tag:theconversation.com,2011:/africa/topics/developmental-disorders-4893/articlesDevelopmental disorders – The Conversation2024-01-11T19:10:53Ztag:theconversation.com,2011:article/2173812024-01-11T19:10:53Z2024-01-11T19:10:53ZWhat is ‘parent training’ for families of children with ADHD?<figure><img src="https://images.theconversation.com/files/566509/original/file-20231219-21-5nuf85.jpg?ixlib=rb-1.1.0&rect=9%2C9%2C6125%2C3439&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-telling-his-wife-front-1677115807">DC Studio/Shutterstock</a></span></figcaption></figure><p>Problems with focus and impulse control can be common developmental stages through which children and adolescents naturally progress. But they can also be symptoms of attention-deficit hyperactivity disorder <a href="https://www.cdc.gov/ncbddd/adhd/facts.html">(ADHD)</a>, a chronic condition. </p>
<p>ADHD is a pattern of inattention or hyperactivity and impulsivity (or both) that interferes with functioning or development, and persists <a href="https://theconversation.com/do-kids-grow-out-of-adhd-as-they-get-older-218692">into adulthood</a>. ADHD affects around <a href="https://link.springer.com/article/10.1186/s13052-023-01456-1">7.6% of children</a> aged three to 12 years and 5.6% of teens.</p>
<p>ADHD can significantly influence family dynamics and can affect a child’s ability to learn and interact socially. Raising children with behavioural, developmental or learning difficulties can also make parenting more challenging, with parents navigating feelings of frustration, grief and guilt.</p>
<p>While medication is <a href="https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf">most effective</a> at minimising core ADHD symptoms, non-drug interventions can also <a href="https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf">reduce</a> the daily impacts of ADHD symptoms. Parenting/family training is one such <a href="https://www.tandfonline.com/doi/full/10.1080/15374416.2017.1390757?needAccess=true">intervention</a>. So what does it involve and is it effective?</p>
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Read more:
<a href="https://theconversation.com/adhd-medications-have-doubled-in-the-last-decade-but-other-treatments-can-help-too-191574">ADHD medications have doubled in the last decade – but other treatments can help too</a>
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<h2>Positive praise and natural consequences</h2>
<p>Parenting training is widely used and can take different forms. Sometimes a psychologist works with one or both parents to give them skills specific to their family and situation. It’s sometimes a structured in-person program for groups of parents. It can also be delivered online, at parents’ own pace or in virtual classrooms.</p>
<p>Most parent/family training will teach parents forms of:</p>
<ul>
<li><p><strong>positive praise</strong>. Notice when your child is behaving in a desirable way and give them positive feedback. For example,“Wow, you’re playing so nicely. I really like the way you’re keeping all the blocks on the table.” Praise nurtures self esteem and their sense of self. Praise teens for starting homework without being reminded or coming home at the agreed time </p></li>
<li><p><strong>effective limit-setting</strong>. Establish ground rules in a quiet moment of family time, where everyone has a say and understands the boundaries, consequences, and expectations </p></li>
<li><p><strong><a href="https://pubmed.ncbi.nlm.nih.gov/30738545/">natural consequences</a></strong>, such as missing out on watching a TV show because packing up took too long. This allows the child to experience failure or loss, but empowers them with what they can focus on or improve the next time round</p></li>
<li><p><strong>planned ignoring of annoying but not serious behaviours</strong> such as making faces or messy rooms. Make a decision to ignore it and breathe. Model desirable behaviours, such as looking after your possessions and fitting in with family life </p></li>
<li><p><strong>positive parent-child interactions</strong>. “Connection before correction” helps a parent shape their child’s behaviour and can <a href="https://linkinghub.elsevier.com/retrieve/pii/S0890-8567(18)31980-4">reduce disruptions</a>.
Emotionally connect by, for example, establishing eye contact, using a gentle tone and getting down on their level. This attunement allows the child to be able to regulate their behaviour and better manage their emotions. </p></li>
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<img alt="Dad talks to child in garden" src="https://images.theconversation.com/files/566515/original/file-20231219-29-tw0fa5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566515/original/file-20231219-29-tw0fa5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566515/original/file-20231219-29-tw0fa5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566515/original/file-20231219-29-tw0fa5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566515/original/file-20231219-29-tw0fa5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566515/original/file-20231219-29-tw0fa5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566515/original/file-20231219-29-tw0fa5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Your responses can reduce their disruptive behaviour.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/man-in-blue-crew-neck-t-shirt-beside-woman-in-blue-crew-neck-t-shirt-eyfaunEy9dM">Max Harlynking/Unsplash</a></span>
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<p>Parents aren’t to blame for their child’s symptoms; the aim of training is to teach parents skills to meet the above-average parenting needs of children with ADHD. </p>
<p>Take inattention, for example. If a task is boring to a child with ADHD, their brain will struggle to pay attention – even if they want to. <a href="https://www.youtube.com/watch?v=_tpB-B8BXk0">ADHD</a> clinical neuropsychologist Russell Barkley explains ADHD like this: the back part of the brain is where you learn, the front part is what you do, and ADHD splits them apart. You can know things but you won’t do them – it’s a performance disorder.</p>
<p>Having a few household rules, schedules, opportunities to problem-solve, effectively using instructions and, most importantly, expressions of <a href="https://5lovelanguages.com/">love</a> can give children positive environments that will help their mental health over time. </p>
<h2>How effective is parent training?</h2>
<p>The <a href="https://adhdguideline.aadpa.com.au/">Australian evidence-based ADHD treatment guidelines</a> reviewed the evidence and found medication treatment was more effective than non-pharmacological treatment in reducing core ADHD symptoms. But combined therapies were better than either treatment alone. </p>
<p>The United Kingdom’s National Institute of Clinical Excellence <a href="https://www.nice.org.uk/guidance/ng87/chapter/Recommendations#managing-adhd">recommends</a> ADHD management plans include treatments to address the child’s psychological, behavioural and educational or occupational needs.</p>
<p>There is <a href="https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf">evidence to support</a> parenting training for children aged five to 17, and greater evidence for its use in children under five and families of children who also have <a href="https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831">oppositional defiant disorder</a> or <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/conduct-disorder">conduct disorder</a>, who require more intensive support. </p>
<p>But more research is needed about the duration and form of the parent training. </p>
<p>The <a href="https://www.who.int/publications/i/item/9789240065505">World Health Organization</a> also recommends parenting interventions because they strengthen the parent-child relationship, assist with alternatives to <a href="https://www.cam.ac.uk/research/news/harsh-discipline-increases-risk-of-children-developing-lasting-mental-health-problems">violent discipline</a> and reduce emotional problem behaviours in children. </p>
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Read more:
<a href="https://theconversation.com/1-in-4-adults-think-smacking-is-necessary-to-properly-raise-kids-but-attitudes-are-changing-218837">1 in 4 adults think smacking is necessary to 'properly raise' kids. But attitudes are changing</a>
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<h2>How do you access parent training?</h2>
<p>Most psychologists offer family training and will charge you the same fee as a normal session. </p>
<p>You can also upskill with the free <a href="https://www.triplep-parenting.net.au/qld-en/free-parenting-courses/triple-p-online-under-12/?gad_source=1&gclid=CjwKCAiAvdCrBhBREiwAX6-6UlIdcIunlsTq4iB0-J6xZN1Bl3wA1Dj9bmN6GuXUG_InDq5HeYHPSxoCjuIQAvD_BwE#au-parents-register-now">Triple P Parenting Program</a> online. </p>
<p>Happy Families also has an online <a href="https://www.happyfamilies.com.au/shop/product/pin-parenting-adhd-the-course">parenting ADHD course</a>. </p>
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<img alt="Mother sits on laptop in doorway" src="https://images.theconversation.com/files/566513/original/file-20231219-15-d4eqa7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566513/original/file-20231219-15-d4eqa7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566513/original/file-20231219-15-d4eqa7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566513/original/file-20231219-15-d4eqa7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566513/original/file-20231219-15-d4eqa7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566513/original/file-20231219-15-d4eqa7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566513/original/file-20231219-15-d4eqa7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">You can do parent training online.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-sitting-on-the-floor-using-a-laptop-ddcLX7Iis44">Surface/Unsplash</a></span>
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<p>Bond University researchers are also conducting a free, <a href="https://research.bond.edu.au/en/persons/cher-mcgillivray/?_ga=2.48431014.1617715341.1703022536-540923691.1665619219">online group parenting program</a>, which includes positive parenting skills. This will be part of a randomised control trial to develop an evidenced-based parenting intervention.</p>
<p>The aim with all of these programs is to better understand the child’s life and have <a href="https://self-compassion.org/wp-content/uploads/publications/GilbertCFT.pdf">compassionate</a> responses to their ADHD and behavioural symptoms. So rather than just focusing on their behaviour – which is an outward expression of an inward emotion – it encourages parents to embrace their uniqueness and help them in their struggles. </p>
<h2>How else can you support your child with ADHD?</h2>
<p>Set <a href="https://drsharonsaline.com/2021/05/18/parenting-older-teens-with-adhd-land-the-helicopter-and-focus-on-scaffolding/">boundaries</a> and be clear about your expectations, but also be compassionate to your child and pick your battles.</p>
<p>Break instructions into simple tasks and allow them to choose and focus on one thing they’re struggling with at a time. Brainstorm what they need to improve, or an area that frustrates them. This will often be organisation, time management and planning. Ask how you can help and stay calm. Celebrate the small wins along the way. </p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/my-kid-is-biting-hitting-and-kicking-im-at-my-wits-end-what-can-i-do-194639">My kid is biting, hitting and kicking. I’m at my wit’s end, what can I do?</a>
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<p>Be curious and seek to understand and connect with your child. Even though your relationship may feel strained or disconnected at times, remember disagreement need not destabilise the relationship. Children express their full emotions, without restraint, among people they feel most safe with. </p>
<p>Finally, ensure you look after yourself, connect with other parents who can support you. Try not to place your anxiety, stress and fears onto your child. Talk to a friend or psychologist so your child feels safe and able to share anything with you and knows you will cope.</p><img src="https://counter.theconversation.com/content/217381/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cher McGillivray does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Raising children with behavioural, developmental or learning difficulties can also make parenting more challenging. So how can parent training help?Cher McGillivray, Assistant Professor Psychology Department, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2166862024-01-03T17:41:27Z2024-01-03T17:41:27ZDyspraxia affects children’s wellbeing – here’s how parents and caregivers can help<figure><img src="https://images.theconversation.com/files/567121/original/file-20231221-22-obf0w5.jpg?ixlib=rb-1.1.0&rect=23%2C59%2C7106%2C5237&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lonely-asian-school-boy-watches-his-1479198308">Vietnam Stock Images/Shutterstock</a></span></figcaption></figure><p>It’s likely <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2066137/">at least one child</a> in every classroom has movement difficulties in the form of developmental coordination disorder (DCD), also known as developmental dyspraxia.</p>
<p>DCD is a disorder that affects a child’s ability to perform and learn everyday tasks that require <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dmcn.14132">motor coordination</a>. Children with DCD typically struggle with academic tasks such as handwriting, as well as dressing themselves and using cutlery and tools. They may <a href="https://dcdaustralia.org.au/what-is-dcd-2/">find it difficult</a> to play ball games or to learn to ride a bike or swim. Parents also report that their children with DCD are <a href="https://dcdaustralia.org.au/wp-content/uploads/2022/09/Impact-for-DCD-Report-Summary.pdf">more tired</a> than other children at the end of the day. </p>
<p>When these skills are hard and frustrating to learn – and tiring too – a child’s motivation to take part in them can wane, along with their self-belief. </p>
<h2>Hidden struggles</h2>
<p>DCD is a <a href="https://dyspraxiafoundation.org.uk/what_is_dyspraxia/dyspraxia-at-a-glance/">common childhood disorder</a>. Children with DCD often also have one or more <a href="https://dyspraxiafoundation.org.uk/what_is_dyspraxia/dyspraxia-foundation-faqs/">other developmental disorders</a>, such as ADHD, autism and developmental language and learning disorders. But because children with DCD often avoid the tasks they struggle with, their issues may become invisible. </p>
<p>Children with DCD often have lower <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770330/">academic attainment</a> than their peers. Parents in Australia reported that they believed the <a href="https://dcdaustralia.org.au/wp-content/uploads/2022/09/Impact-for-DCD-Report-Summary.pdf">main challenges</a> at school for their children with DCD were “teacher awareness of the condition, fatigue and keeping up in class, making friends and socialising, inclusion in the playground, and bullying”.</p>
