychiatry at Harvard Medical School, help parents draw broader lessons about how best to help children face such stresses and even grow through them.

By Drs. Paula K. Rauch and Gene Beresin
Guest contributors

For the most affected families, April 15th, 2013 was a life-changing event. For many in our community it produced a lesser, but still significant, set of challenges, and for some facing other family adversity or chronic stresses, it may have seemed like a minor event with little personal impact.

Regardless of how personal or significant the marathon bombing and its aftermath were for you, every one of us will face life challenges within our families and in the larger community. How can we face stressful experiences in ways that support our children’s resilience, and help them grow through those challenges? How do we raise secure, confident children in an uncertain world?

Start small

Children develop confidence and competence by facing new experiences, difficult transitions and unavoidable frustrations throughout childhood. Life continually presents a child with developmental challenges, such as falling asleep alone in a crib, saying goodbye at a new preschool, facing the first day of school with a sea of unfamiliar faces, dealing with a relentlessly annoying peer, being cut from the travel team, and, for some teens, making this month’s tough decisions about college.

It is often tempting as a parent to want to smooth over these challenges, alleviate uncertainty and facilitate a child’s comfort and success. But it is important to recognize that these age-appropriate frustrations and disappointments are essential for building lifelong coping skills. Children need to learn how to manage new and difficult situations, and while parents cannot solve the challenges for a child, they can provide appreciation and emotional support for that child’s efforts. Living through a multitude of such experiences makes the normal feelings of distress more familiar and less frightening.

Face serious challenges together Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading