tag:theconversation.com,2011:/ca/topics/anxiety-disorders-1346/articlesAnxiety disorders – The Conversation2024-01-04T16:08:40Ztag:theconversation.com,2011:article/2199302024-01-04T16:08:40Z2024-01-04T16:08:40ZWhat is selective mutism? And is it a lifelong condition?<p>Belle* is six years old. Like many children, she is a playful and often boisterous child at home with her family. Unlike many children, she has an anxiety disorder which renders her speechless and often physically frozen in specific situations such as school or when she is out with her family.</p>
<p>This affects her ability to join class activities and make friends at school. Other typical childhood experiences, such as attending birthday parties or joining in after-school activities, prove to be challenging for her. </p>
<p>Belle has selective mutism, which affects about <a href="https://doi.org/10.1097/00004583-200208000-00012">one in 140 children</a> under the age of eight years.</p>
<p>Selective mutism is an anxiety disorder characterised by a consistent pattern of silence in specific social situations where speech is expected (for example, at school or work) while the person is able to speak comfortably in other situations (such as at home with close family). </p>
<p>To receive a <a href="https://doi.org/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders">diagnosis</a>, this pattern must persist for over a month and cannot be explained by another communication or psychiatric condition. This lack of speech affects the person’s education, friendships and work.</p>
<p>Selective mutism usually starts between two to five years. Although the condition becomes less common in <a href="https://doi.org/10.1111/j.1469-7610.1997.tb01859.x">adolescence</a> and <a href="http://www.ispeak.org.uk/ResearchFindings.aspx">adulthood</a>, if left untreated, it has a significant effect on the person’s <a href="https://doi.org/10.1080/14780887.2015.1054533">mental health, wellbeing and life opportunities</a> as an adult.</p>
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<img alt="Child sitting on a bench looking glum" src="https://images.theconversation.com/files/567670/original/file-20240103-23-tt5y1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567670/original/file-20240103-23-tt5y1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567670/original/file-20240103-23-tt5y1k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567670/original/file-20240103-23-tt5y1k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567670/original/file-20240103-23-tt5y1k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567670/original/file-20240103-23-tt5y1k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567670/original/file-20240103-23-tt5y1k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&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">Selective mutism can affect friendships.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-boy-outside-schoolyard-746118838">patat/Shutterstock</a></span>
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<h2>No one cause</h2>
<p>There is no one cause of selective mutism. Instead, it is developed by the interaction of several <a href="https://doi.org/10.1007/s10567-015-0181-y">risk factors</a> such as the person’s genes, temperament, brain development and environment. So each person with selective mutism is different.</p>
<p>In 2011, researchers at the University of California <a href="https://doi.org/10.1016/j.biopsych.2010.11.008">found</a> that the same gene linked to autism, language impairment and anxiety traits is also associated with selective mutism. Parents often report a family history of anxiety or communication difficulties, which supports this.</p>
<p>Children with selective mutism often display what is known as a <a href="https://doi.org/10.1007/s00787-016-0835-4">“behavioural inhibition” temperament</a>. People with this temperament tend to show fear and avoidance of new people, situations and objects. These children often avoid taking risks, which can hinder progress during treatment, since social communication and interaction involve taking risks.</p>
<p>Studies have also shown a high occurrence of <a href="https://doi.org/10.1097/00004583-200002000-00026">communication difficulties</a>, <a href="https://doi.org/10.2147/ndt.s154966">autism</a> and <a href="https://psycnet.apa.org/doi/10.1007/s007870200013">developmental delays</a> in the people with selective mutism.</p>
<p><a href="https://psycnet.apa.org/doi/10.1007/s12310-016-9198-8">Researchers</a> have suggested that some children’s lack of speech may be reinforced by significant people in their environment, such as family members and teachers. </p>
<p>The authors of <a href="https://www.routledge.com/The-Selective-Mutism-Resource-Manual-2nd-Edition/Johnson-Wintgens/p/book/9781909301337">The Selective Mutism Resource Manual</a>, used by many therapists in the UK, suggest that when these significant people pressure the child to speak or allow communication avoidance, they are maintaining a selective mutism environment. </p>
<p>In Belle’s situation, there were two parts to her treatment for selective mutism. The first part was a <a href="https://psycnet.apa.org/doi/10.1007/s12310-016-9198-8">systems approach</a>, which addressed the environmental factors that maintained the selective mutism.</p>
<p>The systems approach involved training her parents and teachers about selective mutism and how to support her communication in everyday situations. They were asked to adapt their communication styles with her to take away the pressure for speaking and yet create opportunities for her to communicate verbally and non-verbally. </p>
<p>They were also asked to address any situation where people put pressure on her to speak (for example, school dinner staff insisting she speak to order her food) or where she was criticised for not speaking (for example, grandparents saying that she was rude).</p>
<p>The second part of Belle’s treatment used a <a href="https://psycnet.apa.org/doi/10.1007/s12310-016-9198-8">behavioural approach</a> involving a small steps exposure and reward programme. The exposure technique used in the programme was “sliding in”, also known as stimulus fading.</p>
<p>During a sliding-in session, Belle and her mother comfortably played and talked in a room at school. The year one class teacher who had never heard Belle’s voice was introduced in small steps to the activity while Belle remained comfortable enough to continue talking. The small steps progressed from Belle using her voice in front of her teacher to eventually speaking to her.</p>
<p>Belle continued to make progress by slowly introducing new people in different situations. She was involved in every step of the treatment, which helped her feel more confident and in control of her anxiety.</p>
<p>My colleagues and I <a href="https://doi.org/10.1002/jcv2.12166">systematically reviewed the literature</a> on selective mutism treatments without medication. We found that children who received treatments using a combined systems and behavioural approach, similar to Belle’s experience, made significant improvements in their speaking behaviour than those who had no treatment. These treatments involved a therapist, parent, teacher or camp counsellor, and the child. </p>
<p>In Belle’s case, she was talking to children in the local park within a year of starting the treatment. She was contributing to class discussions and being her playful and boisterous self in the school playground. And she started making friends in her local gymnastics club.</p>
<p><em>*To ensure anonymity, Belle is a composite of various children I have treated for selective mutism.</em></p>
<p><em>For more information on selective mutism, access the Selective Mutism Information and Research Association (<a href="http://www.selectivemutism.org.uk/">Smira</a>) website. For adults with selective mutism who want to connect with a community for support access the <a href="http://www.ispeak.org.uk/">iSpeak.org.uk</a> website or search <a href="https://www.nsun.org.uk/sm-talking-circles-and-covid-19/">SM Talking Circles</a>.</em></p><img src="https://counter.theconversation.com/content/219930/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gino Hipolito receives funding from the National Institute of Health and Care Research (NIHR) Clinical Doctoral Research Fellowship (NIHR302167). Gino also works for St George's University Hospitals NHS Foundation Trust as paediatric speech and language therapist. The views expressed are those of the author and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.</span></em></p>One in 140 children under the age of eight have selective mutism.Gino Hipolito, DPhil Candidate, Experimental Psychology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1955382023-03-09T13:39:49Z2023-03-09T13:39:49ZBody dysmorphic disorder is more common than eating disorders like anorexia and bulimia, yet few people are aware of its dangers<figure><img src="https://images.theconversation.com/files/513001/original/file-20230301-20-5yrxjp.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C8231%2C4644&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Those with body dysmorphic disorder often check themselves – and their perceived defects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-with-bdd-body-dysmorphic-disorder-royalty-free-image/1360144717">Stevica Mrdja/EyeEm via Getty Images</a></span></figcaption></figure><p><em><a href="https://theconversation.com/el-trastorno-dismorfico-corporal-es-mas-frecuente-que-los-trastornos-alimentarios-como-la-anorexia-y-la-bulimia-pero-pocas-personas-son-conscientes-de-sus-peligros-202290">Leer en español.</a></em> </p>
<p>While eating disorders have been <a href="https://doi.org/10.1177/01454455870114005">widely publicized for decades</a>, far less attention has been given to a related condition called <a href="https://bdd.iocdf.org/about-bdd/">body dysmorphic disorder, or BDD</a>. </p>
<p>Body dysmorphic disorder is often hidden from public view due to the shame people feel about one or more parts of their body, yet it is a devastating, debilitating psychological condition. People with the disorder suffer from obsessive thoughts and repetitive behaviors related to their appearance.</p>
<p>Whereas people with eating disorders might view their underweight body as too fat, those with body dysmorphic disorder see themselves as ugly or disfigured even though they appear normal or attractive to others.</p>
<p>Body dysmorphic disorder is more common in both men and women than bulimia or anorexia. About <a href="https://doi.org/10.1017/s1092852900016436">2.5% of women and 2.2% of men</a> in the U.S. meet the criteria for body dysmorphic disorder – that’s higher than the prevalence of generalized anxiety disorder, schizophrenia or bipolar disorder in the general population.</p>
<p>For comparison, at any point in time, bulimia is seen in <a href="https://www.nationaleatingdisorders.org/statistics-research-eating-disorders">roughly 1.5% of women and 0.5% of men</a> in the U.S., and anorexia in <a href="https://www.nationaleatingdisorders.org/statistics-research-eating-disorders">0.35% of women and 0.1% of men</a>.</p>
<p>We are a team of communication and mental health researchers and clinicians from <a href="https://feartocourage.com/about-dr-eva-fisher/">Colorado State University Global</a>, <a href="https://faculty.medicine.hofstra.edu/2313-fugen-neziroglu">Hofstra Medical School</a> and the <a href="https://psychiatry.utoronto.ca/faculty/jamie-feusner">University of Toronto</a>. One of us, Eva Fisher, lived with the disorder for almost 15 years before getting help and recovering. My book, titled “The BDD Family,” provides insights into my <a href="https://feartocourage.com/thebddfamily-book/">daily struggles with body dysmorphic disorder</a> along with information about diagnosis and treatment. </p>
<p>In our view, body dysmorphic disorder needs to be better understood and publicized so that more people suffering from the condition can be properly diagnosed and treated. </p>
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<figcaption><span class="caption">Body dysmorphic disorder often involves a fixation on a single feature, like the shape or size of one’s nose, a mole or the shape or curvature of a certain part of the body.</span></figcaption>
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<h2>Comparison between BDD and eating disorders</h2>
<p>People with body dysmorphic disorder and those with eating disorders share similar negative emotions such as shame, disgust and anger about their appearance. They also engage in some similar behaviors, such as mirror checking, taking photos to check themselves, seeking reassurance from others about their appearance, and using clothing to camouflage or conceal perceived defects.</p>
<p>People who suffer from these disorders commonly avoid places and activities due to self-consciousness about their appearance. In addition, those with eating disorders and body dysmorphic disorder may lack the knowledge that <a href="https://doi.org/10.1016/j.psychres.2012.03.023">their body image beliefs are distorted</a>.</p>
<p>Depression is common in people with body dysmorphic disorder, and they have a <a href="https://doi.org/10.1017/S0033291720002998">higher rate of suicidality</a> than those with eating disorders, including thoughts about committing suicide and suicide attempts. Although both eating disorders and body dysmorphic disorder can be severe and life-threatening, people with body dysmorphic disorder on average <a href="https://doi.org/10.1016/j.bodyim.2009.03.001">experience more impairment in daily functioning</a> than those with eating disorders.</p>
<h2>A personal view</h2>
<p>My (Eva’s) body dysmorphic disorder symptoms started at age 16. Some causes could have been childhood bullying and perfectionism about my appearance. I would obsess about the shape and size of my nose for more than eight hours a day and constantly <a href="https://www.youtube.com/watch?v=UUkZGSIYcEw&t=23s">compare my appearance</a> to models in fashion magazines. </p>
<p>I was convinced that others were judging me negatively because of my nose, which I perceived to be fat and ugly. I hated my nose so much that I didn’t want to get married or have children because I feared they would inherit it.</p>
<p>Even after getting plastic surgery at age 18 to make my nose thinner, I still hated it. This is a very common outcome for people with the disorder who undergo cosmetic surgery procedures. </p>
<p>Research indicates that 66% of people with body dysmorphic disorder have <a href="https://doi.org/10.1016/S1740-1445(03)00003-2">received cosmetic or dermatological treatment</a>. However, even when people feel better about one part of their body after surgery, the <a href="https://doi.org/10.1093/med/9780190254131.003.0030">image obsession often moves</a> to <a href="https://global.oup.com/academic/product/body-dysmorphic-disorder-9780190254131?cc=ca&lang=en&">one or more other body parts</a>. </p>
<p>Some patients will have multiple procedures on the same body part. Other people are so disappointed by the results of their surgery that <a href="https://doi.org/10.1093/med/9780190254131.003.0013">they want to commit suicide</a>. </p>
<p>Tragically, many people with body dysmorphic disorder think about killing themselves, and others attempt to take their own lives. Approximately 80% of people with body dysmorphic disorder <a href="https://doi.org/10.1093/med/9780190254131.003.0013">experience lifetime suicidal ideation</a>, and 24% to 28% have attempted suicide. Often, they are young men and women who feel so hopeless about their perceived appearance defects that suicide seems like the only way to end their suffering.</p>
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<figcaption><span class="caption">Body dysmorphic disorder carries a high risk of suicide, and sometimes pursuing dermatological solutions can make the issues worse if the person isn’t satisfied with them.</span></figcaption>
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<h2>When appearance concerns become problematic</h2>
<p>So how is body dysmorphic disorder different from normal appearance concerns? Researchers have found evidence that while <a href="https://doi.org/10.1177/1073191119879241">appearance dissatisfaction can range in severity</a>, there is a distinct group of people with much higher appearance concerns, many of whom likely have the disorder. They feel much worse about their appearance than those with normal appearance concerns and experience greater anxiety, depression, shame and self-disgust about some aspects of their appearance.</p>
<p>About one-third of people with the disorder <a href="https://doi.org/10.1093/med/9780190254131.003.0006">obsess about their perceived flaws</a> for one to three hours a day, nearly 40% for three to eight hours a day and about a quarter for more than eight hours a day. Most people with body dysmorphic disorder know they spend <a href="https://global.oup.com/academic/product/body-dysmorphic-disorder-9780190254131?cc=ca&lang=en&">too much time thinking about their appearance</a>, but others with the condition mistakenly believe that it’s entirely normal to worry about their appearance for hours every day. </p>
<p><a href="https://doi.org/10.1093/med/9780190254131.003.0006">Common body dysmorphic disorder behaviors</a> include, from most to least common:</p>
<ul>
<li><p>camouflaging the perceived defects with clothing and makeup</p></li>
<li><p>comparing one’s appearance to others </p></li>
<li><p>checking one’s appearance in mirrors and other reflective surfaces</p></li>
<li><p>seeking cosmetic treatments such as surgery and dermatology</p></li>
<li><p>repeatedly taking photos to check one’s appearance</p></li>
<li><p>seeking reassurance from others about the perceived flaw or convincing others that it is unattractive </p></li>
<li><p>touching the perceived flaw</p></li>
<li><p>excessively changing clothes</p></li>
<li><p>dieting and skin picking to improve appearance</p></li>
<li><p>engaging in excessive exercise, including excessive weightlifting</p></li>
</ul>
<h2>Discovering the causes of body dysmorphic disorder</h2>
<p>The exact causes of body dysmorphic disorder are unknown. Possible developmental causes include <a href="https://doi.org/10.1017/s0033291711002741">genetic factors</a>, <a href="https://doi.org/10.1016/j.psychsport.2007.10.002">childhood bullying</a> and childhood teasing about appearance and competency, as well as <a href="https://doi.org/10.1016/j.comppsych.2021.152256">childhood maltreatment and trauma</a>. Other factors that could play a role include growing up in a family with an <a href="https://www.scientificamerican.com/article/imagined-ugliness/">emphasis on appearance</a>, perfectionist standards concerning appearance and exposure to <a href="https://doi.org/10.1176/appi.ajp.159.10.1788">high ideals of attractiveness</a> and beauty in the mass media. </p>
<p>Common personality traits among people with body dysmorphic disorder include perfectionism along with shyness, social anxiety, low self-esteem and <a href="https://doi.org/10.1016/j.cpr.2005.04.012">sensitivity to rejection and criticism</a>. </p>
<p>Researchers have found that people with the disorder may have abnormalities in brain functioning. For instance, one study found that people with body dysmorphic disorder, as well as those with anorexia, have an <a href="https://doi.org/10.1017/S0033291715000045">information processing bias</a> toward more detailed visual information rather than viewing images globally – in other words, seeing the trees rather than the forest. This suggests that abnormalities in the brain’s visual system could contribute to the distortions that those with body dysmorphic disorder and anorexia experience.</p>
<h2>Effective treatments</h2>
<p>Fortunately, there are effective treatments for people with body dysmorphic disorder. Cognitive behavioral therapy and medication <a href="https://doi.org/10.4103/psychiatry.IndianJPsychiatry_528_18">are both used to treat the disorder</a>. </p>
<p>During cognitive behavioral therapy, therapists work with patients to help them modify intrusive thoughts and beliefs about physical appearance and to eliminate problematic behaviors associated with body image, such as mirror checking and reassurance seeking. </p>
<p>Medications called selective serotonin reuptake inhibitors, or SSRIs, such as Prozac and Zoloft can <a href="https://doi.org/10.3928%2F00485713-20100701-05">reduce or eliminate cognitive distortions</a>, depression, anxiety, negative beliefs and compulsive behaviors. They can also increase levels of insight and improve daily functioning. </p>
<p>I (Eva) worked with a psychologist and psychiatrist to combat the depression and anxiety caused by my appearance concerns. Fortunately, both the <a href="https://bddfoundation.org/beating-bdd-podcast-27">medication and therapy</a> were effective in reducing my negative feelings and compulsive behaviors. </p>
<p>Two years after I started treatment, my symptoms lessened and became manageable. Today I facilitate <a href="https://feartocourage.com/bdd-resources/bdd-support-group/">two online support groups</a> and encourage people to learn more about the disorder. Group members provide support and comfort to others who understand their daily struggles. They also share advice about getting help for this common but little known body image disorder. </p>
<p>More information about diagnosis and treatment for body dysmorphic disorder is available on the <a href="https://bdd.iocdf.org/">International OCD Foundation BDD</a> site.</p><img src="https://counter.theconversation.com/content/195538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eva Fisher works for Colorado State University Global. She is affiliated with the International OCD Foundation.</span></em></p><p class="fine-print"><em><span>Fugen Neziroglu is affiliated with OCDNY, IOCD, ADAA. She has receved funding from Bio Haven Pharmaceutical Company. </span></em></p><p class="fine-print"><em><span>Jamie Feusner receives funding from the National Institutes of Health and the Klarman Family Foundation. He is affiliated with NOCD, Inc. </span></em></p>About a quarter of those with body dysmorphic disorder attempt suicide or struggle with ideas of suicide. Fortunately, medication and therapy have proved highly effective at treating the disorder.Eva Fisher, Communication Faculty Member, Colorado State University GlobalFugen Neziroglu, Clinical Assistant Professor of Psychiatry, School of Medicine, Hofstra UniversityJamie Feusner, Professor of Psychiatry and Clinician Scientist at the Centre for Addiction and Mental Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923802022-10-17T12:30:31Z2022-10-17T12:30:31ZAnxiety detection and treatment in early childhood can lower risk for long-term mental health issues – an expert panel now recommends screening starting at age 8<figure><img src="https://images.theconversation.com/files/489609/original/file-20221013-13-iqoxtv.jpg?ixlib=rb-1.1.0&rect=372%2C40%2C6337%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who experience anxiety in childhood are more likely to deal with it in adulthood too.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/worried-mom-comforting-depressed-teen-daughter-royalty-free-image/1221847312?phrase=anxiety%20kids&adppopup=true">fizkes/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention, issued a final recommendation on Oct. 11, 2022, <a href="https://doi.org/10.1001/jama.2022.16936">published in the journal JAMA</a>, stating that all children and adolescents between the ages of 8 and 18 should be screened for anxiety, regardless of whether they have symptoms. The recommendation follows a systematic review that evaluated the potential harms and benefits of screening.</em> </p>
<p><em>The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s recommendations and what they might mean for kids, parents and providers.</em></p>
<h2>1. Why is the task force recommending young kids be screened?</h2>
<p>Nearly 80% of chronic mental health conditions <a href="https://doi.org/10.1097/YCO.0b013e32816ebc8c">emerge in childhood</a>, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and <a href="https://doi.org/10.1097/CHI.0b013e318160e3a0">that parents</a> and <a href="https://doi.org/10.1007/s12310-014-9125-9">teachers</a> are not always skilled at correctly identifying problems or knowing how to respond.</p>
<p>Anxiety is the <a href="https://dx.doi.org/10.1176%2Fappi.focus.20150029">most common</a> mental health problem affecting children and adolescents. Epidemiological studies indicate that <a href="https://doi.org/10.1016/j.jpeds.2018.09.021">7.1% of children are diagnosed with anxiety disorders</a>. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as <a href="https://childmind.org/wp-content/uploads/2021/09/CMI_2018CMHR.pdf">30% of children</a> experience moderate anxiety that interferes with their daily functioning at some time in their life.</p>
<p>This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is a <a href="https://doi.org/10.1080/15374416.2015.1046177">well-established evidence base</a> for treating childhood anxiety. </p>
<p>The task force evaluated the best available research and concluded that, while there are gaps in the evidence base, the benefits of screening are clear. Untreated anxiety disorders in children <a href="https://doi.org/10.1007/s10802-007-9194-4">result in added burdens</a> to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible. </p>
<p>The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for <a href="https://doi.org/10.1016/j.jaac.2010.05.017">anxiety is among the earliest</a> of all childhood mental health diagnoses. The panel also pointed to a lack of accurate screening instruments available to detect anxiety among younger children; as a result, it concluded that there is not sufficient evidence to recommend screening children age 7 or younger. </p>
<p>Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders <a href="https://doi.org/10.1111/j.1469-7610.2007.01812.x">like depression</a> and an overall diminished quality of life. The task force considered these long-term impacts in making its recommendations, noting that screening in children as young as 8 may alleviate a preventable burden for families.</p>
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<figcaption><span class="caption">The US task force’s recommendations include screening for all children beginning at age 8, regardless of whether they show symptoms of anxiety.</span></figcaption>
</figure>
<h2>2. How can care providers identify anxiety in young kids?</h2>
<p>In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings – such as a pediatrician’s office – the research literature also supports <a href="https://doi.org/10.1177/10598405211056647">in-school screening for mental health problems</a>, including anxiety. </p>
<p>Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including the child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community. </p>
<p>Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.</p>
<p>Among the youths who are actually treated for mental health problems, nearly two-thirds <a href="https://www.nasponline.org/resources-and-publications/resources-and-podcasts/mental-health/school-psychology-and-mental-health/comprehensive-school-based-mental-and-behavioral-health-services-and-school-psychologists">receive those services at school</a>, making school-based screening a logical practice. </p>
<h2>3. How would the screening be carried out?</h2>
<p>Universal screening for all children, including those with no symptoms or diagnoses, is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention. </p>
<p>In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equate to a diagnosis, something that the task force highlighted in its recommendation statement. </p>
<p>Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary-care setting may involve completion of short questionnaires by the child and/or parent, similar to how <a href="https://doi.org/10.1542/peds.2011-2654">pediatricians frequently screen kids</a> for <a href="https://theconversation.com/what-causes-adhd-and-can-it-be-cured-170179">attention-deficit/hyperactivity disorder, or ADHD</a>. </p>
<p>The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, care providers were advised to consider the evidence in the task force’s recommendation and apply it to the particular child or situation. The task force did point to multiple available screening tools such as the <a href="https://www.pediatricbipolar.pitt.edu/resources/instruments">Screen for Child Anxiety Related Emotional Disorders</a> and the <a href="https://www.phqscreeners.com/select-screener">Patient Health Questionnaire Screeners</a> for generalized anxiety disorder, which accurately identify anxiety. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/WAg8keGdbQk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A discussion of the differences between normal worry and anxiety.</span></figcaption>
</figure>
<h2>4. What are care providers looking for when screening for anxiety?</h2>
<p>A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category. </p>
<p>But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.</p>
<p>Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through <a href="https://doi.org/10.1016/j.cbpra.2007.08.003">identification of children with medically unexplained physical symptoms</a>.</p>
<p>The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do the symptoms interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful. </p>
<h2>5. What are the recommendations for supporting kids with anxiety?</h2>
<p>The key to an effective screening process is that it be connected to evidence-based care. </p>
<p>The good news is that we now have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medications or therapeutic approaches like cognitive behavioral therapy, which <a href="https://doi.org/10.1016/j.jaac.2020.05.005">studies show to be safe and effective</a>.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/why-a-us-task-force-is-recommending-anxiety-screening-in-kids-8-and-older-181562">article originally published on May 13, 2022</a>.</em></p><img src="https://counter.theconversation.com/content/192380/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elana Bernstein has received funding from her organization to examine school-based practices for youth with anxiety. She is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for emotional well-being in teens. This project was recently funded through the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut via their Mechanisms Underlying Mind-Body Interventions & Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (Grant #: NIH U24AT011281).</span></em></p>Anxiety is the most common mental health issue facing children and adolescents. But research shows that early screening – including in school settings – can identify children who are at risk.Elana Bernstein, Assistant Professor of School Psychology, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1806442022-05-30T15:12:49Z2022-05-30T15:12:49ZAddressing childhood anxiety as early as kindergarten could reduce its harmful impacts<figure><img src="https://images.theconversation.com/files/465804/original/file-20220527-15-c30ne0.jpg?ixlib=rb-1.1.0&rect=909%2C209%2C4274%2C2152&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Signs of anxiety in kindergarten should not be ignored.</span> <span class="attribution"><span class="source">(Pavel Danilyuk/Pexels)</span></span></figcaption></figure><p>Anxiety disorders are <a href="https://pubmed.ncbi.nlm.nih.gov/20855043/">some of the most common mental disorders</a> in children and youth. They emerge and can be diagnosed as early as <a href="https://doi.org/10.1016/j.chc.2005.06.003">preschool age</a>, with half being diagnosed by the age of six. </p>
<p>Anxiety in early childhood has consistently been associated with symptoms of anxiety throughout <a href="https://doi.org/10.1007/s10826-010-9365-8">childhood</a>, <a href="https://doi.org/10.1111/j.1469-7610.2007.01812.x">adolescence</a> and <a href="https://doi.org/10.1111/j.1469-7610.2004.00279.x">adulthood</a>, and with a <a href="https://journals.lww.com/jrnldbp/Abstract/2016/05000/Association_of_Childhood_Anxiety_Disorders_and.2.aspx">lower quality of life</a>.</p>
<p>We are researchers with the <a href="https://offordcentre.com/">Offord Centre for Child Studies</a> in the department of psychiatry and behavioural neurosciences at McMaster University. With colleagues, we undertook a population-wide <a href="https://doi.org/10.1007/s10578-022-01332-9">study of kindergarten-age children attending public schools across Canada between 2004 and 2015</a>. To our knowledge, this study provided the first Canada-wide snapshot of anxiety symptoms among children as they enter school. </p>
<p>Our results demonstrate that a child showing signs of anxiety in kindergarten should not be ignored. Children with elevated symptoms of anxiety are three to six times more likely to be vulnerable in other areas of their development than those with very few of these symptoms.</p>
<p>This study also provides an estimate of the prevalence of anxiety symptoms among kindergarten-aged children in Canada. These could, in future, serve as a baseline for comparing groups of children after the COVID-19 pandemic.</p>
<figure class="align-center ">
<img alt="A boy and girl seen playing with play tools in a classroom." src="https://images.theconversation.com/files/465807/original/file-20220527-15-5p25fc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465807/original/file-20220527-15-5p25fc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465807/original/file-20220527-15-5p25fc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465807/original/file-20220527-15-5p25fc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465807/original/file-20220527-15-5p25fc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465807/original/file-20220527-15-5p25fc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465807/original/file-20220527-15-5p25fc.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">Limited evidence exists about how anxiety symptoms in young children may be related to their development.</span>
<span class="attribution"><a class="source" href="https://images.all4ed.org/license/">(Allison Shelley/The Verbatim Agency for EDUimages)</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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</figure>
<h2>Adverse effects on development</h2>
<p>Anxiety can have adverse effects on child development, <a href="https://doi.org/10.1097/00004583-199009000-00014">even if a child’s anxiety levels fall below what clinicians would consider an anxiety disorder</a>. Experiencing anxiety symptoms <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018839">can also interfere with children’s functioning</a>, for example, if children avoid situations that make them feel anxious.</p>
<p>With <a href="https://pubmed.ncbi.nlm.nih.gov/34369987/">rates of anxiety increasing in children and youth since 2020</a>, early identification and intervention are important to decrease <a href="https://pathways-psychology.com/long-term-effects-of-stress-and-anxiety">long-term impacts</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/child-and-youth-mental-health-problems-have-doubled-during-covid-19-162750">Child and youth mental health problems have doubled during COVID-19</a>
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</em>
</p>
<hr>
<p>Information about the prevalence of anxiety disorders in young children is quite limited compared to what’s known about <a href="https://doi.org/10.1111/j.1469-7610.2006.01618.x">older children</a>. There is also limited evidence about how symptoms of anxiety in young children may be related to aspects of their development that are important for <a href="https://doi.org/10.1080/10409280701610796">succeeding in school</a>.</p>
<h2>Academic outcomes</h2>
<p>In a <a href="https://doi.org/10.1007/s10964-007-9224-0">2008 study</a>, psychology researchers from Université Laval and Université de Montréal found kindergarteners with high levels of anxiety were at greater risk of not finishing high school, compared to their non-anxious peers. </p>
<p>This was the case even when accounting for other risk factors like aggression, hyperactivity, academic achievement and family problems. These results indicated that how children act, behave and feel in kindergarten can predict academic outcomes years later.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/boys-attention-and-prosocial-behaviour-linked-to-earnings-30-years-later-112388">Boys' attention and prosocial behaviour linked to earnings 30 years later</a>
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<p>Our study sought to understand kindergarten-age children’s anxiety on a larger scale. Our results could similarly be used to study subsets of the population. For example, in Ontario, we have linked some early child development data to standardized test scores in grades 3, 6, 9 and 10, but haven’t yet completed our study.</p>
<figure class="align-center ">
<img alt="A boy is seen playing with dinosaurs." src="https://images.theconversation.com/files/465806/original/file-20220527-13-r6siu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465806/original/file-20220527-13-r6siu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465806/original/file-20220527-13-r6siu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465806/original/file-20220527-13-r6siu6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465806/original/file-20220527-13-r6siu6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465806/original/file-20220527-13-r6siu6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465806/original/file-20220527-13-r6siu6.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">How children act, behave and feel in kindergarten can predict outcomes years later.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Symptoms of anxiety</h2>
<p>We aimed to determine the percentage of children in kindergarten in publicly funded schools across Canada showing symptoms of anxiety. We <a href="https://link.springer.com/article/10.1007/s10578-022-01332-9/tables/1">gathered data from children in 12 of the 13 Canadian provinces and territories (with the exception of Nunavut)</a>.</p>
<p>We used data collected through the <a href="https://edi.offordcentre.com/">Early Development Instrument</a> (EDI), a teacher-completed checklist that measures five main domains of development: physical health and well-being; social competence; emotional maturity; language and cognitive development; and communication skills and general knowledge. </p>
<p>Under these five domains are 16 subdomains, including an anxious and fearful subdomain that falls under the emotional maturity domain, and includes symptoms of anxiety. We used this in our study to classify children as highly anxious.</p>
<p>The study population included 1,038,354 children attending publicly funded schools whose teachers completed the EDI between 2004 and 2015. Most of the EDI data in this study come from <a href="http://dx.doi.org/10.1136/bmjopen-2018-023688">government-funded, full provincial or territorial data collections</a>. </p>
<p>How provinces and territories collect EDI data varies: For example, in Ontario, all schools participated once every three years in three different data collection windows (2004-06; 2007-09; 2010-12). In 2015, however, the province switched to a one-year model and collected all provincial EDI data in one year. </p>
<h2>Relationship between anxiety, vulnerability</h2>
<p>We found that <a href="https://doi.org/10.1007/s10578-022-01332-9">almost three per cent</a> of kindergarteners were rated as being highly anxious by their teachers.</p>
<p>Rates varied somewhat across the country, ranging from 1.1 per cent in Prince Edward Island to five per cent in Northwest Territories. </p>
<p>We also looked at the association between symptoms of anxiety and vulnerabilities in other areas of development. </p>
<p>A child is considered to be vulnerable in a given domain if their score on the EDI falls below the 10th percentile value based on national EDI scores.</p>
<p>A child classified as vulnerable is struggling in a certain area. Overall, anxious children were 3.5 to 6.1 times more likely than their non-anxious peers to be vulnerable in four domains of development: physical, social, language/cognitive and communication.</p>
<figure class="align-center ">
<img alt="A father seen hugging a child." src="https://images.theconversation.com/files/465796/original/file-20220527-11-aobu4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465796/original/file-20220527-11-aobu4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465796/original/file-20220527-11-aobu4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465796/original/file-20220527-11-aobu4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465796/original/file-20220527-11-aobu4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465796/original/file-20220527-11-aobu4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465796/original/file-20220527-11-aobu4u.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">A greater percentage of children considered highly anxious spoke English or French as a second language than non-anxious children.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<h2>Subgroups of children</h2>
<p>Children rated as highly anxious tended to be younger and were more likely to be male than their non-anxious peers, but the differences between these groups were quite small. </p>
<p>A greater percentage of children considered highly anxious had special needs and English or French as a second language than non-anxious children. Other research has also documented associations <a href="https://journalhosting.ucalgary.ca/index.php/cjnse/article/view/30393">between anxiety and second language learning</a> and <a href="https://doi.org/10.1108/20441281211227193">between anxiety and special needs</a>. We found:</p>
<ul>
<li><p>14.2 per cent of children considered highly anxious had either English or French as a second language. This rate is significantly higher than 12.9 per cent of non-anxious kids who spoke English or French as a second language;</p></li>
<li><p>11.1 per cent of children considered highly anxious were classified as having special needs (compared to 3.4 per cent of non-anxious kids). The EDI captures “special needs” when a child has a medical diagnosis or the teacher has observed the child needs assistance in class above and beyond what the average child requires. </p></li>
</ul>
<p>To put these figures in perspective, most children considered highly anxious speak the language of school instruction as their home language (85.8 per cent) and don’t have special needs (89 per cent). </p>
<h2>Valuable source of information</h2>
<p>Our study demonstrates that teacher reports of children’s behaviours at school, <a href="https://doi.org/10.1016/j.jsp.2018.07.003">an environment that might cause some children to be anxious</a>, can be a valuable source of information on anxiety in kindergarteners. Our study supports the idea that anxiety and other aspects of development are closely intertwined.</p>
<p>Results of this study can provide important information for policy. For example, schools with high rates of anxious children may be encouraged to put into practice class-level activities to reduce the long-term effects of anxiety in kindergarten. </p>
<p>Or, board-wide curriculum, educational services or programming could be developed and monitored to determine how these are meeting particular groups of children’s needs: experts in language learning and early childhood education may be able to suggest interventions to reduce anxiety of students whose home language differs from the language of instruction.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/culturally-responsive-teaching-in-a-globalized-world-109881">Culturally responsive teaching in a globalized world</a>
</strong>
</em>
</p>
<hr>
<p>Finally, this study also provides baseline estimates of anxiety symptoms among kindergarten-aged children in Canada. These could, in future, be compared to data collected with the same method in kindergarten-aged students across Canada post-COVID-19.</p><img src="https://counter.theconversation.com/content/180644/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Magdalena Janus received funding from CIHR and is a member of the Offord Centre for Child Studies at McMaster University.</span></em></p><p class="fine-print"><em><span>Caroline Reid-Westoby 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 study of students across Canada between 2004 and 2015 provides an estimate of anxiety symptoms in kindergarteners, and can serve as a baseline for comparing children’s anxiety after COVID-19.Caroline Reid-Westoby, Research Associate, Department of Psychiatry and Behavioural Neurosciences, McMaster UniversityMagdalena Janus, Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1815622022-05-13T12:14:57Z2022-05-13T12:14:57ZWhy a US task force is recommending anxiety screening in kids 8 and older<figure><img src="https://images.theconversation.com/files/461359/original/file-20220504-15-ddxih1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5615%2C3741&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anxiety is the most common mental health problem affecting U.S. children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/upset-problem-child-sitting-on-staircase-royalty-free-image/469612008?adppopup=true">Brian A. Jackson/iStock via Getty Images</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force issued <a href="https://www.uspreventiveservicestaskforce.org/uspstf/public-comments-and-nominations/opportunity-for-public-comment">a draft statement</a> in April 2022 recommending screening for anxiety in children and adolescents between the ages of 8 and 18. This recommendation – which is still open for public comment – is timely, given the impact of the <a href="https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html">COVID-19 pandemic on children’s mental health</a>. The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s new draft recommendations and what they might mean for kids, parents and providers.</em></p>
<h2>1. Why is the task force recommending young kids be screened?</h2>
<p>Nearly 80% of chronic mental health conditions <a href="https://doi.org/10.1097/YCO.0b013e32816ebc8c">emerge in childhood</a>, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and <a href="https://doi.org/10.1097/CHI.0b013e318160e3a0">that parents</a> and <a href="https://doi.org/10.1007/s12310-014-9125-9">teachers</a> are not always skilled at correctly identifying problems or knowing how to respond.</p>
<p>Anxiety is the <a href="https://dx.doi.org/10.1176%2Fappi.focus.20150029">most common</a> mental health problem affecting children and adolescents. Epidemiological studies indicate that <a href="https://doi.org/10.1016/j.jpeds.2018.09.021">7.1% of children are diagnosed with anxiety disorders</a>. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as <a href="https://childmind.org/wp-content/uploads/2021/09/CMI_2018CMHR.pdf">30% of children</a> experience moderate anxiety that interferes with their daily functioning at some time in their life.</p>
<p>This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is an <a href="https://doi.org/10.1080/15374416.2015.1046177">established evidence base</a> for treating childhood anxiety. </p>
<p>The opportunity to prevent potentially chronic lifelong mental health conditions through a combination of early identification and evidence-based treatment certainly informed the task force’s recommendation. Untreated anxiety disorders in children <a href="https://doi.org/10.1007/s10802-007-9194-4">result in added burdens</a> to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible. </p>
<p>The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for <a href="https://doi.org/10.1016/j.jaac.2010.05.017">anxiety is among the earliest</a> of all childhood mental health diagnoses. </p>
<p>Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders <a href="https://doi.org/10.1111/j.1469-7610.2007.01812.x">like depression</a> and an overall diminished quality of life. </p>
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<figcaption><span class="caption">A discussion of the differences between normal worry and anxiety.</span></figcaption>
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<h2>2. How can care providers identify anxiety in young kids?</h2>
<p>Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community. </p>
<p>Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.</p>
<p>In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings, the research literature also supports <a href="https://doi.org/10.1177/10598405211056647">in-school screening for mental health problems</a>, including anxiety.</p>
<p>Among the youths who are actually treated for mental health problems, nearly two-thirds <a href="https://www.nasponline.org/resources-and-publications/resources-and-podcasts/mental-health/school-psychology-and-mental-health/comprehensive-school-based-mental-and-behavioral-health-services-and-school-psychologists">receive those services at school</a>, making school-based screening a logical practice. </p>
<h2>3. How would the screening be carried out?</h2>
<p>Universal screening for all children is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention. </p>
<p>In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equal a diagnosis. Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary care setting may involve completion of short questionnaires by the child and/or parent, similar to how <a href="https://doi.org/10.1542/peds.2011-2654">pediatricians frequently screen kids</a> for <a href="https://theconversation.com/what-causes-adhd-and-can-it-be-cured-170179">attention-deficit/hyperactivity disorder, or ADHD</a>. </p>
<p>The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, it pointed to multiple tools such as <a href="https://www.pediatricbipolar.pitt.edu/resources/instruments">The Screen for Child Anxiety Related Emotional Disorders</a> and the <a href="https://www.massgeneral.org/psychiatry/treatments-and-services/pediatric-symptom-checklist/">Pediatric Symptom Checklist</a>. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost.</p>
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<figcaption><span class="caption">A youth anxiety psychologist who experienced severe anxiety as a child talks about how to raise kids who can overcome anxiety.</span></figcaption>
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<h2>4. What are care providers looking for when screening for anxiety?</h2>
<p>A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category. </p>
<p>But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.</p>
<p>Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through <a href="https://doi.org/10.1016/j.cbpra.2007.08.003">identification of children with medically unexplained physical symptoms</a>.</p>
<p>The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do they interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful. </p>
<h2>5. What are the recommendations for supporting kids with anxiety?</h2>
<p>The key to an effective screening process is that it be connected to evidence-based care. One strategy that is clearly <a href="http://doi.org/10.1007/s12310-013-9109-1">supported by research</a> is for schools to establish a continuum of care that involves universal screening, schoolwide prevention programming and evidence-based treatment options. </p>
<p>The good news is that we have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medical and nonmedical interventions like cognitive behavioral therapy, which <a href="https://doi.org/10.1016/j.jaac.2020.05.005">studies show to be safe and effective</a>.</p><img src="https://counter.theconversation.com/content/181562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elana Bernstein has received funding from her organization to examine school-based practices for youth with anxiety. She is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for emotional well-being in teens. This project was recently funded through the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut via their Mechanisms Underlying Mind-Body Interventions & Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (Grant #: NIH U24AT011281).</span></em></p>Up to 20% of US children have an anxiety disorder, and many suffer in silence.Elana Bernstein, Assistant Professor of School Psychology, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1807292022-04-17T06:35:09Z2022-04-17T06:35:09ZHow COVID added to the stresses of the most vulnerable young women in South Africa<figure><img src="https://images.theconversation.com/files/457358/original/file-20220411-8252-z8jc37.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The burden of mental illness in South Africa is high.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>By 2021, South Africa’s unemployment rate was at <a href="http://www.statssa.gov.za/publications/P0211/Presentation%20QLFS%20Q2_2021.pdf#page=8">44%</a>. Around <a href="https://www.statssa.gov.za/?page_id=1856&PPN=03-10-25&SCH=73272">55.5% of South Africans</a> were living in poverty. <a href="https://cramsurvey.org/wp-content/uploads/2021/07/13.-Van-der-Berg-S.-Patel-L-and-Bridgeman-G.-2021-Food-insecurity-in-South-Africa-%E2%80%93-Evidence-from-NIDS-CRAM-Wave-5.pdf">Figures show</a> that in 2021, 10 million people, including 3 million children, lived in a household affected by hunger. </p>
<p>Poverty is a <a href="https://journals.sagepub.com/doi/10.1177/00812463211015348">key driver</a> of poor mental health. People who also experience insecure income, housing and food supply are particularly vulnerable.</p>
<p>The burden of mental illness in South Africa is high. Nearly <a href="https://doi.org/10.1017/S0033291720003414">half of the population (47.5%)</a> is at risk of developing a psychiatric disorder in their lifetime. Despite this high burden, access to mental healthcare in South Africa is severely limited. Only <a href="https://doi.org/10.1017/S0033291720003414">27% of patients</a> with severe mental illnesses receive treatment. </p>
<p>South Africa’s public health system was under-resourced and overburdened even before the COVID-19 pandemic. Healthcare in the publicly funded system is provided by <a href="https://doi.org/10.1080/17441692.2017.1407813">35% of the country’s doctors for 84% of the population</a>. </p>
<p>Major depressive disorder and anxiety disorders, have <a href="https://doi.org/10.1016/S0140-6736(21)02143-7">drastically increased</a> during the pandemic, with figures from 2020 suggesting that <a href="https://cramsurvey.org/wp-content/uploads/2021/07/6.-Hunt-X.-Breet-E.-Stein-D.-_-Tomlinson-M.-2021-The-COVID-19-Pandemic-Hunger-and-Depressed-Mood-Among-South-Africans.pdf#page=3">24% of the population</a> exhibit depressive symptoms.</p>
<p>Adolescents and young people growing up in households with unemployment and lacking income and a regular supply of food <a href="https://doi.org/10.17159/sajs.2021/8939">are known to</a> experience even greater stress and anxiety than young people in less resource restricted households. Adolescent girls and young women in the poorest communities in South Africa also face <a href="https://www.unicef.org/southafrica/press-releases/fears-over-increased-violence-and-poverty-top-cause-young-peoples-anxiety">additional challenges</a> to their mental health. These include a lack of social support, financial insecurity, and vulnerabilities related to their gender. But services specifically targeted at adolescents and young people are woefully inadequate.</p>
<h2>The HERStory2 study</h2>
<p>In our <a href="https://capmh.biomedcentral.com/articles/10.1186/s13034-022-00457-y#Sec13">recent study</a> we looked at the socio-economic and mental health impacts of COVID-19 on South African adolescent girls and young women. The aim was to understand how the additional challenges brought on by COVID-19 had added to existing risks faced by this population group. </p>
<p>Between November 2020 and March 2021, <a href="https://www.samrc.ac.za/intramural-research-units/HealthSystems-HERStory">we conducted a survey and interviews</a> with adolescent girls and young women aged 15-24 years in six districts of South Africa. The young women in our study came from communities with some of the highest rates of HIV, teenage pregnancy and socio-economic hardship in the country. We found that COVID-19 restrictions had led to increased experiences of stress and anxiety. But despite the many hardships, some of the young women showed signs of emotional resilience.</p>
<p>Understanding the strategies that some young women have used to cope with the uncertainty of COVID-19 could point to better ways to respond to their needs.</p>
<p>Our findings show that the COVID-19 pandemic and the lockdown restrictions, introduced by the South African government in March 2020, worsened situations of poverty, unemployment and food insecurity, adding to mental health stressors. </p>
<p>Young women in our study described how households’ loss of income, economic and food insecurity, fear of infection, and death of family members resulted in feelings of frustration, anxiety and depression. Nearly three quarters (71.8%) of young women reported financial problems during COVID-19 and the lockdowns.</p>
<p>Hunger was a major issue, with 75.4% of young women saying they had been concerned about food running out due to lack of money. A quarter said they had gone a day and night without food. </p>
<p>This anxiety related to food supply negatively affected mental health, with 69% of young women reporting they had became more distressed and anxious during COVID-19 and the lockdown.</p>
<p>Poor mental health was made even worse by strained family relationships, increased fear of domestic violence, household unemployment, economic stress and food insecurity. Respondents described feeling bored, frustrated, isolated, lonely, scared and hopeless. </p>
<p>Young women had not been able to get the emotional support they needed during the lockdowns. They spoke of their experiences of increased tension in the home environment, with fraught family relationships due to lockdown, and family members feeling stressed, frustrated and confined in close quarters. </p>
<p>Fear was a predominant emotion in the narratives of respondents in our study: fear of infection, fear for the health and safety of family, fear related to economic insecurity and future prospects, and fear of leaving home during lockdown due to concerns about <a href="https://theconversation.com/south-africas-military-is-not-suited-for-the-fight-against-covid-19-heres-why-138560">police brutality</a>. </p>
<p>Respondents described an overwhelming sense of hopelessness about their current situation, and the future. Young women spoke of having their dreams for the future shattered. Some shared desperate stories of their friends no longer being able to cope, and choosing to end their lives due to a loss of hope that things would ever improve.</p>
<p>On a positive note, some respondents articulated an emotional resilience, describing how they managed to cope in healthy ways and retain hope. Some described taking things one step at a time, accepting their situation and being patient, hoping that things would improve. Respondents also described sources of psycho-social support which enabled them to cope. These included parents, grandparents, and community or faith based groups.</p>
<h2>Going forward</h2>
<p>The South African government urgently needs to recognise child and adolescent mental health services as a health priority, and develop appropriate interventions. These should be innovative, cost-effective, scalable and evidence-based. Working through schools and community-based services could be a cost-effective way of increasing access. </p>
<p>Building skills and capacity of lay mental health providers and frontline workers, including community health workers and teachers, could help to reduce the mental health treatment gap. </p>
<p>Support could also be offered through accessible and data-free mobile health applications, digital technologies, virtual support solutions and online platforms. Telephonic counselling services and community safe spaces are options too.</p>
<p>Mental health is not possible if basic needs aren’t met. Therefore, it’s critical to strengthen <a href="https://doi.org/10.1177/00812463211015348">social protection responses</a> and social safety nets. </p>
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Read more:
<a href="https://theconversation.com/covid-19-holds-lessons-for-the-future-of-social-protection-155787">COVID-19 holds lessons for the future of social protection</a>
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<p>Finally, efforts need to be made to create an enabling environment to foster hope among adolescents and young people in South Africa.</p><img src="https://counter.theconversation.com/content/180729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zoe Duby receives funding from the South African Medical Research Council.</span></em></p>The loss of income, economic and food insecurity, fear of infection, and death of family members resulted in feelings of frustration, anxiety and depression.Zoe Duby, Socio-behavioural public health researcher, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1666192021-09-06T12:04:44Z2021-09-06T12:04:44ZDoes my child have separation anxiety? How parents can help with children’s back-to-school fears<figure><img src="https://images.theconversation.com/files/419603/original/file-20210906-23-58piv9.jpg?ixlib=rb-1.1.0&rect=241%2C175%2C6512%2C4659&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">After long periods of social isolation with family members, it may be hard for some children — and parents — to be separated.</span> <span class="attribution"><span class="source">(Pexels/ August de Richelieu)</span></span></figcaption></figure><p>Going back-to-school is an exciting time for many children. But for some it also <a href="https://www.anxietycanada.com/articles/helping-your-child-cope-with-back-to-school-anxiety/">stirs up stress and anxiety</a>. Are they going to like their new teacher? Are they going to enjoy their new school? Are their friends going to be in their class? </p>
<p>It is normal for young children to experience anxiety when separating from parents or caregivers. When you <a href="https://www.theglobeandmail.com/canada/article-some-kids-may-experience-separation-anxiety-due-to-covid-19/">layer a pandemic on top of ordinary back-to-school stress, many children will be struggling more than usual</a>. </p>
<p>In everyday language, it’s common for people to <a href="https://childmind.org/article/back-to-school-anxiety-during-covid/">talk about children</a> <a href="https://theconversation.com/how-to-help-dogs-and-cats-manage-separation-anxiety-when-their-humans-return-to-work-148301">(or even pets)</a> experiencing separation anxiety. </p>
<p>When children experience more intense fears and anxieties that interfere with going to school over a prolonged period of time, or that interfere with how they function at school and/or how they interact with others, this is what psychologists call <a href="https://www.anxietycanada.com/disorders/separation-anxiety-2/">separation anxiety disorder</a>. <a href="https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/symptoms-causes/syc-20377455">Separation anxiety disorder</a> is the <a href="https://doi.org/10.1016/j.cpr.2005.12.002">most common anxiety disorder in children</a> under 12 years of age. </p>
<p>Even when children are experiencing typical levels of anxiety — whether they are starting kindergarten, transitioning to a new school — or returning to more familiar surroundings, how parents respond is important.</p>
<figure class="align-center ">
<img alt="A child waves goodbye from school steps." src="https://images.theconversation.com/files/419324/original/file-20210903-15-1x5sxtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419324/original/file-20210903-15-1x5sxtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419324/original/file-20210903-15-1x5sxtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419324/original/file-20210903-15-1x5sxtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419324/original/file-20210903-15-1x5sxtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419324/original/file-20210903-15-1x5sxtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419324/original/file-20210903-15-1x5sxtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A student waves to her parents as she enters the Bancroft Elementary School as students go back to school in Montréal last August.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
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<h2>Anxiety and the pandemic</h2>
<p>After long periods of social isolation with family members, it may be hard for some children — and parents — to be separated from them once the school bell rings.
Particularly after our pandemic year, some children <a href="https://theconversation.com/dreading-going-back-to-the-workplace-you-might-be-feeling-separation-anxiety-from-your-home-145377">and parents may still feel some anxiety about going into unfamiliar places</a>. They may also have concerns about pandemic safety that makes going back to school stressful.</p>
<p>In a normal year, approximately <a href="https://doi.org/10.1016/j.psychres.2018.12.004">one in 10 children experience elevated anxiety levels</a>. However, research shows that <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2782796">anxiety levels in children have doubled during the pandemic</a>, with one in five experiencing significant anxiety. </p>
<p>In the past year and a half, most children spent more time at home than usual, notably when schools were closed. Even when children were allowed to spend time with friends, there were often restrictions in place, such as being outdoors or keeping a mask on, and staying socially distant. </p>
<p>For some children, these restrictions can increase stress associated with interactions outside of their family. </p>
<h2>What separation anxiety can look like</h2>
<p>Separation anxiety can unfold in different ways. Children may refuse to go to school or participate in new activities in the absence of their parent. They may also refuse to go to bed without their parent or sleep away from home. </p>
<p>Some children experiencing separation anxiety have physical symptoms such as stomach aches and nightmares, while others may experience headaches or a racing heartbeat. Others may have persistent thoughts that something bad is going to happen to themselves or to their parents. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-help-your-child-cope-with-the-transition-back-to-school-during-covid-19-144530">How to help your child cope with the transition back to school during COVID-19</a>
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<p>Some children may also be anxious when it comes to the pandemic specifically.