<p>Children with DCD are likely to take part in less <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/oti.1393">physical activity</a> than peers. This can be exacerbated by adult leaders not knowing how to successfully integrate children with DCD into a <a href="https://journals.lww.com/pedpt/fulltext/2018/04000/role_of_pediatric_physical_therapists_in_promoting.9.aspx">team sport environment</a>. Children with DCD are more likely to choose <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/oti.1393">sedentary activities</a>, such as reading and playing computer or board games. </p>
<p>This can result in less physically active lifestyles and lower physical fitness and <a href="https://www.sciencedirect.com/science/article/pii/S0891422218301264?via%3Dihub">cardiovascular health</a>. </p>
<p>What’s more, avoiding group and social activities can lead to a child with DCD becoming left out – and this has an impact on their happiness. Children with DCD often <a href="https://www.sciencedirect.com/science/article/pii/S0891422221002365#:%7E:text=Children%20with%20developmental%20coordination%20disorder,dimensions%20than%20typically%20developing%20peers.">score lower</a> on quality of life measures than their peers in areas including physical wellbeing and friendships. DCD <a href="https://link.springer.com/article/10.1007/s11136-018-2075-1">also affects</a> parents’ and siblings’ wellbeing, family life and the parents’ work. </p>
<p>Adults with suspected DCD <a href="https://www.sciencedirect.com/science/article/pii/S089142221300005X">report issues</a> with anxiety and depression and rate their life satisfaction fairly poorly. </p>
<h2>Taking action</h2>
<p>Seeking a referral to a health professional who is versed in paediatric treatment can be a positive first step to help a child deal with DCD. Telehealth programmes – remote healthcare that takes place, for instance, over video call – to help improve motor skills are just starting to emerge, with <a href="https://journals.sagepub.com/doi/pdf/10.1177/03080226231181018">preliminary evidence</a> suggesting they are effective. </p>
<p>School- and other group-based activity programs are <a href="https://www.sciencedirect.com/science/article/pii/S0891422218300027">also beneficial</a> for skill development, social interaction and fitness, but are not widely available. Active video games <a href="https://www.sciencedirect.com/science/article/pii/S0891422218300027">may also be useful</a> to hone skill and fitness. <a href="http://elearningcanchild.ca/dcd_workshop/index.html">Online resources</a> can help point parents towards ways to assist their child with activities they find difficult. </p>
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<img alt="Boy writing in notebook with pencil" src="https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567141/original/file-20231221-23-wxxywl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">DCD can make handwriting difficult.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/student-drawing-pencil-on-notebook-boy-1582631920">Fabio Principe/Shutterstock</a></span>
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<p>Raising awareness of DCD matters. It has consequences for the child and their families, but also for society. <a href="https://journals.sagepub.com/doi/10.1177/0308022619866642">Research has found</a> that in the UK, the average direct healthcare cost to parents of a child with DCD. over a six-month period was £700. But this does not take into account any changes to employment – affecting the workforce – that might be needed to accommodate care needs. </p>
<p>Awareness of DCD remains low, which means children are not receiving the support they desperately need. Parents also report difficulties <a href="https://journals.sagepub.com/doi/10.1177/0308022619866642">accessing services</a> for their children. </p>
<p>For parents or caregivers, it is recommended that their child with DCD receive intervention delivered by healthcare professionals with the relevant <a href="https://onlinelibrary.wiley.com/doi/10.1111/dmcn.14132">training and expertise</a>. Informed intervention that considers the individual aspirations and preferences of the child, and that integrates sound motor learning strategies will enable them to improve their motor skills, build confidence, and meet their life goals.</p><img src="https://counter.theconversation.com/content/216686/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Dunford receives funding from Elizabeth Casson Foundation.
Authors: Carolyn Dunford, Peter Wilson, Mellissa Prunty as part of the “DCD Big Ideas Group” 25 key researchers in the field of DCD (from early-career to established) working to develop a clear vision for the future of research on DCD.</span></em></p><p class="fine-print"><em><span>Mellissa Prunty receives funding from The Royal College of Occupational Therapists. She is also Chair of the National Handwriting Association.</span></em></p><p class="fine-print"><em><span>Peter Wilson receives funding from the Australian Automobile Association (AAA), and previously from the Australian Research Council (ARC). </span></em></p>Children with DCD often avoid the tasks they struggle with, meaning their issues may become invisible.Carolyn Dunford, Reader in Occupational Therapy, Brunel University LondonMellissa Prunty, Reader in Occupational Therapy, Brunel University LondonPeter Wilson, Professor of Developmental Psychology, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2120972023-08-28T01:53:41Z2023-08-28T01:53:41Z20% of children have developmental delay. What does this mean for them, their families and the NDIS?<p>Professor Bruce Bonyhady is often described as the architect of the National Disability Insurance Scheme (NDIS) and is co-chair of the panel reviewing it. He <a href="https://www.ndisreview.gov.au/sites/default/files/2023-08/a-question-of-balance-speech.pdf">spoke last week</a> about the sustainability challenges faced by the scheme. </p>
<p>Among the key issues identified was that <a href="https://www.abc.net.au/news/2023-08-22/concerns-about-ndis-raised-by-co-chair-of-review/102758296">20% of Australian children</a> experience learning difficulties, developmental concerns, developmental delay or are found to have disability. Bonyhady <a href="https://www.ndisreview.gov.au/news/future-ndis-and-where-we-are-heading">said</a> this made it a “mainstream issue”. He added the NDIS was never designed to be the main support system for the majority of these children. </p>
<p>With the <a href="https://www.ndisreview.gov.au/resources/reports/what-we-have-heard-report">NDIS review</a> due to report to state and federal ministers in October, the comments signal a re-calibration of the scheme. </p>
<p>This presents another challenge: which government systems outside the NDIS will embrace the large number of children who need developmental support?</p>
<h2>What is a developmental delay?</h2>
<p><a href="https://raisingchildren.net.au/guides/a-z-health-reference/developmental-delay#:%7E:text=Developmental%20delay%20can%20show%20up,short%20term%20or%20long%20term.">Developmental delay</a> is a general term that refers to young children who are slower to develop communication, physical, social, emotional and cognitive skills than typically expected. The pace of a child’s development can be measured in many ways, one of which is comparing their development to established <a href="https://www.healthdirect.gov.au/developmental-milestones">milestones</a>, such as when they learn their first word or when they learn to walk.</p>
<p>Many things can cause developmental delay. These include biological differences (such as genetic conditions), environmental challenges (including deprivation) or a combination of both. In many cases, the causes of a child’s developmental delay remain unknown.</p>
<p>Developmental delay is a term commonly used in clinical practice, but not included in official diagnostic manuals like the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">Diagnostic and Statistical Manual</a>. This is because developmental delay is viewed as a temporary state in child development. It is most often used for children under five. </p>
<p>As children grow older, some developmentally catch up with their peers. Others continue to lag behind. At a certain point in development – typically around five - children in the latter group will start to be referred to as having a developmental disability. </p>
<p>Developmental disabilities are included in official diagnostic manuals and include autism, attention deficit hyperactivity disorder (ADHD), intellectual disability, specific learning disorders, communication disorders and developmental coordination disorder.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/new-national-autism-guideline-will-finally-give-families-a-roadmap-for-therapy-decisions-199786">New national autism guideline will finally give families a roadmap for therapy decisions</a>
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<h2>Developmental delay and the NDIS</h2>
<p>The NDIS has a <a href="https://www.ndis.gov.au/understanding/families-and-carers/early-childhood-approach-children-younger-9/developmental-delay-and-early-childhood-approach#how-an-early-childhood-partner-will-evidence-developmental-delay-for-children-younger-than-6">specific definition of developmental delay</a> which encompasses three areas. Children are considered to have a developmental delay if their delay is: </p>
<ul>
<li>due to mental or physical impairments</li>
<li>substantially reduces functional capacity</li>
<li>requires specialist services. </li>
</ul>
<p>Around <a href="https://www.ndis.gov.au/about-us/publications/quarterly-reports">11% of all NDIS participants</a> are classified as having a developmental delay. There are also a significant number of children with developmental delay who are not within the NDIS. Taken together, these groups make up about 20% of Australian children under five. </p>
<p>While there is a general community view that developmental delay is an increasing issue in Australia, there is a lack of data tracking over time to understand if this view is accurate.</p>
<p>Our clearest indication comes from <a href="https://www.aedc.gov.au/early-childhood/findings-from-the-aedc">Australian Early Development Census</a>, which surveys more than 300,0000 children entering primary school. </p>
<p>The latest available data indicate there are now slightly fewer children who are “developmentally on track” (down from 55.4% in 2018 to 54.8% in 2021) and an increase in the number of children who are “developmentally vulnerable” in any one area of development (up from 21.7% in 2018 to 22% in 2021). </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-decade-on-the-ndis-has-had-triumphs-challenges-and-controversies-where-to-from-here-208463">A decade on, the NDIS has had triumphs, challenges and controversies. Where to from here?</a>
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</em>
</p>
<hr>
<h2>Supporting children with developmental delay</h2>
<p>There has always been a large number of children experiencing developmental delay. But the fragmentation across state/territory and Commonwealth health and disability systems has meant the true scale of children struggling with development has not been clear. The unified system of the NDIS has made the percentage of children with delays clearer.</p>
<p>But, as Bonyhady notes, the NDIS was not designed to support all these children. The NDIS was meant to complement existing systems such as health and education, and to provide additional support to children with the most significant disability impacts. This figure is estimated to be a small proportion of the 20% of children who meet criteria for developmental delay.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-early-intervention-for-infants-with-signs-of-autism-and-how-valuable-could-it-be-205839">What is 'early intervention' for infants with signs of autism? And how valuable could it be?</a>
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</em>
</p>
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<h2>Meeting children and families where they are</h2>
<p>The NDIS is rightly <a href="https://www.ndisreview.gov.au/news/future-ndis-and-where-we-are-heading">described</a> as a policy miracle, and has benefited hundreds of thousands of Australians – with millions more to come. Its future thriving is highly dependent on how our community supports children with developmental delay. </p>
<p>The NDIS has accelerated a trend for the <a href="https://www.afr.com/policy/economy/children-undermining-the-sustainability-of-the-ndis-20230630-p5dkp7">medicalisation</a> of development supports. Children with developmental delays receive supports within clinics, rather than in the natural settings in which they live and function every day. </p>
<p>This has <a href="https://theconversation.com/more-children-than-ever-are-struggling-with-developmental-concerns-we-need-to-help-families-connect-and-thrive-209866">weakened major protective factors</a> known to support child development, such as community connection and parental empowerment.</p>
<p>Building capacity to support children with developmental delay in their everyday contexts – at home, in childcare, kindergartens or preschools, in the local community – will be crucial to ensuring children with developmental delay and their families thrive into later childhood. </p>
<p>And it will help the NDIS remain the life-changing system it is.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/babies-crawl-scoot-and-shuffle-when-learning-to-move-heres-what-to-watch-for-if-youre-worried-204913">Babies crawl, scoot and shuffle when learning to move. Here's what to watch for if you're worried</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/212097/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse is the Director of CliniKids, which is the community health arm of the Telethon Kids Institute. Children accessing CliniKids may be supported through the NDIS. Andrew receives research funding from NHMRC, ARC, the Autism CRC, and the Angela Wright Bennett Foundation</span></em></p>Developmental delay is viewed clinically as a temporary state where children are slower to develop than expected. It is most often used for children under five.Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1764342022-02-15T13:24:07Z2022-02-15T13:24:07ZHow poisonous mercury gets from coal-fired power plants into the fish you eat<figure><img src="https://images.theconversation.com/files/446121/original/file-20220213-17-gt0hty.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C3000%2C2110&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Coal-fired power plants are a source of mercury that people can ingest by eating fish.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/danielle-gross-casts-his-fishing-line-into-the-potomac-news-photo/478998730">Mark Wilson/Getty Images</a></span></figcaption></figure><p>People fishing along the banks of the White River as it winds through Indianapolis sometimes pass by ominous signs warning about eating the fish they catch. </p>
<p><a href="https://extension.wsu.edu/foodsafety/content/risks-of-mercury-in-fish">One of the risks</a> they have faced is mercury poisoning.</p>
<p>Mercury is a neurotoxic metal that can cause irreparable harm to human health – especially the brain development of young children. It is <a href="https://doi.org/10.1289/ehp.7743">tied to lower IQ</a> and results in decreased earning potential, as well as higher health costs. Lost productivity from mercury alone was calculated in 2005 to reach <a href="https://doi.org/10.1289/ehp.7743">almost $9 billion per year</a>. </p>
<p>One way mercury gets into river fish is with the gases that rise up the smokestacks of coal-burning power plants. </p>
<p><iframe id="FW8zH" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/FW8zH/6/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The Environmental Protection Agency has had a rule since 2012 limiting mercury emissions from coal-fired power plants. But the Trump administration <a href="https://eelp.law.harvard.edu/2019/03/rolling-back-the-mercury-and-air-toxics-standards-proposed-withdrawal-of-appropriate-and-necessary/">stopped enforcing it</a>, <a href="https://www.reuters.com/article/us-usa-epa-coal-mercury/trump-administration-weakens-mercury-rule-for-coal-plants-idUSKCN21Y1IW">arguing that the costs</a> to industry outweighed the health benefit.</p>
<p>Now, the Biden administration is <a href="https://www.epa.gov/newsreleases/epa-reaffirms-scientific-economic-and-legal-underpinnings-limits-toxic-emissions">moving to reassert it</a>.</p>
<p>I study mercury and its sources as a <a href="https://scholar.google.com/citations?user=MEp4948AAAAJ&hl=en">biogeochemist</a> at Indiana University-Purdue University Indianapolis. Before the EPA’s original mercury rule went into effect, my students and I launched a project to track how Indianapolis-area power plants were increasing mercury in the rivers and soil.</p>
<h2>Mercury bioaccumulates in the food chain</h2>
<p>The risks from eating a fish from a river downwind from a coal-burning power plant depends on both the type of fish caught and the age and condition of the person consuming it.</p>
<p>Mercury is a <a href="https://www.usgs.gov/special-topics/water-science-school/science/mercury-contamination-aquatic-environments">bioaccumulative toxin</a>, meaning that it increasingly concentrates in the flesh of organisms as it makes its way up the food chain.</p>
<figure class="align-center ">
<img alt="A person's hands old a smallmouth bass, with the fish's mouth open" src="https://images.theconversation.com/files/446123/original/file-20220213-87622-e0wm9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446123/original/file-20220213-87622-e0wm9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446123/original/file-20220213-87622-e0wm9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446123/original/file-20220213-87622-e0wm9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446123/original/file-20220213-87622-e0wm9c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446123/original/file-20220213-87622-e0wm9c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446123/original/file-20220213-87622-e0wm9c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mercury accumulates as it moves up the food chain.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/holding-a-smallmouth-bass-royalty-free-image/123084571">doug4537 via Getty Images</a></span>
</figcaption>
</figure>
<p>The mercury emitted from coal-burning power plants falls onto soils and washes into waterways. There, the moderately benign mercury is transformed by bacteria into a toxic organic form called methylmercury.</p>
<p>Each bacterium might contain only one unit of toxic methylmercury, but a worm chewing through sediment and eating 1,000 of those bacteria now contains 1,000 doses of mercury. The catfish that eats the worm then get more doses, and so on up the food chain to humans.</p>
<p>In this way, top-level predator fishes, such as smallmouth bass, walleye, largemouth bass, lake trout and Northern pike, typically contain the highest amounts of mercury in aquatic ecosystems. On average, one of these fish contains enough to make eating only <a href="https://www.epa.gov/fish-tech/epa-fda-fish-advice-technical-information">one serving of them per month dangerous</a> for the developing fetuses of pregnant women and for children.</p>
<h2>How coal plant mercury rains down</h2>
<p>In our study, we wanted to answer a simple question: Did the local coal-burning power plants, known to be <a href="https://www.purdue.edu/discoverypark/energy/assets/pdfs/cctr/outreach/Basics2-Mercury-Mar07.pdf">major emitters of toxic mercury</a>, have an impact on the local environment?</p>
<p>The obvious answer seems to be yes, they do. But in fact, quite a bit of research – and coal industry advertising – noted that mercury is a “<a href="https://doi.org/10.1002/etc.1980">global pollutant</a>” and could not necessarily be traced to a local source. A recurring argument is that mercury deposited on the landscape came from coal-burning power plants <a href="https://doi.org/10.1021/es062707c">in China</a>, so why regulate local emissions if others were still burning coal?</p>
<p>That justification was based on the unique chemistry of this element. It is the only metal that is liquid at room temperature, and when heated just to a moderate level, will evaporate into mercury vapor. Thus, when coal is burned in a power plant, the mercury that is present in it is released through the smokestacks as a gas and dilutes as it travels. Low levels of mercury also <a href="https://www.epa.gov/international-cooperation/mercury-emissions-global-context">occur naturally</a>.</p>
<p>Although this argument was technically true, we found it obscured the bigger picture.</p>
<figure class="align-center ">
<img alt="A view of the river with a bridge and the city in the background." src="https://images.theconversation.com/files/446383/original/file-20220214-19-t52yt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446383/original/file-20220214-19-t52yt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446383/original/file-20220214-19-t52yt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446383/original/file-20220214-19-t52yt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446383/original/file-20220214-19-t52yt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446383/original/file-20220214-19-t52yt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446383/original/file-20220214-19-t52yt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People sometimes fish along the White River where it flows through Indianapolis.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/indianapolis-royalty-free-image/520980871?adppopup=true">alexeys via Getty Images</a></span>
</figcaption>
</figure>
<p>We found the overwhelming source of mercury was within sight of the White River fishermen – a large coal-burning power plant on the edge of the city.</p>
<p>This power plant emitted vaporous mercury at the time, though it has since <a href="https://www.transmissionhub.com/articles/2016/02/indianapolis-powers-harding-street-plant-burns-its-last-coal.html">switched to natural gas</a>. We found that much of the plant’s mercury rapidly reacted with other atmospheric constituents and water vapor to <a href="https://doi.org/10.1007/s11270-010-0703-7">“wash out” over the city</a>. It was <a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1002/gbc.20040">raining down mercury on the landscape</a>.</p>
<h2>Traveling by air and water, miles from the source</h2>
<p>Mercury emitted from the smokestacks of coal-fired power plants can fall from the atmosphere with rain, mist or chemical reactions. Several studies have shown <a href="https://doi.org/10.1016/j.jhazmat.2016.01.026">elevated levels of mercury in soils and plants near power plants</a>, with much of the mercury <a href="https://doi.org/10.1038/srep46545">falling within about 9 miles</a> (15 kilometers) of the smokestack.</p>
<p>When we surveyed hundreds of surface soils ranging from about 1 to 31 miles (2 to 50 km) from the coal-fired power plant, then the single largest emitter of mercury in central Indiana, we were shocked. We found <a href="https://doi.org/10.12952/journal.elementa.000059">a clear “plume” of elevated mercury</a> in Indianapolis, with much higher values near the power plant tailing off to almost background values 31 miles downwind. </p>
<p>The White River flows from the northeast to the southwest through Indianapolis, opposite the wind patterns. When we sampled sediments from most of its course through central Indiana, we found that mercury levels started low well upstream of Indianapolis, but <a href="https://doi.org/10.1007/s11270-010-0703-7">increased substantially</a> as the river flowed through downtown, apparently accumulating deposited mercury along its flow path. </p>
<p>[<em>Understand developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p>
<p>We also found high levels well downstream of the city. Thus a fisherman out in the countryside, far away from the city, was still <a href="https://doi.org/10.12952/journal.elementa.000059">at significant risk</a> of catching, and eating, high-mercury fish.</p>
<p>The region’s <a href="https://www.in.gov/health/files/Marion_sensitive_fishadvisory.pdf">fish advisories</a> still recommend sharply limiting the amount of fish eaten from the White River. In Indianapolis, for example, pregnant women are advised to <a href="https://www.in.gov/health/files/Marion_sensitive_fishadvisory.pdf">avoid eating some fish</a> from the river altogether.</p>
<h2>Reviving the MATS rule</h2>
<p>The EPA announced the Mercury and Air Toxic Standards rule in 2011 to deal with the exact health risk Indianapolis was facing. </p>
<p>The <a href="https://eelp.law.harvard.edu/2017/09/mercury-and-air-toxics-standards/">rule stipulated</a> that mercury sources had to be sharply reduced. For coal-fired power plants, this meant either installing costly mercury-capturing filters in the smokestacks or converting to another energy source. <a href="https://www.eia.gov/totalenergy/data/monthly/">Many converted to natural gas</a>, which reduces the mercury risk but still contributes to health problems and global warming.</p>
<p>The MATS rule helped tilt the national energy playing field away from coal, until the Trump Administration <a href="https://www.epa.gov/mats/proposed-revised-supplemental-finding-and-results-residual-risk-and-technology-review">attempted to weaken the rule</a> in 2020 to try to bolster the <a href="https://www.eia.gov/todayinenergy/detail.php?id=44155">declining U.S. coal industry</a>. The administration rescinded a “supplemental finding” that determined it is “appropriate and necessary” to regulate mercury from power plants.</p>
<p>On Jan. 31, 2022, the Biden Administration <a href="https://www.epa.gov/stationary-sources-air-pollution/proposed-revocation-2020-reconsideration-and-affirmation">moved to reaffirm that supplemental finding</a> and effectively restore the standards.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/446071/original/file-20220213-15-aw2lhh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446071/original/file-20220213-15-aw2lhh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=277&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446071/original/file-20220213-15-aw2lhh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=277&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446071/original/file-20220213-15-aw2lhh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=277&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446071/original/file-20220213-15-aw2lhh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=348&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446071/original/file-20220213-15-aw2lhh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=348&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446071/original/file-20220213-15-aw2lhh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=348&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More than a quarter of U.S. coal-fired power plants currently operating were scheduled as of 2021 to be retired by 2035.</span>
<span class="attribution"><a class="source" href="https://www.eia.gov/todayinenergy/detail.php?id=50658">EIA</a></span>
</figcaption>
</figure>
<p>Some economists have calculated the net cost of the MATS rule to the U.S. electricity sector to be about <a href="https://www.nera.com/content/dam/nera/publications/archive2/PUB_MATS_Rule_0312.pdf">$9.6 billion per year</a>. This is roughly equal to the earlier estimates of productivity loss from the harm mercury emissions cause.</p>
<p>To a public health expert, this math problem is a no-brainer, and I am pleased to see the rule back in place, protecting the health of generations of future Americans.</p><img src="https://counter.theconversation.com/content/176434/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gabriel Filippelli does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Biden administration is moving to revive mercury limits for coal-fired power plants. A scientist explains mercury’s health risks and the role power plants play.Gabriel Filippelli, Chancellor's Professor of Earth Sciences and Executive Director, Indiana University Environmental Resilience Institute, IUPUILicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1586352021-05-06T20:08:56Z2021-05-06T20:08:56ZADHD affects girls too, and it can present differently to the way it does in boys. Here’s what to look out for<figure><img src="https://images.theconversation.com/files/399122/original/file-20210506-19-qp2hyx.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5863%2C3896&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Two female Australian comedians recently revealed they’ve been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).</p>
<p>In an interview before her shows at the Melbourne International Comedy Festival, <a href="https://www.theage.com.au/culture/comedy/it-s-good-to-come-back-fiona-o-loughlin-on-comedy-adhd-and-asexuality-20210326-p57eev.html">Fiona O’Loughlin</a> alluded to lifelong challenges including disorganisation and inability to sustain attention. </p>
<p>O'Loughlin, 57, described her diagnosis as a “seismic shift” in her life, and said medication has helped her immensely. But her struggle with focus will be a story familiar to many girls with ADHD.</p>
<p>And in an article published <a href="https://www.bodyandsoul.com.au/health/em-rusciano-on-being-diagnosed-with-adhd-as-an-adult/news-story/8df3c0ca7e38b4de5f8516d9367011ec">this week</a>, Em Rusciano also revealed she’s been diagnosed with ADHD. For Rusciano, too, treatment has been transformative. The 42-year-old wrote <a href="https://www.facebook.com/EmRuscianoOfficial">on Facebook</a>:</p>
<blockquote>
<p>I don’t feel the world coming at me at 100 all the time anymore. The constant sensory overload has stopped. I don’t feel overwhelmed by life quite as much.</p>
</blockquote>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1388629305215889413"}"></div></p>
<p>While some of us might perceive ADHD as a condition that affects males (particularly boys), it affects girls and women too. And it’s important to understand that the way it presents in girls can be quite different to the way it manifests itself in boys.</p>
<h2>What is ADHD?</h2>
<p>Best understood as a persistent, and sometimes lifelong, neurodevelopmental disorder, <a href="https://www.guilford.com/books/Attention-Deficit-Hyperactivity-Disorder/Russell-Barkley/9781462538874">ADHD</a> <a href="http://ndl.ethernet.edu.et/bitstream/123456789/42255/2/Lily%20Hechtman.pdf#page=206">includes problems</a> with sustaining attention, resisting distraction, and moderating activity levels to suit the environment (for example, sitting in a classroom).</p>