Going back to school can entail <a href="https://theconversation.com/back-to-school-faqs-on-childrens-health-and-covid-19-delta-variant-preventing-infection-testing-and-international-examples-164684">some risks for unvaccinated children</a>, and some may fear contracting COVID-19 or transmitting it to their friends and family. Also, children, much like adults, may feel a little “rusty” when it comes to interacting with people outside the family, particularly with strangers like a new teacher. </p>
<figure class="align-center ">
<img alt="A father and child talk lying down and the boy looks a little apprehensive while the father holds his hand." src="https://images.theconversation.com/files/419335/original/file-20210903-13-1cpo6eh.jpg?ixlib=rb-1.1.0&rect=0%2C995%2C5414%2C3014&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/419335/original/file-20210903-13-1cpo6eh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419335/original/file-20210903-13-1cpo6eh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419335/original/file-20210903-13-1cpo6eh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419335/original/file-20210903-13-1cpo6eh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419335/original/file-20210903-13-1cpo6eh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419335/original/file-20210903-13-1cpo6eh.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">
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<span class="caption">Children, much like adults, may feel a little unpractised at interacting with people outside the family.</span>
<span class="attribution"><span class="source">(Pexels/Ketut Subiyanto)</span></span>
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<h2>Strategies to support your child</h2>
<p>Whether you know your child has struggled significantly with anxiety before, or they seem worried or anxious about going back to school, we offer several strategies below to help you navigate these feelings with them.</p>
<ol>
<li><p><strong>Validate your child’s fears and anxieties.</strong> Feeling anxious about separating from the comfort of caregivers is a normal response to stressful events. When children express anxiety, let them know you hear them and understand. You can validate and normalize their feelings by saying: “I get that you feel worried. I bet many other kids are feeling that way too.” </p></li>
<li><p><strong>Encourage positive self-talk.</strong> Help children develop a growth mindset that includes positive and productive statements such as: “I am brave, I can do this.” Positive self-talk has been linked to <a href="https://link.springer.com/article/10.1007%2FBF02354595">increased self-esteem in kids</a>. Try practising this at home in the lead up to school, so it’s familiar and easy for kids to use these statements when they are separated from you or get anxious at school.</p></li>
<li><p><strong>Plan to take small steps through the fall.</strong> It is a lot to ask children to go from limited social interactions during the pandemic to extended social interactions in a small space at school. During the first few weeks of school, try to resist the temptation to fill the evening weekends with outings and events. Consider doing home-based activities that children are familiar with to help provide some consistency in their environment. As your children get more comfortable with social interactions, start progressively adding more activities to their calendar as pandemic restrictions permit.</p></li>
<li><p><strong>Stick to routines.</strong> The transition to a new school climate may feel unpredictable to children. This can result in increased anxiety. One way to reduce such anxiety is by having consistent routines at home. For example, stick to a consistent schedule when it comes to eating, bath time, screen time and bedtime. Research has found this has <a href="https://doi.org/10.1016/j.ynstr.2020.100291">helped children experience more well-being during the pandemic</a>. </p></li>
<li><p><strong>Talk about the positive aspects of going to school and venturing out in new ways.</strong> Children (and adults!) can have a hard time seeing the positive aspects of anxiety-inducing situations. Parents can help children see the positive side of the back-to-school, including learning new things, time with friends or participating in extracurricular activities. </p></li>
<li><p><strong>Model positive behaviours.</strong> Children are not the only ones that have seen an increase in their anxiety this past year. There have also been <a href="https://doi.org/10.1016/S2215-0366(21)00074-2">rises in</a> <a href="https://theconversation.com/how-parents-can-be-emotion-coaches-as-kids-navigate-back-to-school-during-covid-19-166148">parental anxiety</a>. Even with respect to school, many parents may also be anxious about being separated from their child. When parents discuss their anxiety and stressors, children may internalize these worries. Try to avoid discussing your life stressors in front of your child, and also <a href="https://doi.org/10.1177/0002764203254619">avoid exposure to alarming media, which has been shown to increase children’s anxiety</a>.</p></li>
</ol>
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<figcaption><span class="caption">Video from Anxiety Canada models how parents can accompany their kindergartener to school.</span></figcaption>
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<p>It is understandable that children may struggle with separating from their loved ones as they experience another unconventional back-to-school. Nonetheless, these strategies can help parents play an important role in easing their children’s anxiety and making the back-to-school more enjoyable for them.</p>
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Read more:
<a href="https://theconversation.com/how-to-build-childrens-resilience-and-your-own-amid-coronavirus-unknowns-135789">How to build children's resilience, and your own, amid coronavirus unknowns</a>
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<p>If you have questions about <a href="https://www.camh.ca/en/camh-news-and-stories/separation-anxiety-linked-to-poorer-health">whether your child could benefit from additional support</a>, you can consider reaching out for professional help, including talking to your family physician. Anxiety Canada provides a <a href="https://www.anxietycanada.com/resources/find-help/">directory of professional services available across Canada</a>.</p><img src="https://counter.theconversation.com/content/166619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Audrey-Ann Deneault receives funding from the Social Sciences and Humanities Research Council of Canada and from the Fonds de recherche du Québec - Société et culture. </span></em></p><p class="fine-print"><em><span>Sheri Madigan receives funding from the Social Sciences and Humanities Research Council, the Canadian Institutes of Health Research, the Alberta Children's Hospital Foundation, and the Canada Research Chairs program.</span></em></p>When you layer a pandemic on top of back-to-school, many children may struggle with separation anxiety. Here are some strategies parents can use to help reduce anxiety in their children.Audrey-Ann Deneault, Postdoctoral research fellow, Department of Psychology, University of CalgarySheri Madigan, Associate Professor, Canada Research Chair in Determinants of Child Development, Owerko Centre at the Alberta Children’s Hospital Research Institute, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1541652021-03-14T09:44:36Z2021-03-14T09:44:36ZCoronavirus pandemic restrictions can help or hinder schoolchildren with anxiety disorders<figure><img src="https://images.theconversation.com/files/389055/original/file-20210311-14-182xu3c.jpg?ixlib=rb-1.1.0&rect=26%2C8%2C5964%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children with anxiety disorders experience new challenges created by the pandemic restrictions</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Parents fear children stuck at home for almost a year during the coronavirus pandemic, will lose critical social skills. And children with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861522/">selective mutism, a severe form of anxiety</a>, will lose even more.</p>
<p>As schools reopen, <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools.html">everyone will wear masks, students will sit far apart</a> and teachers may stay behind <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/guidance-schools-childcare-programs.html">plastic barriers</a>. In many schools, <a href="https://www.ontario.ca/page/guide-reopening-ontarios-schools#section-17">students will eat at their desks</a>. Forget about normal <a href="https://thephysicaleducator.com/2020/12/02/rescuing-recess-helping-recess-thrive-in-a-global-pandemic/#disqus_thread">recess</a>. And parents are concerned about how their children will manage.</p>
<p>Best estimates predict <a href="https://www.nhs.uk/conditions/selective-mutism/">one in 140 children</a> have the <a href="https://pubmed.ncbi.nlm.nih.gov/26709680/">under-recognized</a> <a href="https://www.learnalberta.ca/content/inmdict/html/selective_mutism.html">disability</a> of selective mutism, often misdiagnosed as shyness or stubbornness. Some kids say few words in public, while others are so anxious, they cannot nod or point.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/tAkIXpykB5U?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Selective mutism is an anxiety disorder.</span></figcaption>
</figure>
<h2>Selective mutism in the classroom</h2>
<p>In class, children with selective mutism can’t tell a teacher they don’t understand. They will not speak when they are hurt or being bullied. Many cannot ask to go to the bathroom and have accidents.</p>
<p>Virtual learning has helped some children with selective mutism. Students can use chat boxes to communicate. Some upload recordings of themselves, avoiding the anxiety of live participation. For children who’ve adjusted positively to the new learning environment, parents are choosing home school or distance learning over in-person school.</p>
<p>Janet’s 10-year-old son rarely speaks in public. When he was in first grade, she asked the school if he had a speech delay. The evaluation stalled because he would not talk during the assessment. Because he spoke both English and Chinese at home, they assumed he had no delay. Year after year, he didn’t improve.</p>
<p>“People would stand in front of him and talk to him, but he would just stare at them or stare at the ground,” she says.</p>
<p>Now in fourth grade, her son is still waiting for his promised reassessment which has been further delayed due to the pandemic, but received a selective mutism diagnosis from a child psychologist.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child at laptop wearing headphones raises her hand" src="https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389056/original/file-20210311-14-19r5i36.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">Some children with selective mutism can benefit with virtual learning.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>While her son soared academically online, Janet worries about his isolation. She plans on sending him back to school as soon as it opens.</p>
<p>Elizabeth says after years of selective mutism, her daughter was talking outside the home.</p>
<p>“We used to practice a lot of exposures out in the community. That helped build momentum. All of that stopped,” says Elizabeth. Her daughter uses masks as an excuse not to talk and refuses to turn on her computer camera for class.</p>
<p>She’s worried about school in the fall.</p>
<p>“We’ll enter a new middle school, multiple teachers, and 1,600 kids,” says Elizabeth. “They’re no longer just finding each other on the playground. My daughter asked, ‘How do I make new friends?’”</p>
<h2>Moving through school</h2>
<p>Kerry Kolda, a Grade 4 teacher in San Jose, Calif., teaches a student with selective mutism online. She wishes they could be in the same classroom, even with masks and a plexiglass barrier. Right now, he won’t even interact with a close friend during breakout sessions.</p>
<p>“I feel like if he was with me, a lot of this wouldn’t be manifesting so horribly,” Kolda says.</p>
<p>Kolda says schools like hers often lack enough resources to help children with selective mutism succeed. Her advice is to seek a formal evaluation from a doctor, find a psychologist familiar with selective mutism, and talk to other parents. </p>
<p>“Often with these kinds of disorders, there’s still a stigma. Sometimes parents don’t seek help,” she says.</p>
<p>Early intervention is important to avoid academic problems and other <a href="https://pubmed.ncbi.nlm.nih.gov/32405308/">psychiatric disorders</a>.</p>
<p>“It scares me. Because middle school is not kind to anyone, let alone someone with anxiety or depression or selective mutism. If they don’t have the right tools in their toolkit leaving elementary, it can have devastating consequences,” says Kolda.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young children playing with a toy in a playground" src="https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389058/original/file-20210311-19-1lghz4z.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">How children with selective mutism will fare with a return to in-person school remains to be seen.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Accessible virtual visits</h2>
<p>Emily Doll, a speech and language therapist active in the <a href="https://www.selectivemutism.org">Selective Mutism Association</a>, says many parents shun services because of outdated views about special education.</p>
<p>“They hear ‘special education’ and they think ‘they’re going to pull my kid out of their classroom, they’re going to put them somewhere down in the basement,’” says Doll.</p>
<p>Catherine Eckel, a clinical psychologist in Los Gatos, Calif., says some patients have improved during online learning. Although chat boxes can help, Eckel says children should maintain short but frequent vocal interactions with their teachers and other students.</p>
<p>“My goal is always to work toward verbalization and not use tools that allow them to continue to avoid speaking,” says Eckel.</p>
<p>Video visits made treatment more accessible. To transition from online to in-person learning, Eckel recommends the child and teacher safely meet a few times one-on-one. In the classroom is best, but restrictions may require an outdoor meeting. Giving <a href="https://childmind.org/guide/teachers-guide-to-selective-mutism/">teachers information</a> on how to encourage speech, placing the student in class with a child they have spoken with in the past, and coaching children to speak louder when wearing a mask so they don’t have to repeat themselves will help the transition back to in-person learning.</p>
<p>“We don’t want everyone to assume that because the child’s speaking online, they’ll speak in person,” says Eckel. “When that happens, they’ll start avoiding speaking to their teacher when they go back.”</p><img src="https://counter.theconversation.com/content/154165/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Nguyen 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>Moving between in-person and virtual schooling affects children with anxiety disorders like selective mutism. In addition, access to diagnosis and support is delayed because of pandemic restrictions.Christine Nguyen, Global Journalism Fellow, Dalla Lana School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1429562020-08-31T19:33:07Z2020-08-31T19:33:07ZWhy sign language is vital for all deaf babies, regardless of cochlear implant plans<figure><img src="https://images.theconversation.com/files/353720/original/file-20200819-25043-r3r9zy.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4590%2C3529&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Learning how to say 'more.'</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-mother-playing-with-baby-boy-royalty-free-image/138307713">JGI/Jamie Grill via Getty Images</a></span></figcaption></figure><p>When their newborn failed a hearing test, Quinn and Kai were distraught. Their pediatrician reassured them their baby was a candidate for a <a href="https://www.fda.gov/medical-devices/cochlear-implants/what-cochlear-implant#a">cochlear implant</a> – an electronic device consisting of an external part worn behind the ear and an internal part surgically placed under the skin – that could <a href="https://www3.gallaudet.edu/clerc-center/our-resources/cochlear-implant-education-center/navigating-a-forest-of-information/what-is-a-cochlear-implant.html">partially restore hearing</a> through electrical stimulation of the auditory nerve. </p>
<p>“We were told Casey would go to a mainstream school and learn to hear and talk just like any other kid,” Quinn told us. “The doctors said to speak to him as if he were hearing and not to learn sign language, because it would inhibit his spoken language development.” A few years later, Casey could speak some words but fell short of language milestones. Quinn and Kai’s story is one that is all too familiar to <a href="https://doi.org/10.1017/jse.2014.19">parents of deaf children</a>. </p>
<p>As <a href="https://scholar.google.com/citations?hl=en&user=S_q9BKsAAAAJ">researchers of language and literacy</a> in <a href="https://scholar.google.com/citations?user=BaAF_MEAAAAJ&hl=en&oi=ao">deaf education</a>, we regularly see implanted deaf children like Casey arrive at school with limited language and reasoning skills.</p>
<p>September is International Deaf Awareness Month. We want to debunk common misconceptions that can – and often do – harm deaf children.</p>
<h2>Cochlear implant ‘success’</h2>
<p>Cochlear implants are not a proven substitute for natural hearing. After surgery, children must undergo ongoing, intensive therapy to train the brain to make meaning of the sound it hears. Implant users’ understanding of speech is highly variable and <a href="https://doi.org/10.1146/annurev-neuro-080317-061513">declines substantially when talking or other environmental noise is present</a>. </p>
<p>Research shows cochlear implant success is uneven. Although children implanted at younger ages have higher speech and language scores than those implanted at older ages, the majority still <a href="https://doi.org/10.3389/fpsyg.2020.01407">perform “below” to “well below” average</a>. In a 2020 study of 136 children with cochlear implants in grades 3-6, teachers reported <a href="https://siwi.utk.edu/wp-content/uploads/Summary-Demographic-Data-Year-1-3.pdf">half had difficulty expressing “many to most” concepts in spoken English, and 13% did not speak English at all</a>.</p>
<h2>Sign language and speech development</h2>
<p>It is a misconception that learning sign language hinders spoken language development for implanted children. <a href="https://doi.org/10.1017/S0022215112001909">Research shows the opposite to be true</a>. Deaf children of deaf parents, whose first language is sign language, end up having better spoken language skills once they are implanted than deaf children of hearing parents <a href="https://doi.org/10.1093/deafed/ent045">who did not learn sign language</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A twelve year old girl dressed in a red top and an nine year old girl dressed in a lilac top communicate with sign language. The younger girl is fitted with a cochlear implant and the older girl wears a voice amplifier." src="https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352998/original/file-20200814-16-l2nthd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cochlear implants are most successful for children who learn sign language at an early age.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/deaf-children-with-hearing-aids-in-a-school-class-royalty-free-image/1094646216">Brian Mitchell/Corbis Documentary via Getty Images</a></span>
</figcaption>
</figure>
<p>Research also shows <a href="https://siwi.utk.edu/wp-content/uploads/Summary-Demographic-Data-Year-1-3.pdf">a relationship between sign language and spoken English in school-aged children with cochlear implants</a>: The children who scored highly in sign language were the same ones who scored highly in English. And the children with weak sign language skills also struggled with spoken English.</p>
<p>In fact, sign language is so good for the developing brain some <a href="https://www.babysignlanguage.com/">hearing parents teach it to their hearing children</a> to boost brain development and jump-start communication before speech. </p>
<h2>The window of opportunity for language development</h2>
<p>The idea that sign language can be introduced later, if a cochlear implant is not successful, ignores the basic facts of language development.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&rect=8%2C25%2C5565%2C3707&q=45&auto=format&w=1000&fit=clip"><img alt="A white mother signing to her attentive baby who is mimicking the hand gesture" src="https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&rect=8%2C25%2C5565%2C3707&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/352994/original/file-20200814-14-7y7y43.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">Babies’ brains need language to develop properly.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-signing-the-word-dad-in-american-sign-royalty-free-image/89839900">Huntstock via Getty Images</a></span>
</figcaption>
</figure>
<p>In the first years of life, children absorb language like sponges, as long as social interactions are accessible. The longer a child waits for meaningful language input, the greater the <a href="https://doi.org/10.1017/S0142716407070294">risk of never fully acquiring language</a>. The first five years are a critical period for acquisition.</p>
<p>Research shows that deaf children exposed to sign language later – after unsuccessfully developing spoken language – demonstrate <a href="https://doi.org/10.1017/S1366728917000724">rapid word learning but stop short of attaining complex grammatical structures</a>. </p>
<p>The long-term implications of language deprivation are quite serious. A wide range of <a href="https://doi.org/10.1016/j.amepre.2019.04.001">adverse childhood experiences</a> are known to be associated with adult disease and health problems. Communication exclusion and neglect experienced by deaf children create toxic stress that can trigger physiological and psychological responses. </p>
<p>Limited access to communication in childhood is <a href="https://doi.org/10.1016/j.amepre.2020.04.016">linked to heart problems, lung disease, diabetes, hypertension, depression and anxiety disorders</a> as well as <a href="https://doi.org/10.1093/deafed/enj042">chronic mental illness</a>. </p>