<p>Young people with ADHD <a href="http://www.russellbarkley.org/factsheets/TheWorldFederationOfAdhdGuide.pdf">vary considerably</a> in their behaviours. A child might exhibit symptoms of hyperactivity-impulsivity (for example, fidgeting and squirming, or frequently leaving their seat in class), or inattention (careless mistakes, trouble focusing in class, difficulty keeping their belongings in order), or more commonly, both. Hyperfocus (an intense fixation on one activity) can also be a symptom.</p>
<p>Of course, these behaviours are common in childhood to varying degrees. Diagnosis is based on whether symptoms are excessive for the child’s age, developmental level, and cultural background (parents across <a href="https://central.bac-lac.gc.ca/.item?id=NR50775&op=pdf&app=Library&oclc_number=720806889">different cultures</a> <a href="https://journals.lww.com/jrnldbp/Abstract/2006/04000/Mothers__Views_on_Hyperactivity__A_Cross_Cultural.6.aspx">may differ</a> in whether they see a child’s behaviour as hyperactive or normal).</p>
<p>A <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">diagnosis</a> is only made if there’s clear evidence that the symptoms impair functioning across several life domains such as at school, at home and with friends.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-not-a-crime-to-have-adhd-26307">It's not a crime to have ADHD</a>
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</em>
</p>
<hr>
<h2>Does ADHD look different in girls?</h2>
<p>Researchers have only recently <a href="https://journals.sagepub.com/doi/abs/10.1177/1087054711416909">started to unravel</a> the expression of ADHD in girls. </p>
<p>The way ADHD presents in girls and boys is <a href="https://psycnet.apa.org/record/2014-57877-009">in many ways similar</a>, but there are <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890856709614258">a few noteworthy differences</a>. Most importantly, while symptoms of hyperactivity-impulsivity are present across genders (with some studies showing more hyperactivity in boys), <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/">symptoms of inattention</a>, which can be easier to overlook, are seen more frequently in girls. </p>
<p>Further, the onset of ADHD symptoms can <a href="https://www.sciencedirect.com/science/article/abs/pii/S0890856709626125">differ across gender</a>. Symptoms of hyperactivity tend to present early in school life. Inattentiveness, by contrast, has a slightly later onset. So girls with ADHD can often <a href="https://journals.sagepub.com/doi/abs/10.1177/1087054711416909">go undetected</a> until academic and organisational demands increase in late primary and high school. </p>
<p>Girls with ADHD are also at higher risk of developing <a href="https://ir.canterbury.ac.nz/bitstream/handle/10092/6292/44177_final%20version%20of%20gender%20paper%20to%20AACAP.pdf?sequence=1">depression and anxiety</a> than boys. If depression and anxiety occur at the same time as ADHD, it can be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/">more difficult</a> to diagnose ADHD. </p>
<p>A <a href="https://journals.sagepub.com/doi/abs/10.1177/1087054711416909">range of possible mechanisms</a> have been implicated in the difference in ADHD expression between genders, from hormonal changes, to cognitive differences, to social factors. But we need more research to truly understand the reasons behind the disparity. </p>
<figure class="align-center ">
<img alt="Two boys in a classroom." src="https://images.theconversation.com/files/399130/original/file-20210506-20-1hwztxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399130/original/file-20210506-20-1hwztxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399130/original/file-20210506-20-1hwztxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399130/original/file-20210506-20-1hwztxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399130/original/file-20210506-20-1hwztxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399130/original/file-20210506-20-1hwztxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399130/original/file-20210506-20-1hwztxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">ADHD tends to be recognised in boys earlier than it is in girls.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Boys versus girls</h2>
<p>ADHD is the <a href="https://www.health.gov.au/resources/publications/the-mental-health-of-children-and-adolescents">most common</a> psychological disorder among Australian youth. The second Australian Child and Adolescent Survey of Mental Health and Wellbeing, published in 2015, reported <a href="https://www.health.gov.au/resources/publications/the-mental-health-of-children-and-adolescents">7.4% of 4-17-year-olds</a> had ADHD over the previous 12 months. </p>
<p>Interestingly, more than twice as many boys have ADHD than girls. The disparity in prevalence may be a result of ADHD being <a href="https://psycnet.apa.org/record/2014-57877-009">historically viewed as a male disorder</a>.</p>
<p>This gender difference in prevalence has prompted controversy about diagnostic criteria and brought the female expression of ADHD into sharper focus. </p>
<p>There’s some suggestion the current <a href="https://psycnet.apa.org/record/1995-09976-001">diagnostic framework</a>, developed on male-dominated samples, is inadequate for girls and sees more boys than girls get a diagnosis. Some researchers have suggested symptom thresholds for diagnosis in girls should be modified. </p>
<p>Are there female expressions of hyperactivity-impulsivity (for example, internal feelings of restlessness) that could be added to the diagnostic criteria? Should there be <a href="https://journals.sagepub.com/doi/abs/10.1177/1087054711416909">gender-specific cut-offs</a> for current criteria (for example, a lower threshold for hyperactivity for girls)? </p>
<p>Until further research is conducted, <a href="https://link.springer.com/article/10.1007/BF01670100">the jury is out</a> on any changes to the current system.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/imaging-study-confirms-differences-in-adhd-brains-73117">Imaging study confirms differences in ADHD brains</a>
</strong>
</em>
</p>
<hr>
<p>Importantly, many parents and teachers have long-held <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395774/">stereotypes of an ADHD child</a> as a disruptive and hyperactive boy with difficulties staying still and keeping on-task. This perceptual bias <a href="https://www.sciencedirect.com/science/article/pii/S0165178118317347">influences who they recognise</a> as potentially having ADHD and refer to treatment. </p>
<p>Research shows even when students display equivalent levels of impairment, <a href="https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.973.2615&rep=rep1&type=pdf">teachers still refer more boys</a> than girls for ADHD treatment.</p>
<h2>Some signs of ADHD in girls</h2>
<p>Does your child do the following <em>more than other children of her age</em>?</p>
<ul>
<li>make careless mistakes</li>
<li>daydream or appear spaced out</li>
<li>fail to pay close attention to details</li>
<li>have difficulty remaining focused in class, reading, homework, conversations</li>
<li>doesn’t seem to listen (appears distracted)</li>
<li>have difficulty organising tasks and materials</li>
<li>is reluctant to engage in tasks that require mental effort (schoolwork, homework)</li>
<li>often loses everyday things</li>
<li>is forgetful in daily activities.</li>
</ul>
<p>Keep an eye out for an increase in symptoms in late primary or early high school, as workload increases.</p>
<p>A good rule of thumb for when it’s time to seek help is when a child is starting to fail, fall behind or perform significantly below their ability either in schoolwork, friendships or family relationships. </p>
<p>There’s no cure for ADHD, but treatment aims to manage symptoms. Across genders, the first line of treatment for children is stimulant medication (such as Ritalin, Adderall or Concerta) and <a href="https://www.tandfonline.com/doi/abs/10.1080/15374416.2013.850700?journalCode=hcap20">behaviour management</a> (parent training and classroom management).</p>
<p>As more research on female ADHD emerges, we can consider treatment modifications specific to gender. </p>
<p>For many girls, ADHD is a serious and debilitating illness. Ensuring girls are identified early and accurately and that they receive evidence-based treatment is crucial. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-out-of-4-kids-with-mental-health-disorders-arent-accessing-care-118597">3 out of 4 kids with mental health disorders aren't accessing care</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/158635/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachael Murrihy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A better understanding of ADHD in girls will enable earlier recognition, diagnosis and, importantly, treatment for girls, than currently exists.Rachael Murrihy, Director, The Kidman Centre, Faculty of Science, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1572282021-03-17T18:59:28Z2021-03-17T18:59:28ZResearchers have grown ‘human embryos’ from skin cells. What does that mean, and is it ethical?<figure><img src="https://images.theconversation.com/files/390046/original/file-20210317-23-d98z9m.jpeg?ixlib=rb-1.1.0&rect=2%2C2%2C374%2C280&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A human blastocyst. Researchers have now created 'model' versions of this early embryonic structure by reprogramming human skin cells.</span> <span class="attribution"><span class="source">Harimiao/Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Researchers have successfully grown model versions of early human embryos by “reprogramming” cells from human skin. The breakthrough potentially opens up new ways to study the earliest phases of human development, learn more about developmental disorders, infertility and genetic diseases, and perhaps even improve the success of IVF treatment. </p>
<p>In a study <a href="https://www.nature.com/articles/s41586-021-03372-y">published in Nature today</a>, a team led by our colleague Jose Polo discovered that when skin cells are treated in a particular way, 3D structures similar to early human embryos form. A <a href="https://www.nature.com/articles/s41586-021-03356-y%C2%A0">US-Chinese research group led by Jun Wu</a> also reported a similar feat, creating structures that resemble a very early stage of the embryo called a “blastocyst”. </p>
<p>While this is an exciting scientific advance, it will also be vital to consider the ethics behind this and other emerging approaches to modelling human development.</p>
<h2>Growing ‘human organs’ in a dish</h2>
<p>Over the past 50 years, research has revealed a lot about how the different organs of our bodies are formed, and what happens at a cellular level during disease and illness.</p>
<p>Many of these insights came from recent breakthroughs in stem cell research, in which scientists can effectively create 3D models, or miniature organs from human tissue, that resemble the structure and function of particular organs in the body.</p>
<p>These structures, known as organoids, have been used to understand <a href="https://theconversation.com/kidney-failing-grow-a-new-one-48834">how kidneys form</a>, learn what happens to the developing brain <a href="https://www.npr.org/sections/health-shots/2016/11/13/501257433/minibrains-could-help-drug-discovery-for-zika-and-for-alzheimers">during a Zika infection</a>, and to test an array of therapies to find the best ways to <a href="https://www.newscientist.com/article/2219051-mini-organs-grown-from-tumour-cells-can-help-us-choose-the-best-chemo/">halt the progression of bowel or pancreatic cancers</a>.</p>
<p>These advances rely on the innate ability of stem cells to organise themselves into characteristic anatomical and functional features when given the right conditions. Researchers can use stem cells taken from a patient’s own tissue to create 3D models of the organ from which those cells were taken. Many, but not all, organs have their <a href="https://www.sciencemag.org/news/2017/08/scientist-building-miniature-guts-livers-and-lungs-could-save-your-life-one-day">own specific stem cells</a>.</p>
<p>Other approaches use a more basic type of stem cell, called “pluripotent stem cells”, obtained from human embryos or created in the lab from a skin or blood cell through a process called reprogramming. This approach means researchers can create stem cells then coax them to mimic how a particular organ forms. While these 3D structures are often referred to as mini-organs, they usually only replicate <a href="https://www.sciencemag.org/news/2017/03/lab-grown-mini-organs-help-model-disease-test-new-drugs">certain aspects of the organ’s architecture and function</a>.</p>
<h2>Exploring the developmental ‘black box’</h2>
<p>While stem cells can reveal much about how organs form, research so far has provided little insight into the complex interplay between the developing embryo and the lining of the womb required to establish and maintain a pregnancy.</p>
<p>This period, covering the first few weeks after implantation, is sometimes referred to as the “black box” of development, as it is extremely difficult to access reproductive material at this early stage. </p>
<p>What’s more, even in countries that allow research on donated IVF embryos, studies are usually limited to just the <a href="https://theconversation.com/destroying-research-embryos-within-14-days-limits-chance-of-medical-breakthroughs-71986">first 14 days</a> after fertilisation, and alternative animal models are of little value in revealing the unique process of human embryo implantation.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/destroying-research-embryos-within-14-days-limits-chance-of-medical-breakthroughs-71986">Destroying research embryos within 14 days limits chance of medical breakthroughs</a>
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</em>
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<p>With miscarriages <a href="https://theconversation.com/miscarriages-affect-1-in-6-pregnancies-we-need-better-investigations-and-treatments-120672">affecting 1 in 6 pregnancies</a>, and high rates of infertility due to failure of embryos to implant, we need better ways to understand and address these devastating outcomes.</p>
<h2>Creating 3D models could provide answers</h2>
<p>Human pluripotent stem cells have been used to create structures that <a href="https://www.genengnews.com/news/stem-cell-based-human-gastruloid-allows-peek-into-black-box-of-embryonic-development/">replicate specific aspects of development</a>, but not the entire embryo, at and immediately after implantation.</p>
<p>The new discoveries reported today offer another way to explore development around the time of implantation. <a href="https://www.the-scientist.com/news-opinion/early-embryo-models-generated-from-mouse-stem-cells-66583">Unlike animal studies</a>, in which the 3D model embryo is compiled by assembling cells from pre-established stem cell lines, this approach relied on adapting the technology used to create induced pluripotent stem cells. </p>
<p>In the approach taken by Polo’s group, skin cells from adult donors were first treated to “reprogram” them over several weeks, effectively resetting their development back to an earlier, less specialised state. </p>
<p>The researchers then grew these cells in 3D clusters for six days, after which some of them formed structures very similar to “blastocysts” — the final stage of embryonic development before implantation. These lab-grown structures are dubbed “iBlastoids”. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic of human and lab-grown blastocysts and iBlastoids" src="https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/390044/original/file-20210317-23-7jje8o.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Growth process for human blastocysts (top) and iBlastoids grown in the lab from human skin cells (bottom).</span>
<span class="attribution"><span class="source">Monash Biomedicine Discovery Institute</span></span>
</figcaption>
</figure>
<p>The second group cultured human pluripotent stem cell lines - both embryonic stem cell lines and those created through reprogramming - in a slightly different two-step process to encourage 3D clusters to form. They called their structures “blastoids”.</p>
<p>While iBlastoids and blastoids both seem to be structurally and functionally similar to real blastocysts, it is not yet clear exactly how closely they resemble true embryos formed by a sperm and an egg. While the models were shown to share gene patterns and respond in culture in ways characteristic of actual embryos, researchers also saw significant anomalies, such as unsynchronised growth and cells that are not usually present in an embryo.</p>
<h2>Ethical issues</h2>
<p>It can be hard to decide where we should draw the ethical line between using stem cells to grow “model embryos”, and research on real human embryos created by IVF.</p>
<p>Some people may see no ethical distinction between these two processes at all. Others might support the creation of models but only for specific types of research, such as to understand the origins of infertility or genetic disease. Those people may draw the line at attempts to use these models to test gene-editing techniques to correct genetic diseases rather than simply study them.</p>
<p>When considering these ethical issues, we need to address three important questions: </p>
<ul>
<li><p>what are the likely benefits? </p></li>
<li><p>can the scientific goals be met by other means? </p></li>
<li><p>what is the appropriate oversight process?</p></li>
</ul>
<p>While 3D models are not human embryos, existing national laws around the creation and use of IVF embryos may provide useful guidance and oversight. Many countries have specialised review committees to provide independent advice to researchers and ensure ethical transparency.</p>
<p>Above all, we need to approach this issue carefully. The science is complex, and likely to trigger many of the same concerns raised 25 years ago by breakthroughs in <a href="https://theconversation.com/dolly-the-sheep-and-the-human-cloning-debate-twenty-years-later-63712">cloning technology</a>. One thing seems clear, just as it was back then: this new technology should only be used for laboratory research. Any attempt to use it to establish pregnancies in humans or animals must be strictly prohibited. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dolly-the-sheep-and-the-human-cloning-debate-twenty-years-later-63712">Dolly the Sheep and the human cloning debate - twenty years later</a>
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</em>
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<hr>
<p>The <a href="https://www.isscr.org/news-publicationsss/isscr-news-articles/article-detail/2020/01/16/isscr-statement-on-ethical-standards-for-stem-cell-based-embryo-models">International Society for Stem Cell Research will soon release a new set of guidelines</a> that are likely to provide more explicit recommendations for research in human embryo modelling. As it has done in the past for other ethically charged issues, this global approach is essential. There is too much at stake to ignore the complexities.</p><img src="https://counter.theconversation.com/content/157228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megan Munsie receives funding from the Australian Research Council and the Medical Research Future Fund. She is a non-executive director with the National Stem Cell Foundation of Australia, Vice-President of the Australasian Society for Stem Cell Research, Chair of the Ethics Committee of the International Society for Stem Cell Research and a member of the taskforce currently updating the ISSCR Guidelines.</span></em></p><p class="fine-print"><em><span>Helen Abud receives funding from the National Health and Medical Research Council, Cancer Australia, Cancer Council Victoria and the Australian Research Council. She is President of the Australian Society for Stem Cell Research</span></em></p>Two research groups have turned human skin cells into structures resembling an early-stage human embryo, paving the way for exciting new research avenues, and opening up some tricky ethical questions.Megan Munsie, Deputy Director - Centre for Stem Cell Systems and Head of Engagements, Ethics & Policy Program, Stem Cells Australia, The University of MelbourneHelen Abud, Professor, Head of the Department of Anatomy and Developmental Biology and Director of the Organoid Program, Monash Biomedicine Discovery Institute, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779432017-09-11T19:41:21Z2017-09-11T19:41:21ZEssays on health: Australia is failing new parents with conflicting advice – it’s urgent we get it right<figure><img src="https://images.theconversation.com/files/181928/original/file-20170814-28487-1h0x1q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Much of the baby's distress, as well as that of the parents, can be prevented.</span> <span class="attribution"><a class="source" href="https://unsplash.com/search/photos/baby?photo=EpbIXGCrtK0">Janko Ferlič/Unsplash</a></span></figcaption></figure><p>Every year, hundreds of thousands of Australians embark on a disorienting, life changing journey. They have a baby.</p>
<p>What happens after a woman gives birth should be a matter of serious public interest. Screaming babies, breast pain, baby weight-gain worries, breastfeeding issues, wind, colic, reflux, allergies, tongue tie, sleep deprivation, and parental anxiety and depression. These are common concerns at the beginning of the life of every Australian citizen. </p>
<p>In reflecting on these, we’re actually considering the developmental origins of disease. This is so for many reasons, including that the infant gut microbiome <a href="https://www.ncbi.nlm.nih.gov/pubmed/26663826">affects</a> metabolism and immunity even as an adult, and that postnatal depression has <a href="https://www.ncbi.nlm.nih.gov/pubmed/25455250">long-term effects</a> on a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412485/">child’s cognitive potential and mental health.</a></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gut-instinct-how-the-way-youre-born-and-fed-affect-your-immune-system-65104">Gut instinct: how the way you're born and fed affect your immune system</a>
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<p>Throughout the developed world, <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/AFF3C1C460BA5300CA257BF0001A8D86/$File/NFUCFHS.PDF">non-communicable diseases</a> are now the <a href="http://adc.bmj.com/content/early/2016/08/29/archdischild-2016-310991">major cause of illness</a> and death in children, mirroring trends in adults. Among these, immune, gut, developmental disorders and mental illness feature prominently. All are shaped by environmental factors in very early life.</p>
<p>Yet, our health professionals often recommend approaches to behaviour problems in infants - such as with <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">breastfeeding</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">crying</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">fussing</a>, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/26555938">sleep</a> - that have been demonstrated to be ineffective. Some <a href="https://www.ncbi.nlm.nih.gov/pubmed/23905907">recommendations</a> actually <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">risk worse health outcomes</a> for both the mother and baby.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What happens after a woman gives birth is a matter of serious public interest.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>From the moment their baby is born, Australian parents receive vastly conflicting advice from <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">different health disciplines</a>, or even from different health professionals in the one discipline. Confusion during an already challenging life transition drives parents to seek <a href="https://www.ncbi.nlm.nih.gov/pubmed/21679331">opinions from multiple providers</a>: the GP, paediatrician, midwife, child health nurse, pharmacy nurse, lactation consultant, dentist (yes dentist), and the emergency department. Many visit complementary and alternative medicine practitioners.</p>
<p>Yet <a href="https://www.mja.com.au/journal/2016/205/2/prioritising-general-practice-research">less than 2%</a> of the National Health and Medical Research Council funding goes to research into primary care, the first port of call for new parents. Research performed in hospitals or specialised settings, including concerning issues of early life care, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221610/">often isn’t relevant in the community</a>. We must take primary care research seriously if we want to ensure parents are provided with consistent, evidence-based advice that is beneficial to the baby, themselves and society at large.</p>
<h2>Breastfeeding confusion</h2>
<p>Up to <a href="http://www.health.gov.au/breastfeeding">96% of Australian women</a> want to breastfeed at the time of the birth. Women want to breastfeed so much that not being able to do so <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">affects their mental health</a>. Yet multiple studies demonstrate <a href="https://www.ncbi.nlm.nih.gov/pubmed/25864129">serious gaps</a> in health professional training in the two most common post-birth problems: <a href="https://www.ncbi.nlm.nih.gov/pubmed/28167998">breastfeeding difficulty</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">unsettled</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">infant</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">behaviour</a>. Both <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">increase</a> a woman’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/19432839">risk of postnatal depression</a> and are <a href="http://www.bmj.com/content/343/bmj.d7772">linked with</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26869575">poorer infant outcomes</a>.</p>
<p>Undiagnosed problems with the baby latching on to the breast and finding a stable position during breastfeeding (which I call “fit and hold”) can lead to a range of distressing infant behaviours. These include back arching, refusing or fussing at the breast, crying, poor weight gain and excessive night waking. These signs of positional instability are often thought to be signs of reflux and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23495859">treated with acid medications</a>. But evidence shows these medications <a href="https://www.ncbi.nlm.nih.gov/pubmed/25556017">don’t help</a> the problem.</p>
<p>Existing approaches used to support fit and hold, including letting the baby find their own way to the breast, don’t <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">improve outcomes</a> for many. Common advice, such as using one hand on the back of the baby’s neck while the other creates a particular shape of the breast, has been shown to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">increase nipple pain</a>. </p>
<p>I commonly see women who have been told by multiple professionals their fit and hold is good, even though the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24075595">baby’s behaviour communicates</a> inability to fit stably into the mother’s body. That is, the baby is showing their <a href="https://www.ncbi.nlm.nih.gov/pubmed/18243594">position is uncomfortable</a> or there is a drag of breast tissue pulling in another direction in the baby’s mouth, in conflict with the inward pull created by the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">vacuum when the jaw drops</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Australian mothers need more support to breastfeed.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Oral tie ‘epidemic’</h2>
<p>Then there’s the issue with tongue tie, upper lip tie, and buccal (cheek to gum) tie. This is another way health professionals are dealing with breastfeeding problems and unsettled behaviour – by referring the child for oral surgery. A classic tongue-tie needs a simple scissors snip. But normal <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas%20BFM%202013.pdf">variations of the frenulum</a> - the bits of connective tissue under the tongue and upper lip - are these days <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">often labelled abnormal</a> and blamed for problems. </p>
<p>If we put aside the situation of a classic tongue-tie, the belief cutting or lasering the frenula (called a frenotomy) helps breastfeeding is <a href="http://www.cochrane.org/CD011065/NEONATAL_surgical-release-tongue-tie-treatment-tongue-tie-young-babies">not supported by research</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">Our work</a> suggests that diagnoses of normal variants of connective tissue as abnormal are based on an <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">outdated and inaccurate</a> model of how infants attach to the breast.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/deep-cuts-under-babies-tongues-are-unlikely-to-solve-breastfeeding-problems-54040">Deep cuts under babies' tongues are unlikely to solve breastfeeding problems</a>
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<p>Parents are <a href="http://tonguetie.net/consequences/">sometimes warned</a> if the baby doesn’t have a frenotomy for the diagnoses of posterior tongue-tie or upper lip-tie, their baby is at risk of speech and swallowing problems, expensive orthodontic problems, sleep disorders and other developmental problems in later childhood, though <a href="http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2015-0658">there is no evidence</a> to support these claims. </p>
<p>There are now studies demonstrating that the diagnosis of “oral ties” in breastfeeding babies has reached epidemic proportions in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28168891">United States</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27280112">Canada</a>. Exponential increases in frenotomy rates are also evident in our team’s analysis of early Australian Medicare data (yet to be published). Many, if not most, frenotomies are <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">performed by dentists</a> using laser, and are not captured by Medicare. </p>