<p>In severe cases, individuals may be institutionalized with language deprivation syndrome. They struggle with <a href="https://doi.org/10.1007/s00127-017-1351-7">social and emotional skills, memory, problem solving and judgment</a>, all of which can impact their ability to live independently.</p>
<h2>Audism in the medical community</h2>
<p>Just as racism is at the root of structural inequalities towards Black, Indigenous and other people of color, <a href="https://doi.org/10.1177/0160597613481731">audism</a> is institutionalized discrimination against deaf people. The medical community is steeped in <a href="https://doi.org/10.1007/s10995-020-02989-1">hearing-at-all-costs attitudes and beliefs</a> that can <a href="https://doi.org/10.1007/s10995-017-2287-y">lead to language deprivation</a> in deaf children. </p>
<p>Doctors are trained to treat and remedy specific physical ailments. Unfortunately, their <a href="https://doi.org/10.1007/s40670-014-0073-7">training is unlikely to include</a> topics of early language acquisition and sign language. </p>
<p>When a deaf baby is born, parents receive the bulk of their <a href="https://doi.org/10.1093/deafed/enq004">information and advice from the medical community</a> – audiologists, ENTs and pediatricians. These doctors too often <a href="https://doi.org/10.1177/0162243913512538">discourage sign language</a>, suggesting it impedes speech development. As a result, deaf children risk growing up without a solid foundation in any language, which is <a href="https://www.routledge.com/Language-Deprivation-and-Deaf-Mental-Health/Glickman-Hall/p/book/9781138735392">dehumanizing and reduces their quality of life</a>. </p>
<h2>The way forward</h2>
<p>We believe the medical community must be educated about <a href="https://doi.org/10.1007/s10995-017-2287-y">deaf children’s need for sign language education</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/3o8Z2lzS764?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A two-year-old deaf girl chatting with her mother in British Sign Language.</span></figcaption>
</figure>
<p>Families can learn sign language along with their babies. It takes two years to acquire conversational skills and five to seven years to develop language fluency, which perfectly matches a child’s language development timeline. </p>
<p>Free services are available to families, including home visits, sign language classes and deaf mentorship. <a href="https://www.ceasd.org/administrative-educational-members/">Schools for the deaf</a> are a great resource, as are civil rights organizations like the <a href="https://www.nad.org/">National Association of the Deaf</a>. For deaf children and their families, taking part in the deaf community can deepen their understanding and appreciation of the deaf experience and increase their linguistic role models, which in turn <a href="https://doi.org/10.1353/sls.2015.0006">provides a long-term educational advantage</a>.</p>
<p>The catastrophe of language deprivation is entirely preventable with early sign language exposure. Lack of awareness is all that stands in the way.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/142956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R324A170086 to the University of Tennessee. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education.</span></em></p><p class="fine-print"><em><span>Kristina Bernhardt and Leala Holcomb do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Teaching deaf babies sign language improves the success of cochlear implants – and also safeguards their long-term physical and mental health.Kimberly A. Wolbers, Professor of Deaf Education, University of TennesseeLeala Holcomb, Postdoctoral Researcher of Language and Literacy, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1331662020-03-06T15:26:50Z2020-03-06T15:26:50ZCoronavirus: how to stop the anxiety spiralling out of control<figure><img src="https://images.theconversation.com/files/319074/original/file-20200306-118956-1r3nfw3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don't let fear ruin your life.</span> <span class="attribution"><a class="source" href="https://www.cambridge.org/core/journals/psychological-medicine/article/global-prevalence-of-anxiety-disorders-a-systematic-review-and-metaregression/484845CE01E709EE4FB6554AA78E612F">TeamDAF</a></span></figcaption></figure><p>As <a href="https://theconversation.com/the-hunt-for-a-coronavirus-cure-is-showing-how-science-can-change-for-the-better-132130">the coronavirus</a> proliferates on a global scale, worry and panic <a href="https://www.nbcnews.com/better/lifestyle/coronavirus-fears-have-emptied-supermarket-shelves-are-you-panic-buying-ncna1148536">is on the rise</a>. And it is no wonder when we are constantly being told how to <a href="https://theconversation.com/yes-washing-our-hands-really-can-help-curb-the-spread-of-coronavirus-132915">best protect ourselves</a> from being infected. But how do you stay safe in this climate and simultaneously make sure that the fear doesn’t take over your life, developing into obsessive compulsive disorder or panic?</p>
<p>Fear is a normal, necessary evolutionary response to threat – ultimately designed to keep us safe. Whether the threat is emotional, social or physical, this response is dependent on a <a href="https://www.sciencedirect.com/science/article/pii/S0166223696100692">complex interaction</a> between our primitive “animal brain” (the limbic system) and our sophisticated cognitive brain (the neo-cortex). These work busily in concert to assess and respond to threats to survival. </p>
<p>Once a threat has been identified, a <a href="https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response">“fight or flight” response</a> can be triggered. This is the body’s biological response to fear and involves flooding us with adrenaline in a bid to ensure that we are able to escape or defeat any threat, such as a dangerous animal attacking. The response produces a range of intense physical symptoms – palpitations, perspiration, dizziness and difficulty breathing – which are designed to make us run faster and fight harder. </p>
<p>However, this system can be prone to glitches, sometimes responding disproportionately to threats that aren’t actually that serious or imminent. Worrying about health conditions such as heart attacks, stroke and even COVID-19 (the disease caused by the coronavirus) can therefore also trigger a fight-or-flight response.</p>
<p>That’s despite the fact that there is no role for a primitive biological response to COVID-19 – no running or fighting is necessary. Instead, it is our high-level, cognitive neocortex that is required here, a rational and measured approach to infectious disease, without the messy complications of panic. </p>
<p>Sadly, this is easier said than done. Once the fear has kicked in, it can be hard to stop it. </p>
<h2>Vulnerable groups</h2>
<p>It is highly unlikely that a viral outbreak, even at pandemic levels, will trigger mental health problems in people who don’t already have them or are in the process of developing them. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925038/">Research shows</a> that most mental health problems start between early adolescence and the mid-20s, with <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/development-of-anxiety-disorders-in-childhood-an-integrative-review/78CA4C983719D652402CA1F5A0E259DD">complex factors being involved</a>. Around 10% of the global population experience clinical levels of anxiety at any one time, although some estimates are higher. </p>
<p>People who are chronically and physically unwell – the ones who are the most vulnerable to the coronavirus – are at particular risk of spiralling anxiety. This should not be ignored. Their concern is warranted and is vital in motivating them to take up precautionary measures. But it is important that these individuals have the support they need in dealing with their emotions.</p>
<p>People with health anxiety, preoccupied with health-related information or physical symptoms, are also at risk of worsening mental health as the virus spreads. So are individuals who are prone to frequent or increased “checking”, such as constantly making sure that the oven is off or that the front door is locked. Those at the extreme end of the scale when it comes to such behaviour may be displaying signs of <a href="https://theconversation.com/brain-scans-reveal-why-it-is-so-difficult-to-recover-from-ocd-and-hint-at-ways-forward-74092">obsessive compulsive disorder</a>.</p>
<p>People who have a lot of background anxiety, and are not easily reassured, may also benefit from assessment and support in the shadow of the coronavirus outbreak. This may include people with <a href="https://theconversation.com/explainer-what-is-an-anxiety-disorder-8206">generalised anxiety disorder or panic disorder</a>, which have strong physiological features.</p>
<h2>Ways to manage the stress</h2>
<p>If you find yourself excessively worrying about the coronavirus, this doesn’t necessarily mean that you have a psychological disorder. But high levels of emotional distress, whatever the source, should be appropriately and compassionately attended to, particularly if it is interfering with normal day to day activities.</p>
<p>At times of stress and anxiety, we are often prone to using strategies that are designed to help but <a href="https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/importance-of-behaviour-in-the-maintenance-of-anxiety-and-panic-a-cognitive-account/B3BAA0EFEF179C99BBCA5F983B05A534">prove counter-productive</a>. For example, you may Google symptoms to try to calm yourself down, even though it is unlikely to ever make you feel better. When our strategies for de-stressing instead increase our anxiety, it is time to take a step back and ask if there is anything more helpful we can do.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319076/original/file-20200306-118966-1ai11pl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stop checking.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-asian-chinese-student-woman-1631236618">TeamDAF</a></span>
</figcaption>
</figure>
<p>There are actually ways to dampen down the physical and emotional symptoms associated with anxiety. One is to stop checking. For example, avoid looking for signs of illness. You are likely to find unfamiliar physical sensations that are harmless but make you feel anxious. Normal physical changes and sensations pass in time, so if you feel your chest tighten, shift your focus onto pleasurable activities and adopt “watchful waiting” in the meantime.</p>
<p>In the case of COVID-19, checking may also include constant monitoring of news updates and social media feeds, which significantly increases anxiety – only serving to reassure us momentarily, if at all. So if you are feeling anxious, consider tuning off automatic notifications and updates on COVID-19. </p>
<p>Instead, do less frequent checks of reliable, impartial sources of information updates on COVID-19. This might include national health websites rather than alarmist news or social media feeds that exacerbate worry unnecessarily. Information can be reassuring if it is rooted in facts. It is often the <a href="https://www.sciencedirect.com/science/article/pii/S0005796707000952">intolerance of uncertainty</a> that perpetuates anxiety rather than fear of illness itself. </p>
<p>At times of stress and anxiety, hyperventilation and shallow breathing is common. Purposeful, regular breathing can therefore <a href="https://link.springer.com/article/10.1007/s10484-015-9279-8">work to reset</a> the fight or flight response and prevent the onset of panic and the unpleasant physical symptoms associated with anxiety. This is also true for exercise, which can help reduce the excess adrenaline build-up associated with anxiety. It can also give much needed perspective. </p>
<p>Perhaps most importantly, don’t isolate yourself. Personal relationships are crucial in maintaining perspective, elevating mood and allowing distraction away from concerns that trouble us. Even in imposed isolation, it is important to combat loneliness and keep talking – for example, via video chats. </p>
<p>We are globally united in living with a very real yet uncertain health threat. Vigilance and precautionary measures are essential. But psychological distress and widespread panic does not have to be part of this experience. Continuing normal daily activities, maintaining perspective and reducing unnecessary stress is key to psychological survival. In other words, where possible, keep calm and carry on. </p>
<p>If you continue to feel anxious or distressed despite trying these techniques, do talk to your GP or refer to a psychologist for evidence-based treatment such as cognitive behavioural therapy.</p><img src="https://counter.theconversation.com/content/133166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jo Daniels 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>Stop constant checking and stay social.Jo Daniels, Senior Lecturer of Psychology, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1253462019-10-18T11:25:13Z2019-10-18T11:25:13ZWhere is my Xanax Rx? Why your doctor may be concerned about prescribing benzodiazepines<figure><img src="https://images.theconversation.com/files/297596/original/file-20191017-98670-1fz706i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Xanax, sold generically as alprazolam, is a popular drug to treat anxiety -- and to sell on the street.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/september-3-2017-ogden-utah-xanax-714836047?src=Xf9c3aT8gmECixAW1xnBUg-1-3">PureRadiancePhoto/Shutterstock.com</a></span></figcaption></figure><p>As an <a href="https://www.starclab.org/members/arash-javanbakht">academic psychiatrist who treats people with anxiety and trauma</a>, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.</p>
<p>There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose and cognitive impairment. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Cohort+Study+of+the+Impact+of+High-Dose+Opioid+Analgesics+on+Overdose+Mortality">overdose death rate</a> among patients receiving both benzodiazepines and opioids is 10 times higher than those only receiving opioids, and benzo misuse is a serious concern.</p>
<h2>What are benzodiazepines?</h2>
<p>Benzodiazepines are a class of anti-anxiety medications, or anxiolytics, that <a href="https://www.aafp.org/afp/2000/0401/p2121.html">increase the activity of the gamma-aminobutyric acid</a> receptors in the brain. GABA is a neurotransmitter, a molecule that helps brain cells, or neurons, communicate with each other. GABA receptors are widely available across the brain, and benzodiazepines work to reduce anxiety by enhancing GABA inhibitory function.</p>
<p>The benzo family includes diazepam, or Valium; clonazepam, or Klonopin; lorazepam, or Ativan; chlordiazepoxide, or Librium; and the one most commonly known to the pop culture, alprazolan, or Xanax, among others. </p>
<p>Different benzos have similar effects, but they differ in strength, how long it takes for them to work and half-life, a measure of how long the drug stays in your system. For example, while <a href="https://www.rxlist.com/valium-drug.htm#clinpharm">diazepam</a> has a half-life of up to 48 hours, the half-life of <a href="https://www.rxlist.com/xanax-drug.htm#clinpharm">alprazolam can be as short as six hours</a>. This is important, as a shorter half-life is linked with higher potential for addiction and dependence. That is one reason physicians typically are not excited about prescribing Xanax for long periods of time.</p>
<h2>When are they used?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/297429/original/file-20191016-98636-1t09kde.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297429/original/file-20191016-98636-1t09kde.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297429/original/file-20191016-98636-1t09kde.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297429/original/file-20191016-98636-1t09kde.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297429/original/file-20191016-98636-1t09kde.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297429/original/file-20191016-98636-1t09kde.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297429/original/file-20191016-98636-1t09kde.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">Benzos are often prescribed to treat short-term anxiety.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-sad-depressed-black-afro-american-1159789150?src=UUPgoCwuIcGIXa856ZIftg-1-38">TheVisualsYouNeed/Shutterstock.com</a></span>
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</figure>
<p>When benzos were introduced to the market in the 1950s, there was excitement as they were considered safer compared to <a href="https://www.drugs.com/drug-class/barbiturates.html">barbiturates</a>, which had been used to treat anxiety. By the 1970s, benzos made it to the list of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24007886">most highly prescribed medications</a>.</p>
<p>Benzos are mainly used to treat anxiety disorders, such as phobias, panic disorder and generalized anxiety disorder. They are mostly used for <a href="https://www.ncbi.nlm.nih.gov/pubmed/30454582">a short period</a> at the beginning of the treatment. That is because it may take a few weeks for the main pharmacological treatment for anxiety, antidepressants, to kick in. During that time, if anxiety is severe and debilitating, benzodiazepines may be prescribed for temporary use. </p>
<p>Benzos are also prescribed for occasional situations of high anxiety, such as that caused by phobias. The main treatment of phobias, such as excessive fear of animals, places and social interactions, is <a href="https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610">psychotherapy</a>. Sometimes, however, phobias can interfere with one’s functioning just sporadically, and the person may not be interested in investing in therapy. For example, a person with fear of flying who may fly on a plane once or twice a year may choose to take a benzo before flying. However, for a businessman or woman who flies several times a months, psychotherapy is recommended. </p>
<p>Benzos may also be used for situations of short-term stress, such as a stressful job interview. </p>
<p>Benzos are also used for other medical conditions, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/25323468">treatment of seizures</a> or alcohol withdrawal in the hospital. There is <a href="https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGClinicianSummaryFinal.pdf">no good evidence for use of benzos in post-traumatic stress disorder</a>.</p>
<h2>So why the worry?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/297597/original/file-20191017-98632-df4e6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297597/original/file-20191017-98632-df4e6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297597/original/file-20191017-98632-df4e6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297597/original/file-20191017-98632-df4e6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297597/original/file-20191017-98632-df4e6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297597/original/file-20191017-98632-df4e6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297597/original/file-20191017-98632-df4e6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Doctors often are reluctant to prescribe benzodiazepines, and many prefer to talk to their patients about the risks and also about other potential treatments, such as psychotherapy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-doctor-talking-middle-aged-woman-769470607?src=H24N3M5KnjChVCHoWtmrpA-1-23">Pormezz/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Now we get to the part about why I and other doctors are not eager to prescribe benzodiazepines for long-term use: We have a Hippocratic oath to “first do not harm.” I sometimes tell patients who insist on getting benzos: “I am not paid differently based on the medication I prescribe, and my life would be much easier not arguing with you about this medication. I do this because I care about you.” </p>
<p>A major risk of long-term use of benzos is <a href="https://www.ncbi.nlm.nih.gov/pubmed/21714826">addiction</a>. That means you may become dependent on these meds and that you have to keep increasing the dose to get the same effect. Actually benzos, especially Xanax, have street value because of the pleasant feeling they induce. In 2017, there were more than <a href="https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates">11,000 deaths involving benzos</a> alone or with other drugs, and in 2015, a <a href="https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids">fifth of those who died of opioid overdose</a> also had benzos in their blood. </p>
<p>Benzos to anxiety can be seen like opioids to pain. They both are mostly for short use, have a potential for addiction and are not a cure. Benzo overdose, especially when mixed with alcohol or opioids, may lead to slowing of breathing, and potentially death. Benzo misuse can also lead to lack of restraint of <a href="https://www.ncbi.nlm.nih.gov/pubmed/30454581">aggressive or impulsive behavior</a>. </p>
<p>As benzos are sedating medications, they also <a href="https://www.ncbi.nlm.nih.gov/pubmed/28448593">increase the risk of accidents and falls</a>, especially in the elderly. This is worse when they are mixed with other central nervous system suppressants like alcohol or opioids.</p>
<p>Recently, we have been learning more about the <a href="https://www.ncbi.nlm.nih.gov/pubmed/21714826">potential cognitive, memory and psychomotor impairment</a> in long-term use of benzodiazepines, especially in older adults. Cognitive functions impacted may include <a href="https://www.ncbi.nlm.nih.gov/pubmed/15762814">processing speed and learning</a> among others. <a href="https://www.ncbi.nlm.nih.gov/pubmed/15841867">Such effects may persist</a> even after discontinuation of long-term use of the benzos.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/7841856">Stopping benzos abruptly</a>, especially if high dose, can cause withdrawal symptoms, such as restlessness, irritability, insomnia, muscle tension, blurred vision and racing heart. Withdrawal from high doses of benzos, especially those that are shorter acting, may be dangerous, leading to seizure, and getting off of these medications should be done under supervision of a physician.</p>
<h2>Safer options abound</h2>
<p>There are safer effective treatments for anxiety, but they require patience to work. A first line treatment for anxiety disorders is psychotherapy, mainly <a href="https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610">cognitive behavioral therapy</a>. During therapy, the person learns more adaptive coping skills, and corrects cognitive distortions to reduce stress. </p>