<p>I regularly see <a href="https://griffithreview.com/articles/tongues-tied-about-tongue-tie/">babies after laser surgery</a> with worsened breastfeeding problems. Sometimes their <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12773/abstract">wounds become infected</a>. I often see pale cords of scarred tissue under the tongue. I have also seen the underbelly of a little tongue somewhat separated by a too-deep cut. I have seen suture knots hanging from a newborn’s upper gum after scissors frenotomy. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Breastfeeding problems are often blamed on the baby’s frenulum - the bit of connective tissue under the tongue and upper lip.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>The tongue-tie epidemic hasn’t come from a sudden burst of new congenital abnormalities in the mouths of infants in the English-speaking world in the past ten years, as <a href="http://mthfr.net/the-intersection-of-tongue-tie-mthfr/2014/05/23/">some proponents argue</a>. The epidemic parallels broader <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32585-5/abstract">international trends of medical overtreatment</a> and is, in my mind, a painful sign clinical breastfeeding support is in crisis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-rein-in-the-widening-disease-definitions-that-label-more-healthy-people-as-sick-76804">How to rein in the widening disease definitions that label more healthy people as sick</a>
</strong>
</em>
</p>
<hr>
<h2>The importance of sleep</h2>
<p>Parents are also being advised their child’s healthy development and their own wellbeing depends on implementing sleep training. This includes strategies such as: don’t breastfeed your baby to sleep; don’t let the baby get overtired or overstimulated; put the baby down in the cot at the first tired sign; teach the baby to self-settle in the cot; make sure the baby is getting big blocks of sleep instead of catnapping during the day; and use feed-play-sleep cycles. </p>
<p>Technically known as <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">first wave behaviourism</a>, these approaches arose in the 1950s and 1960s. Girls like me were taught them in the 1970s in compulsory mothercraft classes at high school – a long time before the emergence of evidence-based medicine. </p>
<p>But now, <a href="https://www.nhmrc.gov.au/book/promoting-social-and-emotional-development-and-wellbeing-infants-nhmrc-report-evidence-5">high-level evidence</a> demonstrates these approaches do not <a href="http://www.smrv-journal.com/article/S1087-0792(15)00100-8/abstract">decrease night waking</a> or reliably improve women’s mental wellbeing in the first year of life, and especially not in the <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas_Hill%20JDBP%20%2023_9_13.pdf">first six months</a>. </p>
<p>A <a href="http://onlinelibrary.wiley.com/doi/10.1111/bjep.12109/abstract">small subgroup of babies</a> with sleep problems go on to have sleep problems in later childhood. The evidence <a href="https://www.ncbi.nlm.nih.gov/pubmed/22748447">does not support</a> the idea that applying sleep training in the first year will prevent this, yet I hear parents are often told if the baby doesn’t get enough sleep, or if they let “bad habits” grow, their baby’s development and capacity to learn in later childhood will suffer. The threat they are doing the wrong thing if they don’t sleep train <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934563/">heightens parental anxiety</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents are advised their baby’s healthy development depends on implementing conventional sleep strategies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/sleeping-baby?photo=WCbCRXk7nmU">Carlo Navarro/Unsplash</a></span>
</figcaption>
</figure>
<p>In my experience in general practice, where I’ve had the privilege of following many families over months and years, first wave behavioural approaches cause parent-baby communication confusion, and also unnecessarily disrupted nights for many, due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312214/">disruption of the baby’s circadian clock</a>. </p>
<p>In Australia, many sleep-deprived mothers seek help from <a href="https://www.stayathomemum.co.uk/my-kids/behaviour/sleep-schools-in-australia">residential sleep schools</a>. Some are even referred there by health professionals if the baby just <a href="http://www.saveoursleep.com.au/free-reading/triggers-sleep-problems/">catnaps during the day</a> and doesn’t go to sleep alone in the cot, due to fear of developmental implications. Yet only families with the most severe problems should require this hospital-based solution, which is extremely expensive to the health system. </p>
<h2>So, what are the solutions?</h2>
<p>We have enough evidence to show what works. For instance, <a href="http://www.cppah.com/article/S1538-5442(11)00049-6/pdf">latest research</a> tells us it is important to respond to our baby’s cues for the baby to develop secure psychological attachment. Babies should not be left to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113571">grizzle or cry</a> as a pattern over time, and breastfeeding to sleep is one sensible tool for making the days and nights manageable. </p>
<p>It’s also important to know about the young human’s biological need for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223372/">rich sensory nourishment</a>. This means encouraging parents to enjoy a social life outside the house, trusting that the baby’s biological sleep regulators will take whatever sleep he or she needs with minimal effort on the parent’s part.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parents should trust the child’s natural sleep sensors will kick in when he or she is tired.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We’ve developed an <a href="https://education.possumsonline.com/sleep-film">alternative parent-baby sleep program</a>. This repairs <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">unnecessary disruption to night-time sleep</a> either by identifying underlying breastfeeding problems in younger babies, or by helping to reset the circadian clock, which is commonly disrupted by the first wave behavioural focus on long blocks of sleep during the day. </p>
<p>And breastfeeding problems can resolve when women are <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">helped to stabilise</a> the way their and their baby’s <a href="https://education.possumsonline.com/programs/gestalt-breastfeeding-online-program">unique anatomies fit together</a>. This is when the baby’s breastfeeding reflexes are turned on, his or her face is symmetrically buried into the breast, and as much breast tissue as possible is drawn deep into the baby’s mouth without a drag in another direction. </p>
<p>Our programs have a well-developed and published evidence base, and <a href="http://www.publish.csiro.au/PY/PY13011">promising preliminary evaluations</a>. Obviously, these require bigger trials. But there is too little funding available for clinical primary care research. The UK’s <a href="https://www.nuffieldtrust.org.uk/">Nuffield Trust</a> recently issued <a href="http://adc.bmj.com/content/101/12/1084">a report</a> advising that if we are to care for our children’s health needs in a sustainable health system, models need to shift the focus from hospital-based care to integrated child health care in community settings.</p>
<p>Investing in primary health care <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12348/abstract">has been demonstrated</a> to be more effective, at a fraction of the price of treating problems in hospitals. Just a single visit to an Australian hospital’s emergency department costs the tax-payer <a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">ten times</a> the cost of a visit to a GP. </p>
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Read more:
<a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">Medicare spending on general practice is value for money</a>
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<p>We can’t expect hospital-based parenting support centres to improve outcomes when mothers and babies are seen there by health professionals who continue to offer conflicting advice. It would be much cheaper and more cost effective to invest in freely accessible, evidence-based, perinatal services in a family’s own community, co-ordinated by their own GP.</p>
<p>In view of the health system costs and tsunami of mental health problems and chronic disease, this is a matter for urgent political and health system attention.</p><img src="https://counter.theconversation.com/content/77943/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Pamela Douglas is Medical Director of a charitable organisation, the Possums Clinic <a href="http://www.possumsonline.com">www.possumsonline.com</a> (Possums for Mothers and Babies Ltd). Possums Education sells two educational products online, the Gestalt Breastfeeding Online Program and the Possums Sleep Film (also available as a DVD). All proceeds are invested into the development of further educational materials.</span></em></p>From the moment their baby is born, Australian parents receive conflicting advice on how to cope with newborn issues. What we are doing wastes our resources, but we’re not investing in alternatives.Pamela S Douglas, General Practitioner, Researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/669482016-11-11T15:53:55Z2016-11-11T15:53:55ZDyspraxia is more than just “clumsy child syndrome” – it can cause emotional distress and anxiety throughout life<figure><img src="https://images.theconversation.com/files/145589/original/image-20161111-9093-1yl6ny0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dyspraxia is more commonly associated with movement than emotions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/104504702?src=NwC613rDPYxQYKfqfR9DBg-1-10&id=104504702&size=huge_jpg">Rob Hainer/www.shutterstock.com</a></span></figcaption></figure><p>Compared to other <a href="http://www.bdadyslexia.org.uk/educator/what-are-specific-learning-difficulties">specific learning difficulties</a>, major research into <a href="http://www.movementmattersuk.org/dcd-dyspraxia-adhd-spld/uk-dcd-consensus/what-is-dcd-dyspraxia-.aspx">dyspraxia</a> – or <a href="https://theconversation.com/explainer-what-is-dyspraxia-and-how-is-it-different-to-clumsiness-64540">developmental coordination disorder (DCD)</a> as it is more formally known – has only begun fairly recently.</p>
<p>DCD is the term used to diagnose children who have motor skills substantially below what is expected for their age. They are not lazy, clumsy or unintelligent – in fact, their intellectual ability is in line with the general population – but they do struggle with everyday tasks that require coordination.</p>
<p>Take a typical boy with DCD: he is a bright and capable 10-year-old boy, but he struggles to tie his shoe laces and needs help to fasten the buttons on his school shirt. He can’t ride a bike and no one passes him the ball when he plays sports. His teacher has told his parents that while he is a clever and very able student, his handwriting is slow and difficult to read. He finds it hard to keep up in class or to complete his homework – and his performance at school is deteriorating. </p>
<p>DCD <a href="https://www.eacd.org/file-download.php?id=95">affects around 5-6% of children</a> – which roughly equates to one child in every classroom – and tends to be more prevalent in <a href="https://www.eacd.org/file-download.php?id=95">boys than girls</a>. At home, children have difficulties getting ready and taking care of themselves. In the classroom, handwriting is significantly affected and can be slow, hard to read and sometimes painful to produce. On the playground, a child with DCD may have trouble with throwing, catching, running and jumping. In many cases it is a child’s difficulties with handwriting that triggers a referral to healthcare services, following parent and teacher concerns. </p>
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<p>Unfortunately for many children, DCD does not act alone: it commonly presents alongside other developmental disorders such as dyslexia, specific language impairment and attention deficit hyperactivity disorder. Children with DCD have been found to be generally slower than their peers to <a href="http://www.esrc.ac.uk/news-events-and-publications/news/news-items/children-with-dyspraxia-anxious-and-downhearted-teachers-say/?utm_medium=email&utm_source=govdelivery">hit early movement milestones</a> such as crawling and walking. </p>
<p>Though its symptoms may appear to be mostly physical, new research based on teacher reports has found that those with DCD actually have <a href="http://www.esrc.ac.uk/news-events-and-publications/news/news-items/children-with-dyspraxia-anxious-and-downhearted-teachers-say/?utm_medium=email&utm_source=govdelivery">much higher levels of emotional distress than their peers</a> and are frequently anxious and downhearted. </p>
<p>In addition, the study from Goldsmiths University found that children aged between seven and ten with DCD have lower social skills than others of the same age. Previous studies have identified a link between poorer <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2005.tb01168.x/full">recognition of facial emotions and DCD</a>, which <a href="https://www.ncbi.nlm.nih.gov/pubmed/27126816">may contribute to</a> children with the condition having these social problems. </p>
<h2>Growing up with DCD</h2>
<p>DCD is a lifelong disorder that cannot be explained by a general medical condition; there is <a href="https://www.eacd.org/file-download.php?id=95">no definitive answer</a> as to what causes it at present. However, it is known that DCD is not due to brain damage, like some learning difficulties. </p>
<p>Although children presenting with the symptoms of DCD have long been recognised, formal diagnosis has only become prevalent recently – compared to some other conditions such as dyslexia – as awareness of it grows. This may be partly because movement difficulties were not previously recognised in themselves as needing attention. </p>
<p>For a long time it was assumed that children would “grow out of” their movement difficulties. But we now have evidence that in many children the <a href="http://psychology.research.southwales.ac.uk/research/developmental-psychology/amanda-kirby/">motor difficulties persist into adulthood</a> and are commonly associated with a range of <a href="http://www.nhs.uk/conditions/Dyspraxia-in-adults/Pages/Introduction.aspx">socio-emotional problems later on</a>. </p>
<p><a href="http://www.movementmattersuk.org/dcd-dyspraxia-adhd-spld/developmental-disorders-documentation/dcd-and-employment.aspx">Adults with DCD</a> still bump into objects and continue to struggle with handwriting. They may also have trouble with timekeeping and planning ahead, meaning they may be frequently late to work and social events. Self-care is also a problem, but rather than fastening clothes it turns into struggling to keep a home tidy. Tasks such as preparing a meal from scratch and ironing clothes can also be troublesome. DCD adults can also have issues with learning a new skill that requires speed and accuracy – so it can be difficult for them to learn to drive a car.</p>
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<p>Research into adults with DCD is still in its early stages. This means that many adults with DCD may still be undiagnosed, or have spent their childhood wondering what was “wrong” with them, before being diagnosed relatively late in life.</p>
<p>But academic research is increasing – and there is more <a href="http://www.movementmattersuk.org/dcd-dyspraxia-adhd-spld/developmental-disorders-documentation/dcd-and-employment.aspx">information out there for employers</a>, as well as family and friends, to support those with DCD. The next step for researchers is to look at doing a long-term study, following the lives of specific participants with DCD. Only then can we really begin to understand the condition.</p><img src="https://counter.theconversation.com/content/66948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mellissa Prunty does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Developmental coordination disorder has only recently been recognised for what it is.Mellissa Prunty, Lecturer in Occupational Therapy, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/540692016-02-04T13:52:40Z2016-02-04T13:52:40ZAre children who walk and talk early geniuses in the making?<figure><img src="https://images.theconversation.com/files/109979/original/image-20160202-32251-yye0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Future tennis champion? 'He walked at eight months, ran at ten months and could catch a ball by the age of one.'</span> <span class="attribution"><span class="source">leungchopan </span></span></figcaption></figure><p>From rolling over to walking and saying words, most parents will remember the exact age at which their child achieved a certain “milestone”. They will often also compare these early “rites of passage” to the progress of a sibling, cousin or friend, or to charts in the myriad parenting books setting out the ages at which children should develop certain skills. </p>
<p>For some parents this will provide reassurance about their child’s start in life. For others it will be a source of anxiety. But do milestones really say anything about a child’s potential? For example, is an early talker more likely to be academically gifted than others? Let’s take a look at the evidence.</p>
<h2>Checking the charts</h2>
<p>Research on developmental disorders suggests that the age at which infants hit motor or language milestones can be a “marker” of later outcome. In particular, studies have found links between <a href="http://research.gold.ac.uk/9875/1/Leonard%20%26%20Hill%20CAMH%202014.pdf">early motor abilities and later language skill</a> and social cognition in children with, and at-risk of, an autism spectrum disorder. Similarly, children with developmental coordination disorder, which affects movement and co-ordination, can be distinguished by delays in early motor skill development. Children with language disorders too can be identified by their early language skills. </p>
<p>In this sense, milestones have some value for identifying young children that may require follow-up care. However, whether they can say anything about the future potential of children who are developing typically is less well known. </p>
<p>What we do know is that new skills grow from the acquisition of foundation skills. Crawling enables a child to move independently to objects that they would like to explore, and adults <a href="http://www.depauw.edu/site/learn/lab/publications/documents/infant%20development/2000_Infant_development_Travel_broadens_the_mind.pdf">increase the type of social signals</a> they offer the crawling child. Walkers, with their new vantage point on the world, are typically more socially interactive and better at sharing objects. Therefore, it may be expected that those children that reach motor milestones at an early age will benefit from more opportunities to learn and refine new skills in the long run. </p>
<p>A study using a British cohort <a href="http://onlinelibrary.wiley.com/doi/10.1002/ana.21120/full">looked at the relationship</a> between early development and cognitive skills at the age of eight. Cognitive ability was determined largely by literacy-type assessments, like reading comprehension and vocabulary, and a single measure of non-verbal IQ. While motor and language milestones were identified retrospectively by parents, meaning the accuracy may be questionable, the findings do suggest a tentative link between early and later development. </p>
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<img alt="" src="https://images.theconversation.com/files/109987/original/image-20160202-32222-1od7rfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/109987/original/image-20160202-32222-1od7rfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/109987/original/image-20160202-32222-1od7rfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/109987/original/image-20160202-32222-1od7rfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/109987/original/image-20160202-32222-1od7rfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/109987/original/image-20160202-32222-1od7rfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/109987/original/image-20160202-32222-1od7rfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There’s some evidence that early talkers may be slightly ahead in certain cognitive skills later in life.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=HmyPIZ7osnMcR0h6HqvC_g&searchterm=baby%20talking&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=146931200">victorsaboya</a></span>
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<p>However, when “late bloomers” in motor development were excluded from the sample the mentioned effect was significantly reduced. In the remaining sample of “typical” achievers, only the measure of early speech development was associated with later cognitive skills, and the remaining relationship was significantly weaker.</p>
<p>When it comes to future potential for motor skills, however, there is <a href="http://www.sciencedirect.com/science/article/pii/S0167945707000991">no conclusive evidence</a> that children who hit motor milestones early are, on average, more likely to have better motor skills than others later in life.</p>
<p>Nevertheless, motor skills may have an indirect effect on cognitive and later motor skills through the opportunities it gives a child to engage in and learn about the world. </p>
<h2>When are first steps or words too late?</h2>
<p>One thing to note when recording milestones is that children achieve basic motor milestones at a significantly different rate, <a href="http://www.who.int/childgrowth/standards/motor_milestones/en/">as reported</a> in a cross-cultural study by the World Health Organisation. Children can begin to walk unaided any time between eight and 18 months, and still be classified within the “typical” range. In reality, rather little can be done to accelerate the time at which a child first turns over or crawls, other than providing the infant with adequate stimulation in their environment.</p>
<p>While parents may be concerned if their child is a “late bloomer”, typically-progressing children fortunately are able to catch up. Research has demonstrated that the majority of late talkers <a href="blogs.shu.edu/dlcl/files/2015/02/Late-Talkers-Predictors-of-Outcomes.pdf">resolve their language difficulties</a> by school age. Also, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374292/">more thorough assessments</a> of infant vocabulary – at 18-20 months – rather than just first words have questioned the strength of the link between early talking and cognitive skills. So while there may be a relationship there, these studies have shown it is not a strong predictor for later language abilities. Of course, a very small proportion of late talkers may go on to develop language problems but a family history of language problems are a more reliable predictor of persistent difficulties. </p>
<p>It is inevitable that parents will compare their child’s development to the norms or others, but the use of these as a window into the future remains unclear. To fully establish the role of early milestones, we would benefit from studying a large cohort of children prospectively from birth, identifying their milestones in early development and their relationship to later educational, behavioural and social outcomes. </p>
<p>Our current knowledge might not provide all parents with the direct reassurances that they crave. But further studies would allow more targeted guidance, support, and intervention for those children that would most benefit from immediate help that will have a lasting effect throughout their lives.</p><img src="https://counter.theconversation.com/content/54069/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emma Sumner receives funding from The Leverhulme Trust. </span></em></p><p class="fine-print"><em><span>Elisabeth L Hill receives funding from The Leverhulme Trust.</span></em></p>Milestone charts can be an effective tool in spotting developmental problems. But do they say anything about the future potential of children who are developing normally?Emma Sumner, Postdoctoral Research Associate in Psychology, Goldsmiths, University of LondonElisabeth L Hill, Professor of Neurodevelopmental Disorders, Goldsmiths, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/427582015-06-16T20:20:37Z2015-06-16T20:20:37ZChildren with autism aren’t necessarily visual learners<figure><img src="https://images.theconversation.com/files/84663/original/image-20150611-11441-1l6h87v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">But it doesn't mean teachers and therapists should abandon picture-based therapy.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-198260657/stock-photo-cute-boy-using-a-laptop.html?src=G8ma-dBmSqgmXYtdJGrPog-1-1">Dubova/Shutterstock</a></span></figcaption></figure><p>Children with autism are often described as “visual learners” and said to “think in pictures”. Accordingly, teachers and therapists routinely prescribe picture-based communication systems in an effort to support their learning. </p>
<p>However, the findings of a study my colleagues and I published this week in the <a href="http://link.springer.com/article/10.1007%2Fs10803-015-2488-4">Journal of Autism and Developmental Disorders</a> contradict this notion, casting doubt on a key rationale for routinely using these systems. </p>
<p>In the experiment, children with autism, children with developmental delay, and typically developing children were seated in front of an eye-tracking computer and a set of common objects. </p>
<p>A teacher appeared on the screen and gave instructions, such as “pick up the ball and put it in the box.” She gave half of the instructions using her speech alone, and half by pointing to pictures of the objects as she spoke. </p>
<p>The computer tracked the children’s eye movements while a video camera recorded their actions. </p>
<h2>Unexpected patterns of looking and doing</h2>
<p>The children with autism looked at the videos in the same way as the other children. They did not linger on the pictures longer than the other children, or avoid looking at the teacher’s face. </p>
<p>This means that if children with autism make greater use of visual information than do other children, it wasn’t apparent in this study in terms of observed differences in their pattern of attention to pictures and faces. </p>
<p>When it came to following the instructions, the children with developmental delay and typically developing children performed better when the pictures were used. </p>
<p>The children with autism did not. This was despite the children with autism being of similar age and having a similar language comprehension level to the children with developmental delay. </p>
<p>Ironically, it was the comparison groups of children who showed a visual learning style, not the children with autism. </p>
<h2>Implications for practice</h2>
<p>There has been an explosion of phone and tablet-based apps providing picture-based communication systems for children with autism, based on the belief that these are well suited to their visual learning advantage. </p>
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<img alt="" src="https://images.theconversation.com/files/84664/original/image-20150611-11396-jgwjf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/84664/original/image-20150611-11396-jgwjf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84664/original/image-20150611-11396-jgwjf1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84664/original/image-20150611-11396-jgwjf1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84664/original/image-20150611-11396-jgwjf1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84664/original/image-20150611-11396-jgwjf1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84664/original/image-20150611-11396-jgwjf1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There are genetic and behavioural differences among children with autism, as well as differences in response to treatment.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?models=15048224&models=15052601&context_photo=280236185&page=1&inline=280236128">Sergey Novikov/Shutterstock</a></span>
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<p>So should teachers and therapists stop using picture-based communication systems with children with autism? </p>
<p>The simple answer is no. There is <a href="http://www.ncbi.nlm.nih.gov/pubmed/21380612">growing evidence</a> that picture-based communication systems can be effective for <em>some</em> children with autism, and there are several alternative explanations for why they may be effective. More attention needs to be given to these. </p>
<h2>Alternative explanations</h2>
<p>Picture-based communication systems may clarify the process of communication for children with autism. </p>
<p>When a child is taught to hand a picture of a drink to his mother to request a drink, for example, he can touch and see the picture in his hand. He then watches it as it moves through space into her hand. The exchange is physical and consistent, not fast and fleeting like spoken words. </p>
<p>As she recognises that he wants a drink and reacts, the power of communication is demonstrated by his attempt to communicate being rewarded. The use of pictures, in this case, is just one possible “ingredient” in the intervention. </p>
<p>Our study results suggest that teachers and therapists should consider the range of possible “ingredients” when deciding whether or not to prescribe picture-based communication systems to children with autism, rather than assuming he or she is a visual learner. </p>
<h2>Individual differences</h2>
<p>The study results also highlight the need to understand individual differences in autism. </p>
<p>In his <a href="http://www.neurodiversity.com/library_kanner_1943.pdf">original paper on autism in 1943</a>, Austrian-American researcher Leo Kanner described 11 children who presented with a common set of pervasive behavioural traits, but he also described individual differences across the children. </p>
<p>Today, <a href="http://informahealthcare.com/doi/abs/10.3109/17549507.2013.859300">considerable research effort</a> is being directed at explaining the genetic and behavioural differences observed in children with autism, as well as differences in response to treatment. </p>