<p>Exposure therapy is an effective treatment for phobias, social phobia, obsessive compulsive disorder and PTSD. During exposure therapy, the person is gradually exposed to the feared situation under the guidance of the therapist, until the situation does not create anxiety anymore. Importantly, the skills earned during therapy can always be used, allowing better long-term outcome compared to medications.</p>
<p><a href="https://adaa.org/finding-help/treatment/medication">Medications are also used</a> for treatment of anxiety disorders. The main group of such medications is selective serotonin reuptake inhibitors, commonly known as antidepressants. Examples of such medications are fluoxetine, sertraline and citalopram. Especially when combined with psychotherapy, these medications are effective and are safer options than the benzos, and without a risk of addiction.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/125346/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht 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>Benzodiazepines, or benzos, are some of the most widely prescribed drugs in the US. They are meant to be used only short-term, but thousands use them long-term. That’s a big worry.Arash Javanbakht, Assistant Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1216542019-10-03T10:22:00Z2019-10-03T10:22:00ZHow music therapy can help anxious children<figure><img src="https://images.theconversation.com/files/295211/original/file-20191002-49346-r9ta5s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tuning in.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-smiling-child-enjoys-listens-music-1344479351?src=oV3oG49qq35yv5J_HdtLNg-1-98">Shutterstock/MIA Studio</a></span></figcaption></figure><p><a href="https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017">According to the NHS</a>, as many as one in eight children aged five to 19 faces a mental health challenge. And a significant number of these cases are related to some form of anxiety. </p>
<p>Of course, a degree of anxiety or worry may be a normal state of affairs for young people – particularly when moving schools, or around exam time. But for some, anxiety can affect <a href="https://www.anxietyuk.org.uk/get-help/anxiety-information/young-people-and-anxiety/">every aspect of their daily lives</a>. </p>
<p>One effective method of providing support for this anxiety is music therapy, where music becomes the main tool the therapist uses to connect and work with the patient. This kind of therapy <a href="https://www.bamt.org">has been shown</a> to be effective when treating children and young people living with anxiety based disorders. </p>
<p>After all, lots of young people love listening to music, and the music choices they make can be closely tied to their sense of self and identity. During times of stress and worry, <a href="https://www.researchgate.net/publication/229471062_The_role_of_music_in_adolescents'_mood_regulation">research</a> indicates that young people have an innate sense of the kinds of music they need to listen to. </p>
<p>It is also a particularly adaptable form of therapy. <a href="https://www.sciencedirect.com/science/article/pii/S019745561300186X?via%3Dihub">Research suggests</a> that young people’s “passionate commitment” to songs and genres of music can shift depending on the situation. </p>
<p>A track like Taylor Swift’s Dancing with Our Hands Tied, for example, could be first heard as a love song, then as a break-up song, and then again as a song of triumph and survival. This demonstrates a complex and adaptable set of emotional interactions with music, and shows how it can offer support in ever changing situations.</p>
<h2>Making it up</h2>
<p>In a music therapy session, the therapist might use a variety of accessible instruments, such as drums, small percussion instruments and keyboards, as well as apps to put together beats and loops, to make music with the child. Songwriting is also a good option, perhaps taking an existing song and changing the lyrics to fit the current situation, or composing an original song. </p>
<p>When I worked in the NHS at a facility for young people with psychological difficulties, I found a combination of structured musical activities and improvisation useful – especially with those who experienced anxiety due to the unpredictability of social situations. </p>
<p>Using improvisation in a safe setting helped with the idea of making things up as you go along, and feeling more comfortable with this as a concept. To all intents and purposes, that is essentially what many social situations require. </p>
<p>There are other proven benefits, too. A clinical trial called <a href="https://pure.qub.ac.uk/portal/en/publications/music-in-mind-a-randomized-controlled-trial-of-music-therapy-for-young-people-with-behavioural-and-emotional-problems-study-protocol(0bcf64a8-ba4e-45a8-ad22-edc03903e6d3).html">Music in Mind</a> based in Northern Ireland used music therapy to individually treat children and young people with behavioural problems and mental health needs. It found improvements in communication, self esteem and social functioning. </p>
<p>Other studies have seen positive results in the <a href="https://academic.oup.com/jmt/article-abstract/49/4/395/942989">combined use</a> of cognitive behavioural therapy (CBT) and music therapy.</p>
<p>As well as its supportive value, music therapy can help young people develop their skills of emotional regulation – the mechanism which allows us to function in our daily lives, managing difficult situations by adjusting our emotional responses to events and feelings. </p>
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<p><a href="https://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780198765844.001.0001/med-9780198765844">Developing emotional regulation</a> skills is key to reducing the risks of psychological challenges later on, and can begin in early childhood with interactive musical play. </p>
<p>Here, the music therapist and child play games in which both take turns to be in charge of the music. Having the chance to signal “stop” and “go”, as well as choosing whether the music will be loud or soft gives the child a chance to see how it feels be in charge. </p>
<h2>A positive note</h2>
<p>They are also able to explore how the differences in music make them feel.
An American <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2015.00572/full?utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Human_Neuroscience&id=146406">study</a> using this method showed a considerable improvement in emotional regulation scores, suggesting that using music in playful activities can have very positive effects on young children.</p>
<p>It is clear, then, that there is potential for a spectrum of practice in the use of music to support children and young people who live with anxiety disorders. </p>
<p>Listening to preferred music and using that experience to explore feelings and moderate anxiety is at one end of the spectrum. The early use of music in pre-school and school settings can also help develop ER, building resilience in children to adverse life events. </p>
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Read more:
<a href="https://theconversation.com/music-therapy-improves-the-health-of-premature-babies-and-boosts-parental-bonding-118281">Music therapy improves the health of premature babies and boosts parental bonding</a>
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<p>If disorders develop, music can be used as a tool to explore emotions and work towards understanding, with music therapy being offered as a treatment to those who need more focused clinical support. </p>
<p>So perhaps we all need to be thinking about the use of music in managing anxiety in our children and young people. There is a wealth of evidence emerging as to its effectiveness – which we can all tune in to.</p><img src="https://counter.theconversation.com/content/121654/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Coombes 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>Music for pleasure, self-expression and emotional regulation.Elizabeth Coombes, Senior Lecturer in Music Therapy, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1208242019-07-29T20:24:47Z2019-07-29T20:24:47ZMore Australians are diagnosed with depression and anxiety but it doesn’t mean mental illness is rising<figure><img src="https://images.theconversation.com/files/285668/original/file-20190725-136786-e0gw4r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women are almost twice as likely to be diagnosed with depression or anxiety as men.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/akT1bnnuMMk">Eric Ward</a></span></figcaption></figure><p>Diagnoses of depression and anxiety disorders have risen dramatically over the past eight years. That’s according to new data out today from the <a href="https://melbourneinstitute.unimelb.edu.au/hilda">Housing Income and Labour Dynamics (HILDA) Survey</a>, which tracks the lives of 17,500 Australians. </p>
<p>The increase spans across all age groups, but is most notably in young people. </p>
<p>The percentage of young women (aged 15-34) who had been diagnosed with these conditions increased from 12.8% in 2009, to 20.1% in 2017. </p>
<p><iframe id="gBi8a" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/gBi8a/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>In young men, there was a similar increase, from 6.1% to 11.2%. </p>
<p><iframe id="X7qbd" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/X7qbd/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>But this doesn’t mean Australians’ mental health is worsening.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-an-anxiety-disorder-8206">Explainer: what is an anxiety disorder?</a>
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<h2>What’s behind the numbers?</h2>
<p>HILDA surveys collate data on the “reported diagnosis” of depression and anxiety disorders. Many people with these conditions have remained undiagnosed by a health practitioner, so it could simply be a matter of more people seeking professional help and getting diagnosed.</p>
<p>To find out whether there is a real increase, we need to survey a sample of the public about their symptoms rather than ask about whether they have been diagnosed. This has been done for almost two decades in the <a href="https://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001">National Health Survey</a>. </p>
<p>This graph shows the percentage of the population reporting very high levels of depression and anxiety symptoms over the previous month, from 2001 to 2017-18. </p>
<p><iframe id="aZ3ri" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/aZ3ri/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Rather than worsening, the nation’s mental health has been steady over this period.</p>
<h2>Shouldn’t our mental health be improving?</h2>
<p>So it seems while our mental health is not getting worse, we are more likely to get diagnosed. With increased diagnosis, it’s no surprise Australians have been rapidly embracing treatments for mental-health problems. </p>
<p>Antidepressant use has been rising for decades, with Australians now among the <a href="https://www.oecd.org/australia/Health-at-a-Glance-2015-Key-Findings-AUSTRALIA.pdf">world’s highest users</a>. One in ten Australian adults take an <a href="https://www.mja.com.au/journal/2016/204/9/unfulfilled-promise-antidepressant-medications">antidepressant each day</a>. </p>
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Read more:
<a href="https://theconversation.com/if-youre-coming-off-antidepressants-withdrawals-and-setbacks-may-be-part-of-the-process-114179">If you're coming off antidepressants, withdrawals and setbacks may be part of the process</a>
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<p>Psychological treatment has also <a href="https://journals.sagepub.com/doi/abs/10.1177/0004867418804066?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=anpa">skyrocketed</a>, particularly after the Australian government introduced Medicare coverage for psychology services in 2006. There are now around 20 psychology services per year for every 100 Australians.</p>
<p>The real concern is why we’re not seeing any benefit from these large increases in diagnosis and treatment. In theory, our mental health should be improving. </p>
<p>There are two likely reasons for the lack of progress: the treatments are often not up to standard and we have neglected prevention.</p>
<h2>Treatment is often poor quality</h2>
<p>A number of treatments <a href="https://resources.beyondblue.org.au/prism/file?token=BL/0556">work for depression and anxiety disorders</a>. However, what Australians receive in practice <a href="https://journals.sagepub.com/doi/abs/10.1177/0004867415606224?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=anpa">falls far short</a> of the ideal.</p>
<p>Antidepressants, for example, are most appropriate for severe depression, but are <a href="https://journals.sagepub.com/doi/abs/10.1046/j.1440-1614.2003.01132.x?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=anpa">often used</a> to treat people with mild symptoms that reflect difficult life circumstances.</p>
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<img alt="" src="https://images.theconversation.com/files/285670/original/file-20190725-136737-1m9jvma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285670/original/file-20190725-136737-1m9jvma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285670/original/file-20190725-136737-1m9jvma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285670/original/file-20190725-136737-1m9jvma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285670/original/file-20190725-136737-1m9jvma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285670/original/file-20190725-136737-1m9jvma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285670/original/file-20190725-136737-1m9jvma.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">It takes more than a couple of sessions with a psychologist to treat a mental health disorder.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/KQfxVDHGCUg">Kylli Kittus</a></span>
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<p>Psychological treatments can be effective, but require many sessions. <a href="https://www.mja.com.au/journal/2016/204/9/better-access-and-equitable-access-clinical-psychology-services-what-do-we-need">Around 16 to 20 sessions</a> are recommended to treat depression. Getting a couple of sessions with a psychologist is too often the norm and unlikely to produce much improvement.</p>
<p>Treatments are also not distributed to the people most in need. The <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4329.0.00.003%7E2011%7EMain%20Features%7EAntidepressants%7E10008">biggest users of antidepressants</a> are older people, whereas <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2017-18%7EMain%20Features%7EMental%20and%20behavioural%20conditions%7E70">younger people are more likely to experience</a> severe depression.</p>
<p>Similarly, people in wealthier areas are <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja14.00330?sid=nlm%3Apubmed">more likely to get psychological therapy</a>, but depression and anxiety disorders are more common in poorer areas.</p>
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Read more:
<a href="https://theconversation.com/when-its-easier-to-get-meds-than-therapy-how-poverty-makes-it-hard-to-escape-mental-illness-114505">When it's easier to get meds than therapy: how poverty makes it hard to escape mental illness</a>
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<h2>Prevention is neglected</h2>
<p>The big area of neglect in mental health is prevention. Australia achieved enormous gains in physical health during the 20th century, with <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/trends-in-deaths">big drops in premature death</a>. Prevention of disease and injury played a major role in these gains. </p>
<p>We might expect a similar approach to work for mental-health problems, which are the next frontier for improving the nation’s health. However, while we have been putting increasing resources into treatment, prevention has been neglected. </p>
<p>There is now good evidence that prevention of mental-health problems is possible and that it <a href="https://journals.sagepub.com/doi/full/10.1177/0004867414546387">makes good economic sense</a>. For every dollar invested on school-based interventions to reduce bullying, for instance, there is an <a href="http://eprints.lse.ac.uk/39300/1/Mental_health_promotion_and_mental_illness_prevention%28author%29.pdf">estimated economic return of $14</a>.</p>
<p>Much could to be done to reduce the <a href="https://journals.sagepub.com/doi/abs/10.1177/0004867418761581?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=anpa">major risk factors for mental-health problems</a> which occur during childhood and increase risk right across the lifespan. </p>
<p>Parents who are in conflict with each other and fight a lot, for example, may increase their children’s risk for depression and anxiety disorders, while parents who show warmth and affection towards their children decrease their risk. <a href="https://mental.jmir.org/2017/4/e59/">Parents can be trained</a> to reduce these risk factors and increase protective factors. </p>
<p>Yet successive Australian governments have lacked the political will to invest in prevention.</p>
<h2>Where to next?</h2>
<p>There is an important opportunity to consider whether Australia should be heading in a very different direction in its approach to mental health. The Australian government has asked the Productivity Commission to <a href="https://www.pc.gov.au/inquiries/current/mental-health#draft">investigate mental health</a>. </p>
<p>While we’ve had many previous inquiries, this one is different because it’s looking at the social and economic benefits of mental health to the nation. This broader perspective is important because action on prevention is a whole-of-government concern with resource implications and benefits that extend well beyond the health sector. </p>
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Read more:
<a href="https://theconversation.com/theres-a-reason-youre-feeling-no-better-off-than-10-years-ago-heres-what-hilda-says-about-well-being-121098">There's a reason you're feeling no better off than 10 years ago. Here's what HILDA says about well-being</a>
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<img src="https://counter.theconversation.com/content/120824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Jorm receives funding from the National Health and Medical Research Council. He is a Chief Investigator on the Centre for Research Excellence on Childhood Adversity and Mental Health. He is Chair of the Scientific Advisory Committee of Prevention United, Chair of the Board of Mental Health First Aid International, a member of the Alliance for Prevention of Mental Disorders and a member of the Association for Psychological Science. </span></em></p>Around 20% of young Australian women had a diagnosis of depression or anxiety in 2017 compared with 12.8% in 2009. But the proportion of people reporting significant symptoms has remained stable.Anthony Jorm, Professor emeritus, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1062312018-11-08T19:33:52Z2018-11-08T19:33:52ZOne in four Australians are lonely, which affects their physical and mental health<figure><img src="https://images.theconversation.com/files/244501/original/file-20181108-74787-97nmyz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Younger Australians struggle more with loneliness than older generations.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/WY_J0_9sVFg">Toa Heftiba</a></span></figcaption></figure><p>One in four Australians are lonely, our new report has found, and it’s not just a problem among older Australians – it affects both genders and almost all age groups. </p>
<p>The <a href="https://psychweek.org.au/loneliness-study/">Australian Loneliness Report</a>, released today by my colleagues and I at the <a href="https://www.psychology.org.au">Australian Psychological Society</a> and <a href="https://www.swinburne.edu.au">Swinburne University</a>, found one in two (50.5%) Australians feel lonely for at least one day in a week, while more than one in four (27.6%) feel lonely for three or more days.</p>
<p>Our results come from a survey of 1,678 Australians from across the nation. We used a comprehensive measure of loneliness to assess how it relates to mental health and physical health outcomes. </p>
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Read more:
<a href="https://theconversation.com/politics-with-michelle-grattan-andrew-giles-on-the-growing-issue-of-loneliness-106544">Politics with Michelle Grattan: Andrew Giles on the growing issue of loneliness</a>
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<p>We found nearly 55% of the population feel they lack companionship at least sometime. Perhaps unsurprisingly, Australians who are married or in a de facto relationship are the least lonely, compared to those who are single, separated or divorced.</p>
<p>While Australians are reasonably connected to their friends and families, they don’t have the same relationships with their neighbours. Almost half of Australians (47%) reported not having neighbours to call on for help, which suggests many of us feel disengaged in our neighbourhoods.</p>
<h2>Impact on mental and physical health</h2>
<p>Lonely Australians, when compared with their less lonely counterparts, reported higher social anxiety and depression, poorer psychological health and quality of life, and fewer meaningful relationships and social interactions.</p>
<p>Loneliness increases a person’s likelihood of experiencing depression by 15.2% and the likelihood of social anxiety increases by 13.1%. Those who are lonelier also report being more socially anxious during social interactions. </p>
<p>This fits with previous research, including a <a href="https://www.ncbi.nlm.nih.gov/pubmed/27124713">study</a> of more than 1,000 Americans which found lonelier people reported more severe social anxiety, depression, and paranoia when followed up after three months. </p>
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<img alt="" src="https://images.theconversation.com/files/244509/original/file-20181108-74775-zhtep7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/244509/original/file-20181108-74775-zhtep7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244509/original/file-20181108-74775-zhtep7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244509/original/file-20181108-74775-zhtep7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244509/original/file-20181108-74775-zhtep7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244509/original/file-20181108-74775-zhtep7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244509/original/file-20181108-74775-zhtep7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older Australians are less socially anxious than younger folks.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/KioSWLPXFXM">Fabio Neo Amato</a></span>
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<p>Interestingly, Australians over 65 were less lonely, less socially anxious, and less depressed than younger Australians. </p>
<p>This is consistent with previous studies that show older people fare better on particular <a href="https://www.psychiatrist.com/jcp/article/Pages/2016/v77n08/v77n0813.aspx">mental health and well-being</a> indicators. </p>
<p>(Though it’s unclear whether this is the case for adults over 75, as few participants in our study were aged in the late 70s and over). </p>
<p>Younger adults, on the other hand, reported significantly more social anxiety than older Australians.</p>
<p>The evidence outlining the negative effects of loneliness on physical health is also growing. Past research has found loneliness <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Loneliness+and+Social+Isolation+as+Risk+Factors+for+Mortality%3A+A+Meta-Analytic+Review">increases the likelihood of an earlier death by 26%</a> and has negative consequences on the <a href="http://dx.doi.org/10.1037/0022-3514.85.1.105">health of your heart</a>, <a href="http://pss.sagepub.com/content/13/4/384.full.pdf">your sleep</a>, and <a href="https://ac.els-cdn.com/S0306453003000866/1-s2.0-S0306453003000866-main.pdf?_tid=cdefeaff-e369-438e-912f-514b4eeb3048&acdnat=1529311650_63a5438f3a90a9bd5dcdc77e901dd944">levels of inflammation</a>.</p>
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<p>
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Read more:
<a href="https://theconversation.com/loneliness-is-a-health-issue-and-needs-targeted-solutions-96262">Loneliness is a health issue, and needs targeted solutions</a>
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<p>Our study adds to this body of research, finding people with higher rates of loneliness are more likely to have more headaches, stomach problems, and physical pain. This is not surprising as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143485/#!po=8.62069">loneliness is associated with increased inflammatory responses</a>. </p>
<h2>What can we do about it?</h2>
<p>Researchers are just beginning to understand the detrimental effects of loneliness on our health, social lives and communities but many people – including service providers – are unaware. There are no guidelines or training for service providers. </p>
<p>So, even caring and highly trained staff at emergency departments may trivialise the needs of lonely people presenting repeatedly and direct them to resources that aren’t right. </p>
<p>Increasing awareness, formalised training, and policies are all steps in the right direction to reduce this poor care. </p>
<p>For some people, simple solutions such as joining shared interest groups (such as book clubs) or shared experienced groups (such as bereavement or carers groups) may help alleviate their loneliness. </p>
<p>But for others, there are more barriers to overcome, such as stigma, discrimination, and poverty. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/244502/original/file-20181108-74772-15fx4wp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/244502/original/file-20181108-74772-15fx4wp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/244502/original/file-20181108-74772-15fx4wp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/244502/original/file-20181108-74772-15fx4wp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/244502/original/file-20181108-74772-15fx4wp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/244502/original/file-20181108-74772-15fx4wp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/244502/original/file-20181108-74772-15fx4wp.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">Shared interest groups can help some people feel less alone.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/3ckWUnaCxzc">Danielle Cerullo</a></span>
</figcaption>
</figure>
<p>Many community programs and social services focus on improving well-being and quality of life for lonely people. By tackling loneliness, they may also improve the health of Australians. But without rigorous evaluation of these health outcomes, it’s difficult to determine their impact.</p>
<p>We know predictors of loneliness can include <a href="https://www.ncbi.nlm.nih.gov/pubmed/25910391">genetics</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2810252/?report=reader">brain functioning</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28320380">mental health</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/20668659">physical health</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29468772">community</a>, <a href="http://faculty.wharton.upenn.edu/wp-content/uploads/2012/05/Work_Loneliness_Performance_Study.pdf">work</a>, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27357305">social</a> factors. And we know predictors can differ between groups – for example, young versus old. </p>
<p>But we need to better measure and understand these different predictors and how they influence each other over time. Only with Australian data can we predict who is at risk and develop effective solutions. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-deadly-truth-about-loneliness-43785">The deadly truth about loneliness</a>
</strong>
</em>
</p>
<hr>
<p>There are some things we can do in the meantime. </p>
<p>We need a campaign to end loneliness for all Australians. Campaigns can raise awareness, reduce stigma, and empower not just the lonely person but also those around them. </p>
<p>Loneliness campaigns have been successfully piloted in the <a href="https://www.campaigntoendloneliness.org">United Kingdom</a> and <a href="http://modensomhed.dk">Denmark</a>. These campaigns don’t just raise awareness of loneliness; they also empower lonely and un-lonely people to change their social behaviours. </p>
<p>A great example of action arising from increased awareness comes from <a href="http://www.rcgp.org.uk/policy/rcgp-policy-areas/loneliness.aspx">the Royal College of General Practitioners</a>, which developed action plans to assist lonely patients presenting in primary care. The college encouraged GPs to tackle loneliness with more than just medicine; it prompted them to ask <em>what matters to the lonely person</em> rather than <em>what is the matter with the lonely person</em>.</p>
<p>Australia lags behind other countries but loneliness is on the agenda. Multiple <a href="https://www.endloneliness.com.au">Australian organisations</a> have come together after identifying a need to generate Australian-specific data, increase advocacy, and develop an awareness campaign. But only significant, sustained government investment and bipartisan support will ensure this promising work results in better outcomes for lonely Australians.</p><img src="https://counter.theconversation.com/content/106231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle H Lim receives funding from Barbara Dicker Brain Sciences Foundation. </span></em></p>Half of Australians feel lonely for at least one day a week, while one in four feel lonely for three or more days. This can impact on sleep, heart health and levels of anxiety.Michelle H Lim, Senior Lecturer and Clinical Psychologist, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1055412018-11-02T10:53:46Z2018-11-02T10:53:46ZDeveloping teen brains are vulnerable to anxiety – but treatment can help<figure><img src="https://images.theconversation.com/files/243125/original/file-20181031-76411-11c80l0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The character of Kayla in 'Eighth Grade' is a true-to-life representation of an anxious teen.</span> <span class="attribution"><a class="source" href="https://www.imdb.com/title/tt7014006/mediaindex?ref_=tt_ov_mi_sm">A24</a></span></figcaption></figure><p>Adolescence is the life stage when mental illnesses are <a href="https://doi.org/10.1001/archpsyc.62.6.593">most likely to emerge</a>, with anxiety disorders being the most common. Recent estimates suggest that <a href="https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml#part_155096">over 30 percent of teens</a> have an anxiety disorder. That means about one of every three teenagers is struggling with anxiety that significantly interferes with their life and is <a href="https://doi.org/10.1016/j.psc.2009.06.002">unlikely to fade</a> without treatment.</p>
<p><iframe id="08i3I" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/08i3I/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Kayla is the anxious teen protagonist in the recent movie “<a href="https://www.imdb.com/title/tt7014006/?ref_=nv_sr_1">Eighth Grade</a>.” From the acne peeking out through her makeup to the frequent “likes” that punctuate her speech, she seems to be a quintessentially awkward teen. Inside her mind, though, the realities of social anxiety meet the typical storm and stress of adolescence. Through its warm yet heart-wrenchingly truthful portrayal of an awkward and anxious teen, “Eighth Grade” provides a relatable character for identifying and understanding how teen anxiety can really look and feel.</p>
<p><a href="https://scholar.google.com/citations?user=HlR1nSAAAAAJ&hl=en&oi=ao">As developmental</a> <a href="https://scholar.google.com/citations?user=4SpCHKcAAAAJ&hl=en&oi=ao">neuroscientists</a>, watching the film sparked a conversation about the latest science on anxiety during adolescence. Researchers are learning more about why the teenage brain is so vulnerable to anxiety – and developing effective treatments that are increasingly available.</p>
<h2>What does teen anxiety look like?</h2>
<p>The hallmark of <a href="http://www.abct.org/Information/?m=mInformation&fa=fs_ANXIETY">anxiety disorders</a> is fear or nervousness that does not go away, even in the absence of any real threat. In an emotional scene, Kayla shares that she’s “really, like, nervous all the time” and she “[tries] really hard not to feel that way,” as if she’s constantly waiting to ride a roller coaster with butterflies in her stomach, but never getting the relief of the ride ending.</p>
<p>For teens and parents, it can be hard to disentangle normal emotional changes that often accompany puberty from anxiety that may require professional care. Some of Kayla’s worries and fears are highly typical - feeling nervous about what others will think, worrying about making friends, wanting to “fit in.” The problem is that, unlike everyday worry, Kayla experiences these feelings all the time and in ways that force her to miss out on important opportunities of adolescence like exploring relationships.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=573&fit=crop&dpr=1 600w, https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=573&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=573&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=720&fit=crop&dpr=1 754w, https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=720&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/243128/original/file-20181031-76396-1syjnq3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=720&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Connections between the amygdala and the prefrontal cortex at the front of the brain are involved in the experience of fear and anxiety.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Ptsd-brain.png">National Institute of Mental Health</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Studies on the teenage brain are increasingly revealing <a href="https://doi.org/10.1073/pnas.1600013113">why adolescence may be such a vulnerable time for anxiety</a>. Researchers have focused on connections between the brain’s limbic system, including the amygdala which governs emotion, and the prefrontal cortex, the frontmost part of the brain. These <a href="https://doi.org/10.1146/annurev.neuro.23.1.155">connections are essential for controlling emotions</a>, including fear, a core symptom in anxiety disorders. </p>
<p>The problem is that these amygdala-prefrontal cortex connections are slow to develop; they continue to strengthen into one’s early 20s. During adolescence, the brain goes through rapid changes in its shape and size and also in how it works. The very structures and connections in the brain that help to manage emotions are in flux <a href="http://www.jneurosci.org/content/38/44/9433">during this developmental period</a>, making teens especially vulnerable to stress and anxiety.</p>
<p>Anxious teens are at heightened risk for a host of long-term problems, including <a href="https://doi.org/10.1097/00004583-200109000-00018">depression, substance abuse and suicide</a>.</p>
<h2>Evidence-based treatments work</h2>
<p>Fortunately, help exists for anxious teens. As is the case for the startlingly high <a href="https://childmind.org/2015-childrens-mental-health-report/">80 percent</a> of youth struggling with anxiety who don’t get treatment, Kayla’s journey through “Eighth Grade” also does not include any professional help. Yet no teen should need to face anxiety on their own. <a href="https://doi.org/10.1056/NEJMoa0804633">Psychotherapy and medications can both</a> be <a href="https://doi.org/10.1016/j.jaac.2013.11.010">highly effective</a>.</p>
<p>Cognitive behavioral therapy (CBT) is one of the most effective and widely used psychosocial treatments for anxiety in teens. In CBT, therapists help individuals with anxiety to gradually and repeatedly expose themselves to the very situations that they fear.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/243130/original/file-20181031-76387-ht1rzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Practicing something that causes fear or anxiety can lessen its power in real-life situations.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ollisplace/15834558334">olli's place/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>A socially anxious teen might start with imagining sending a classmate a text asking to hang out, gradually move on to sending that text, or even calling a classmate on the phone, and eventually initiating a conversation with an unfamiliar peer at a party. The goal is to practice these anxiety-provoking actions and associate them with a new state of safety.</p>
<p>Decades of studies in animals and <a href="https://doi.org/10.1016/j.neuron.2004.08.042">people</a> have helped psychology researchers understand more about how the brain regulates fear. Building on this work, emerging neuroscience evidence suggests that current treatments for anxiety directly modify the same amygdala-prefrontal connections that are in flux during adolescence and implicated in anxiety.</p>
<p>For example, evidence suggests that both cognitive behavioral therapy and medication treatment with selective serotonin reuptake inhibitors (SSRIs) may <a href="https://doi.org/10.1001/archpsyc.59.5.425">reduce amygdala reactivity</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23945981">enhance prefrontal control</a>. The treatments help these brain circuits regulate fear and keep them from overreacting to potentially anxiety-provoking situations.</p>
<p>Researchers <a href="http://candlab.yale.edu/category/research">like us</a> are actively working to leverage growing insight into the teenage brain to further optimize anxiety-focused treatments. Neuroscientific studies have the unique advantage of peering inside the teenage brain to <a href="https://doi.org/10.1523/JNEUROSCI.3446-12.2013">directly assess developmental changes</a> in amygdala-prefrontal cortex connections. Using imaging technologies, we’re able to characterize the state of this neural circuitry and how well it’s controlling fear at a given stage of development. And this knowledge provides clues about how to match up the most effective behavioral techniques for regulating anxiety with a particular teen’s stage of brain circuit development.</p>
<p>Evidence suggests that the ways in which people learn about potential dangers in their environment and how they are able to control or regulate responses to those threats <a href="https://doi.org/10.1038/ncomms11475">undergo important changes</a> during the teenage years. Translating this knowledge into the treatment realm could provide new windows into precision medicine, allowing treatments to be <a href="https://doi.org/10.1126/science.1260497">tailored specifically</a> for teenagers.</p>
<p>Although the teenage brain is prone to anxiety because of where it is on its path of biological development, effective treatment options exist and are continually being refined to target the adolescent brain.</p><img src="https://counter.theconversation.com/content/105541/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paola Odriozola receives funding from the National Science Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Science Foundation.</span></em></p><p class="fine-print"><em><span>Dylan Gee receives funding from the National Institutes of Health and the Brain and Behavior Research Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Brain and Behavior Research Foundation.</span></em></p>Almost a third of American adolescents have anxiety disorders. Researchers in developmental neuroscience are figuring out that how the brain matures over time may be part of the reason why.Paola Odriozola, Ph.D. Student in Psychology, Yale UniversityDylan Gee, Assistant Professor of Psychology, Yale UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/945712018-04-19T21:56:00Z2018-04-19T21:56:00ZMental illness on campus really is ‘a thing’<figure><img src="https://images.theconversation.com/files/215481/original/file-20180418-163991-1ff8r57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most mental illnesses begin before or during young adulthood, and a quarter of young Canadians have both a mood or anxiety disorder and a substance-abuse problem</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Unlike his former classmates, Alex isn’t writing final exams right now, or searching for a summer job, or choosing electives for next year. Alex is no longer a student at all.</p>
<p>As an academic leader responsible for student affairs, I know that Alex (not the student’s real name) was diagnosed with a severe mental health condition soon after graduating high school. </p>
<p>According to a detailed letter from a clinical psychologist, the condition made it hard, if not impossible, for the then-19-year-old to get out of bed some days, to wash, to eat. To succeed in getting a degree and starting a professional career, Alex would need help. </p>
<p>Many people tried to help: Professors, advisers, counsellors and administrators massaged protocols, stretched the envelope of academic policies and accommodated extended absences from class. But time is a finite resource, and when it’s spent on one student, it’s unavailable to another. </p>
<p>In the end, Alex failed a few too many courses a few too many times and is now working a minimum-wage job. </p>
<p>A dreadful transcript and almost a decade of difficult life experience are the return on the time and money that this student invested with us. And, sadly, the story is far from unique.</p>
<h2>“Normal” life pathologized?</h2>
<p><em>Well, cry me a river</em>, some older and allegedly wiser fellow citizens seem to say. <em>We remember tough times, and they didn’t come with smartphones, deadline extensions and <a href="https://www.tandfonline.com/doi/abs/10.3200/JACH.57.5.545-548">therapy dogs</a></em>. </p>
<p>From this point of view, most students who seek mental-health services and accommodations really just need a kick in the pants. As the <em>Globe and Mail</em> ’s resident <a href="https://en.wikipedia.org/wiki/Generation_Snowflake">snowflake</a>-melter, Margaret Wente scoffed: “<a href="https://beta.theglobeandmail.com/opinion/why-treat-university-students-like-fragile-flowers/article36292886/">You’re too depressed because of Grandma</a>, no problem. The disability office will provide you with <a href="https://www.thestar.com/news/gta/2016/01/15/why-keep-mental-disability-a-secret-mallick.html">a private room and extra time to write your final</a>. Your professor never even needs to know.”</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/215482/original/file-20180418-163982-1jbgax7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215482/original/file-20180418-163982-1jbgax7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215482/original/file-20180418-163982-1jbgax7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215482/original/file-20180418-163982-1jbgax7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215482/original/file-20180418-163982-1jbgax7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215482/original/file-20180418-163982-1jbgax7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215482/original/file-20180418-163982-1jbgax7.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">Stress is a normal part of human life; under the always-public gaze of social media, it can become debilitating.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Even scholarly lips sometimes curl reactively at <a href="https://www.thestar.com/news/canada/2017/05/29/youth-mental-health-demand-is-exploding-how-universities-and-business-are-scrambling-to-react.html">reports of pressure faced by universities’ mental-health and intellectual-disability services</a>. </p>
<p>In a recent <a href="https://theconversation.com/is-my-child-depressed-being-moody-isnt-a-mental-illness-92789">article in <em>The Conversation</em></a>, Stanley Kutcher, the Sun Life Financial Chair in Adolescent Mental Health at Dalhousie University, noted that reports on student mental health challenges are often based upon students’ descriptions of their own symptoms, and that these reports are routinely followed by calls for “more pills, more therapy, more of everything, including more panic.” </p>
<p>Kutcher alleged that “many” health professionals are “pathologizing normal life” by failing to recognize that it’s healthy for young people to experience and report negative emotions.</p>
<p>He’s right, of course, that <a href="https://www.ipsos.com/sites/default/files/ct/news/documents/2017-11/Children%20and%20Youth%20Mental%20Health%20Survey%20Findings_FINAL_Nov.pdf">self-reported symptoms</a> do not, in themselves, demonstrate the incidence of illness. People sometimes misleadingly (but innocently) use clinical terms to describe negative feelings. </p>