<p>With this in mind, it should perhaps not come as a surprise that the children with autism in the present study did not present with a common and observable visual learning style. The challenge moving forward is to ensure that teachers and therapists acknowledge these individual differences when prescribing treatments to children with autism.</p><img src="https://counter.theconversation.com/content/42758/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Trembath receives funding from the National Health and Medical Research Council (GNT1071881).</span></em></p>In our study, it was the comparison groups of children who showed a visual learning style, not the children with autism.David Trembath, NHMRC ECR Fellow in Autism, Menzies Health Institute Queensland, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/263072014-05-08T20:38:23Z2014-05-08T20:38:23ZIt’s not a crime to have ADHD<figure><img src="https://images.theconversation.com/files/47805/original/cz8bb86z-1399271028.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Are kids being chemically quelled in order to fit into modern schools and workplaces?</span> <span class="attribution"><span class="source">Flickr: Mindaugas Danys</span></span></figcaption></figure><p>Every few months, the same question about attention deficit hyperactivity disorder (ADHD) is posed in the media - is it real? The latest example comes from leading American neuroscientist, Dr Bruce Perry, who claims ADHD is better thought of as a <a href="http://www.theguardian.com/society/2014/mar/30/children-hyperactivity-not-real-disease-neuroscientist-adhd">description than a disease</a>.</p>
<p>I have been conducting research into ADHD for almost 20 years and statements like these have been around for all that time. We’re still asking if ADHD is real because science is yet to establish an agreed physiological test for it. </p>
<p>That’s why this is an important question for researchers to keep asking. And it’s also important for parents because there’s a range of causes for hyperactive behaviour other than ADHD, and these should be checked out first. </p>
<p>Other questions really worth asking are why hyperactivity is such a problem today and why it was not so in the past. Until recently, when social scientists considered ADHD, they explored it as an example of the “medicalisation” of society. In this view, where once a child might have been seen as a ratbag, increasingly kids are seen as disordered (and given drugs). </p>
<p>This approach leads to questions about whether children are now being quelled chemically so they can fit in modern schools and workplaces. These are important, if not entirely new, questions.</p>
<h2>Criminal links?</h2>
<p>In a <a href="http://jos.sagepub.com/content/early/2014/01/07/1440783313514643.abstract">recently published paper</a>, I identified another growing trend within the social sciences to associate ADHD with crime.</p>
<p>This paper cites a number of US studies that have identified a link between ADHD, <a href="http://www.sciencedirect.com/science/article/pii/S0047235213001177">school exclusion</a> and <a href="http://link.springer.com/article/10.1007/s10802-010-9443-9#">delinquency</a>, while a previous <a href="http://www.vathek.org/doi/abs/10.1350/ijps.4.4.344.10873">review of 48 studies</a> found strong connections between ADHD diagnostic measures, crime and delinquent behaviour.</p>
<p>Within Europe, studies have linked ADHD to <a href="http://euc.sagepub.com/content/7/6/442.short">juvenile delinquency and criminal behaviour</a>, while other studies indicate higher rates of ADHD among <a href="http://www.cepip.org/sites/default/files/CEPiP.2012.1.138-143.pdf">youth offenders</a>, <a href="http://informahealthcare.com/doi/abs/10.3109/15622975.2011.600319">offenders generally</a> and <a href="http://jaapl.org/content/29/2/186.short">prison populations</a>. </p>
<p>In Australia, the <a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/ch54_draft_guidelines.pdf">national guidelines on ADHD</a> point to research that indicates a consistent association between ADHD, delinquency, criminal behaviour and recidivism.</p>
<p>That there may be some association between ADHD and criminality is an important insight. But there are reasons for exercising caution in accepting these findings on face value.</p>
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<img alt="" src="https://images.theconversation.com/files/47921/original/cyb5gjz6-1399427442.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/47921/original/cyb5gjz6-1399427442.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/47921/original/cyb5gjz6-1399427442.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/47921/original/cyb5gjz6-1399427442.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/47921/original/cyb5gjz6-1399427442.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/47921/original/cyb5gjz6-1399427442.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/47921/original/cyb5gjz6-1399427442.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Where once a child might have been seen as a ratbag, increasingly kids are seen as disordered – and given drugs.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/richteabiscuit/876248679/in/photostream/">Aislinn Ritchie/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>First, the descriptors that are the basis for ADHD diagnosis span across hyperactive, inattentive and combined subtypes. This results in a vast array of possible combinations of behaviour that can be diagnosed as ADHD. </p>
<p>To put it another way, ADHD is such a diverse category that it’s nearly impossible to identify aspects of it that might be linked to crime.</p>
<p>Second, in these studies, the research categories and definitions of ADHD rarely align. The focus of the studies vary between hyperactivity, inattention or attention deficit, and most of them consider adults. </p>
<p>In other words, we don’t know how many of these studies are looking at the same population group, how many would fit the clinical definition of ADHD, and which label came first – ADHD or criminal.</p>
<p>Third, it’s important to stress that the occurrence of inattention doesn’t make a child delinquent and the presence of hyperactivity doesn’t turn a them into a criminal. The majority of society is united in its opposition of major crimes (such as murder), although less convinced about the seriousness of others (such as shoplifting). </p>
<p>The research so far has located offenders with ADHD at the lower end of that scale.</p>
<p>If more of these young people are becoming involved in crime as they get older, it’s not because something within their bodies is driving them to do it, it’s because, as a society, we have encouraged the conditions for it.</p>
<p>It may be more important to explore what sets a young person down the path toward crime in the first place.</p>
<h2>A sociological view?</h2>
<p>It’s long been recognised that repeated negative labelling and stigmatisation by social institutions can result in careers of delinquency and deviance.</p>
<p>Why would you hesitate to strike back against a system when you have lost faith that it has anything to offer you? Why would you respect the rules of a society that has alienated you since you were young?</p>
<p>The reality is that any path from ADHD to criminality is a long one, with many events and opportunities along the way. What may only appear to be one reaction by a friend’s parent, or an assumption by a teacher has a cumulative effect.</p>
<p>Labels such as hyperactive or ADHD tell us more about the people attaching the labels than those receiving them. It’s this insight about ADHD that’s worthy of far more exploration.</p><img src="https://counter.theconversation.com/content/26307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brenton Prosser does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Every few months, the same question about attention deficit hyperactivity disorder (ADHD) is posed in the media - is it real? The latest example comes from leading American neuroscientist, Dr Bruce Perry…Brenton Prosser, Senior Research Fellow in Policy, Sociology and Public Health, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/256462014-04-29T20:30:57Z2014-04-29T20:30:57ZIs ‘sluggish cognitive tempo’ a valid new childhood disorder?<figure><img src="https://images.theconversation.com/files/47198/original/rwww93jw-1398734457.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sluggish cognitive tempo is used to describe kids whose attentional deficits are due to low levels of mental energy.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/courosa/5240046576">Alec Couros/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>Sociology influences medicine more than we like to admit. One only needs to look at the history of psychiatric disorders – a term used broadly here to incorporate developmental disorders – to see how “normal” in one era is often deemed “abnormal” in another. And how the dividing line between these two ends is often wafer thin.</p>
<p>Research advances are certainly key to what we claim as being a disorder, but political and social influences also play their part.</p>
<p>Autism is an excellent case in point; the cutoff for “abnormal” has shifted from recognising severely affected individuals only (30 years ago) to a more moderate position (20 years ago) and now to a point somewhere in between (today).</p>
<p>Variations aren’t just seen over time, but also between geographical locations. The proportion of children receiving a particular diagnosis can vary dramatically between states, for instance. Without question, the social and political influences of different jurisdictions are major drivers of this variation. </p>
<p>That’s not to say that people receiving these diagnoses don’t warrant assistance from health professions – they clearly do – but rather that our decisions about normal and abnormal are not as objective as we pretend.</p>
<h2>Enter ‘sluggish cognitive tempo’</h2>
<p>Consider the case of a possible new developmental disorder called sluggish cognitive tempo, identified by US researchers and discussed at length in <a href="http://www.nytimes.com/2014/04/12/health/idea-of-new-attention-disorder-spurs-research-and-debate.html?_r=0">a recent New York Times article</a>.</p>
<p>The disorder is characterised by behavioural symptoms such as drowsiness, daydreaming, mental confusion, physical lethargy and apathy, and appears to be an offshoot of attention deficit/hyperactivity disorder (ADHD). </p>
<p>Whereas some children may have attentional deficits because of hyperactivity (the child who is “bouncing off the walls”), sluggish cognitive tempo is used to describe kids whose attentional deficits are due to low levels of mental energy.</p>
<p>The case for sluggish cognitive tempo representing a new disorder has been gathering pace over the past five years, so much so that the <a href="http://link.springer.com/journal/10802/42/1/page/1">Journal of Abnormal Child Psychology</a> dedicated most of its January issue to research related to the subject. </p>
<p>Indeed, in the issue, the journal claimed to have “laid to rest” any questions over the existence of the disorder, and that the cluster of symptoms is well on the way to being recognised as a legitimate disorder.</p>
<h2>Cause for controversy</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/47199/original/dm4hyztf-1398734830.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/47199/original/dm4hyztf-1398734830.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=764&fit=crop&dpr=1 600w, https://images.theconversation.com/files/47199/original/dm4hyztf-1398734830.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=764&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/47199/original/dm4hyztf-1398734830.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=764&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/47199/original/dm4hyztf-1398734830.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=960&fit=crop&dpr=1 754w, https://images.theconversation.com/files/47199/original/dm4hyztf-1398734830.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=960&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/47199/original/dm4hyztf-1398734830.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=960&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Sluggish cognitive tempo stands in contrast to attentional deficits because of hyperactivity.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/courosa/4207788360">Alec Couros/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>Still, the proposal for sluggish cognitive tempo to be recognised as a disorder has been met with derision from many within the scientific community. </p>
<p>Allen Frances, a former chair of the task force that delivered a previous revision of the <a href="https://theconversation.com/explainer-what-is-the-dsm-and-how-are-mental-disorders-diagnosed-9568">Diagnostic and Statistical Manual</a> (the so-called psychiatrist’s bible), has been among the most vocal critics.</p>
<p>In a recent article <a href="http://www.huffingtonpost.com/allen-frances/no-child-left-undiagnosed_b_5139060.html">No Child Left Undiagnosed</a>, he wrote:</p>
<blockquote>
<p>‘Sluggish Cognitive Tempo’ is a remarkably silly name for an even sillier proposal…[It] may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.</p>
</blockquote>
<p>These are fighting words, and there’s no hint of a backdown.</p>
<p>I am more circumspect than Dr Frances in my evaluation of sluggish cognitive tempo, but there are two aspects that cause me concern.</p>
<p>The first is about clinical need. The point of a diagnosis is to identify people who require assistance from health professionals, and then use that diagnosis to inform treatment. </p>
<p>At this point, research hasn’t demonstrated that children with these behaviours require assistance from health and education professionals. Is sluggish cognitive tempo just pathologising normal variation in childhood behaviour?</p>
<p>My second concern is the unclear influence of pharmaceutical companies on this line of research. Pharmaceutical giant Eli Lilly has a long-standing association with Professor Russell Barkley, one of the key researchers in the sluggish cognitive tempo field, and the company has already funded drug trials in this area.</p>
<p>This may be a completely innocent relationship driven by a mutual desire to help children. But, at the very least, it’s a bad look.</p>
<h2>Higher standard of evidence</h2>
<p>Disorders of the body are typically diagnosed based on clear biological observations. A diagnosis of diabetes, for example, is based on fasting blood sugar levels, and a diagnosis of kidney disease is based on a suite of urine tests.</p>
<p>We don’t have that luxury with disorders of the mind. Diagnoses are based on behaviours, which makes it an inherently subjective task that will always attract vehemently opposing views.</p>
<p>For this reason, the field must demand the highest levels of scientific evidence showing this cluster of symptoms characterises a group of children who require assistance from health professionals.</p>
<p>At this stage, sluggish cognitive tempo is not even close to reaching these standards.</p><img src="https://counter.theconversation.com/content/25646/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the National Health and Medical Research Council, the Australian Research Council, and the Autism Cooperative Research Centre. </span></em></p>Sociology influences medicine more than we like to admit. One only needs to look at the history of psychiatric disorders – a term used broadly here to incorporate developmental disorders – to see how “normal…Andrew Whitehouse, Winthrop Professor, Telethon Institute for Child Health Research, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.