<p>“Students might say they feel ‘depressed,’ when actually, they feel sad,” says Maura O’Keefe, clinical coordinator of Ryerson University’s Student Health and Well-being Services. </p>
<h2>A screentime generation</h2>
<p>One thing can, however, lead to another. <a href="http://news.berkeley.edu/2014/02/11/chronic-stress-predisposes-brain-to-mental-illness/">Mental and physical health challenges may be triggered or aggravated by chronic stress</a>, and just being young is stressful. </p>
<p>Stress, of course, is part of a healthy and productive life. However, adolescent stress has rapidly become more traumatic under the always-public gaze of social media. (Facebook was born in 2004, when today’s undergraduate was entering grade school.) </p>
<p>The damage of cyber-shaming is significantly greater and more enduring than the bullying experienced in pre-internet times, according to <a href="http://www.jeantwenge.com/">psychology professor Jean M. Twenge</a>, who has mined huge datasets about <a href="http://www.jeantwenge.com/igen-book-by-dr-jean-twenge/">the American generation that she calls iGen</a>. </p>
<p>The picture that emerges from her research is of a cohort that grows up slower, socializes less, sleeps less and whose capacity for happiness is inversely proportionate to screentime. (Equivalent Canadian studies are nonexistent but there’s no theoretical reason to hypothesize a stronger and freer northern cohort.) </p>
<p>And then as teens become 20-something and graduation looms, a big new stress emerges: Facing today’s uncertain, demanding and complex job market.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/215484/original/file-20180418-163975-183c55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215484/original/file-20180418-163975-183c55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215484/original/file-20180418-163975-183c55y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215484/original/file-20180418-163975-183c55y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215484/original/file-20180418-163975-183c55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215484/original/file-20180418-163975-183c55y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215484/original/file-20180418-163975-183c55y.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">In one or two conversations, a trained counsellor can tease out mental illnesses from everyday emotional challenges.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Are all of these worried young people suicidal or psychotic? Of course not; most (significantly more than half) of the people we encounter on any given day are mentally healthy. But many are not. </p>
<p>One in five Canadians will be affected by mental illness during the course of a single year, according to a 2011 <a href="https://www.mentalhealthcommission.ca/sites/default/files/MHCC_Report_Base_Case_FINAL_ENG_0_0.pdf">report from the Mental Health Commission of Canada</a>, and 70 per cent of mental illnesses have their <a href="http://www.phac-aspc.gc.ca/publicat/human-humain06/pdf/human_face_e.pdf">onset either before or during post-secondary study</a>. </p>
<p>Diagnosed psychiatric conditions were reported by 7.6 per cent of the 25,600 Ontario community college students who participated in the <a href="http://oucha.ca/pdf/2016_NCHA-II_WEB_SPRING_2016_ONTARIO_CANADA_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf">2016 National College Health Assessment</a>, with <a href="http://journals.sagepub.com/doi/abs/10.1177/0829573515601396">demonstrated damage to academic performance</a>.</p>
<p>Of Canadians aged 15-24, about a quarter had both a mood or anxiety disorder and a substance-abuse problem, according to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/19087478">2008 study in the <em>Canadian Journal of Psychiatry</em></a>. </p>
<p>True, diagnostic data <a href="http://psycnet.apa.org/record/2015-47526-004">fails to match</a> impressions among counsellors in the United States that they are seeing more severe mental-health conditions. But <a href="http://psycnet.apa.org/buy/2007-14485-013">this disparity</a> may be linked to higher demand for services and growing complexity of diagnoses. Either way, no one doubts that university students are at <a href="https://www.tandfonline.com/doi/abs/10.1080/00050067.2010.482109">high risk for mental illness</a>. </p>
<p>Today’s students seem more willing than yesteryears’ to talk about distress and mental health in general terms (“I feel sad”) but the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25270007">stigma attached to scary symptoms</a> (“I hear voices”) has by no means disappeared. </p>
<h2>Campus supports</h2>
<p>Meanwhile, clinicians have become increasingly aware that symptoms of relatively minor mood issues may mask <a href="https://www.tandfonline.com/doi/abs/10.1080/87568225.2013.824326">personality disorders</a> and <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/j.1476-5381.2010.00721.x">psychosis</a>, which, again, are most likely to show up by the early 20s, and are often accompanied and complicated by substance abuse. </p>
<p>Identified and treated early, even those scary diagnoses can be followed by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158489/">years of productive and symptom-free life</a>.</p>
<p>For these reasons and more, mental illness among young people may well be receiving more media attention these days than in past decades, but this doesn’t make it any less “a thing.” </p>
<p>Nor is it a small thing: Thankfully, not all untreated mental illness ends in tragedy, but no parent or educator needs a reminder that <a href="http://www.statcan.gc.ca/pub/82-624-x/2012001/article/11696-eng.htm">accidents and suicide are the two leading killers of young people</a>, and each of these is <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/suicide-as-an-outcome-for-mental-disorders/1AAE5E8FEDA89A87A68EF082A783FEEE">linked decisively to mental illness</a>, <a href="http://psycnet.apa.org/record/1999-05238-005">substance abuse</a> or both. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/215487/original/file-20180418-163978-1yvkat7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215487/original/file-20180418-163978-1yvkat7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215487/original/file-20180418-163978-1yvkat7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215487/original/file-20180418-163978-1yvkat7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215487/original/file-20180418-163978-1yvkat7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215487/original/file-20180418-163978-1yvkat7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215487/original/file-20180418-163978-1yvkat7.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">Today’s uncertain job market can be a huge stressor for graduating students.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Compared to death, the other potential consequences of mental illness may seem trivial. But a few lost classes can quickly add up to a lost year, a cycle of discouragement and a prematurely ended academic career. </p>
<p>Someone showing <a href="https://www.nami.org/Learn-More/Know-the-Warning-Signs">symptoms of illness</a> should be able to check in with a professional quickly, which is the beauty of a properly resourced and well-managed counselling centre. </p>
<p>Some students might be treated on campus with psychotherapy, others referred out to community health-care, others taught (individually or in workshops) <a href="https://www.ryerson.ca/news-events/news/2017/09/a-new-way-to-help-students-thrive/">new tactics</a> for tolerating sadness, fear and the after-effects of trauma.</p>
<p>While many institutions have <a href="https://uwaterloo.ca/stories/mental-health-review-results-increased-support-students">expanded</a> or <a href="https://www.thespec.com/news-story/5448559-mac-overhauls-its-mental-health-services/">overhauled</a> mental health services, <a href="http://journals.sagepub.com/doi/abs/10.1177/0706743716640752">demand generally exceeds the supply</a>. As a result, waiting times for on-campus services can be long, and students’ health insurance plans <a href="http://psycnet.apa.org/record/2014-19014-007">seldom pay enough</a> to cover psychotherapy in the community.</p>
<p>But for those who do get help, the benefits can be dramatic. I have been a professor for 17 years, and long ago lost count of the formerly struggling students who have shaken my hand in hallways, or on graduation stages, to thank me for connecting them to the counselling office. </p>
<p>Turns out it wasn’t a kick in the pants they needed, after all. Just a chance to get acquainted with strengths they didn’t know they had.</p><img src="https://counter.theconversation.com/content/94571/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ivor Shapiro 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>Today’s students are at increasingly high risk for mental health diagnoses. Universities need to step up.Ivor Shapiro, Associate Dean (Undergraduate Education & Student Affairs), Faculty of Communication & Design, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/893602017-12-20T01:56:51Z2017-12-20T01:56:51ZMental disorders linked to poor NAPLAN performance in Australian schools<figure><img src="https://images.theconversation.com/files/199862/original/file-20171219-27568-1dvcqjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mental disorders affected one in seven students and were associated with being less connected and engaged at school, having lower attendance rates, and poorer academic outcomes than their peers.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A national <a href="https://youngmindsmatter.telethonkids.org.au/">survey</a> has shown Australian school students with a mental disorder can be almost three years behind in their studies by the time they sit their final NAPLAN test in year 9. Results also showed students with mental disorders had more absences from school and an increased likelihood of self-harm.</p>
<p>The survey, led by the University of Western Australia and Telethon Kids Institute, was the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. It was conducted in 2013-14 and saw 6,310 families with children and adolescents aged four to 17 taking part. </p>
<p>Data was collected on the mental health of children, covering major depressive disorder, anxiety disorders, attention deficit hyperactive disorder (ADHD) and conduct disorder (extreme behaviour such as aggression towards people, destruction of property, theft, or other law-breaking behaviour). Over 5,000 survey participants agreed to provide access to NAPLAN records from 2008 through to 2016.</p>
<h2>Students with mental health disorders struggle at school</h2>
<p>Mental disorders affected one in seven Australian students. They were prevalent in more males than females. This was largely due to the higher prevalence of ADHD in males, occurring in 12.2% of young males, and 9.3% of adolescent males. The most prevalent mental disorder for females were anxiety disorders, affecting approximately 7-8%. </p>
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<p>The biggest change moving from primary to high school years was the increase in major depressive disorder, particularly for females where it went from 1.5% to 5.6%.</p>
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<p>School attendance was also affected. Students in years 1 to 6 with a mental disorder missed an average 12 days per year compared with eight days per year for students without a mental disorder. In years 7 to 12, students with a mental disorder missed an average 24 days per year compared with 11 days per year for those without mental disorders.</p>
<p>Students with ADHD and conduct disorder had the lowest academic performance of all mental disorders. Major depressive disorder was associated with increased risks of self-harm and suicidal thoughts and behaviours. Socio-economic factors were shown to impact negatively on academic performance as well.</p>
<hr>
<p><strong><em><a href="https://theconversation.com/talking-about-suicide-and-self-harm-in-schools-can-save-lives-83232">Talking about suicide and self-harm in schools can save lives</a></em></strong></p>
<hr>
<p>Academic trajectories showed students with mental health disorders fall increasingly behind their peers as time goes on. Students with a mental disorder in year 3 were, on average, seven to 11 months behind students with no mental disorder. But by year 9, they were an average of 1.5 to 2.8 years behind.</p>
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<p>Students who received help for their mental health problems were more likely to improve in their NAPLAN tests over time. Results from the study indicated some students with severe cases of mental disorders who used services in primary school, eventually overtook some students with mild cases of mental disorders who didn’t use any services. But these students rarely overtook their peers who were unaffected by a mental disorder. </p>
<h2>Students need more support</h2>
<p>Over the last 15 years, the availability and use of services in both the health and education sectors for children with mental health problems and their families <a href="https://youngmindsmatter.telethonkids.org.au/">has improved substantially</a>. But there are still too many children who do not receive the help they need at the time they most need it. Parents face significant barriers when trying to access services. These include long waiting times, confusion about where to go for help, and problems getting their child to go to a service such as a child or school psychologist.</p>
<p>Early childhood interventions should continue to be improved to allow timely identification of at-risk children, and connect them with services. Mental disorders such as ADHD, conduct disorder, and anxiety disorders often start early in life and persist for many years. Many students with mental disorders are already below their peers in academic achievement in year 3 and then fall further behind as they progress through school.</p>
<hr>
<p><strong><em><a href="https://theconversation.com/explainer-what-is-an-anxiety-disorder-8206">Read more: Explainer: what is an anxiety disorder?</a></em></strong></p>
<hr>
<p>Teachers are not mental health professionals and should not be expected to diagnose and treat mental disorders. But student mental health is vital to schools achieving their educational goals. Programs such as <a href="https://mhfa.com.au/">Mental Health First Aid</a> courses and <a href="https://mindspot.org.au/">Mental Health literacy</a> training may help ensure all teachers can identify problems when they occur and seek appropriate help. School counsellors and psychologists also play a critical role. </p>
<p>Existing school-based and health care systems struggle to deal with the large number of children with a mental disorder. Consideration also has to be given to other ways to help children and families. This includes the option of self-guided online or mobile application based <a href="http://www.apa.org/monitor/2011/11/behavior-change.aspx">programs</a> to supplement cognitive and behavioural based therapies used by psychologists. </p>
<p>This may also alleviate some concerns around the lack of effectiveness of infrequent treatment. Waiting times in between appointments to see psychologists can be longer than a month, which does not necessarily lead to effective treatment of symptoms. </p>
<p>Continuing to improve how we identify, treat and support students with mental health problems is critical to improving our children’s educational outcomes.</p><img src="https://counter.theconversation.com/content/89360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Young Minds Matter was funded by the Australian Government Department of Health. This analysis of educational outcomes was funded by the Australian Government Department of Education and Training. </span></em></p><p class="fine-print"><em><span>Benjamin Goodsell 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 national survey has shown Australian school students with a mental disorder can be almost three years behind in their studies by the time they sit their final NAPLAN test in year nine.Benjamin Goodsell, Senior Research Officer in Childhood and Adolescent Mental Health, The University of Western AustraliaDavid Lawrence, Principal Research Fellow, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/858852017-10-26T14:38:42Z2017-10-26T14:38:42ZThe science of fright: Why we love to be scared<figure><img src="https://images.theconversation.com/files/191433/original/file-20171023-1738-1w6q8qu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scary pumpkins are the least of what frightens us at Halloween, a day devoted to being frightened. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/halloween-pumpkin-lantern-dry-leaves-black-715784869?src=oTD6a8IATcbbcVlWOWMeWA-1-21">asife/Shutterstock.com </a></span></figcaption></figure><p>Fear may be as old as life on Earth. It is a fundamental, deeply wired reaction, evolved over the history of biology, to protect organisms against perceived threat to their integrity or existence. Fear may be as simple as a cringe of an antenna in a snail that is touched, or as complex as existential anxiety in a human.</p>
<p>Whether we love or hate to experience fear, it’s hard to deny that we certainly revere it – devoting an entire holiday to the celebration of fear. </p>
<p>Thinking about the circuitry of the brain and human psychology, some of the main chemicals that contribute to the “fight or flight” response are also involved in other positive emotional states, such as happiness and excitement. So, it makes sense that the high arousal state we experience during a scare may also be experienced in a more positive light. But what makes the difference between getting a “rush” and feeling completely terrorized?</p>
<p>We are psychiatrists who treat fear and study its neurobiology. Our studies and clinical interactions, as well as those of others, suggest that a major factor in how we experience fear has to do with the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072129">context</a>. When our “thinking” brain gives feedback to our “emotional” brain and we perceive ourselves as being in a safe space, we can then quickly shift the way we experience that high arousal state, going from one of fear to one of enjoyment or excitement.</p>
<p>When you enter a haunted house during Halloween season, for example, anticipating a ghoul jumping out at you and knowing it isn’t really a threat, you are able to quickly relabel the experience. In contrast, if you were walking in a dark alley at night and a stranger began chasing you, both your emotional and thinking areas of the brain would be in agreement that the situation is dangerous, and it’s time to flee!</p>
<p>But how does your brain do this? </p>
<h2>How do we experience fear?</h2>
<p>Fear reaction starts in the brain and spreads through the body to make adjustments for the best defense, or flight reaction. The fear response starts in a region of the brain called the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3055445/">amygdala</a>. This almond-shaped set of nuclei in the temporal lobe of the brain is dedicated to detecting the emotional salience of the stimuli – how much something stands out to us. </p>
<p>For example, the amygdala activates whenever we see a human face with an emotion. This reaction is more pronounced with anger and fear. A threat stimulus, such as the sight of a predator, triggers a fear response in the amygdala, which activates areas involved in preparation for motor functions involved in fight or flight. It also triggers release of stress hormones and sympathetic nervous system. </p>
<p>This leads to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181681/">bodily changes</a> that prepare us to be more efficient in a danger: The brain becomes hyperalert, pupils dilate, the bronchi dilate and breathing accelerates. Heart rate and blood pressure rise. Blood flow and stream of glucose to the skeletal muscles increase. Organs not vital in survival such as the gastrointestinal system slow down.</p>
<p>A part of the brain called the hippocampus is closely connected with the amygdala. The hippocampus and prefrontal cortex help the brain interpret the perceived threat. They are involved in a higher-level processing of context, which helps a person know whether a perceived threat is real. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/191703/original/file-20171024-30587-xvhxzk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/191703/original/file-20171024-30587-xvhxzk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191703/original/file-20171024-30587-xvhxzk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191703/original/file-20171024-30587-xvhxzk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191703/original/file-20171024-30587-xvhxzk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191703/original/file-20171024-30587-xvhxzk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191703/original/file-20171024-30587-xvhxzk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&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">A lion in the wild can make us fearful.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wild-lion-595730450?src=UMSNoJTDXpMy24usJGetVA-1-12">Chadofski/Shutterstock.com</a></span>
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</figure>
<p>For instance, seeing a lion in the wild can trigger a strong fear reaction, but the response to a view of the same lion at a zoo is more of curiosity and thinking that the lion is cute. This is because the hippocampus and the frontal cortex process contextual information, and inhibitory pathways dampen the amygdala fear response and its downstream results. Basically, our “thinking” circuitry of brain reassures our “emotional” areas that we are, in fact, OK.</p>
<h2>How do we learn the difference?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/191436/original/file-20171023-1695-17rrd7e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/191436/original/file-20171023-1695-17rrd7e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191436/original/file-20171023-1695-17rrd7e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191436/original/file-20171023-1695-17rrd7e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191436/original/file-20171023-1695-17rrd7e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191436/original/file-20171023-1695-17rrd7e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191436/original/file-20171023-1695-17rrd7e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Being attacked by a dog or seeing someone else attacked by a dog triggers fear.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/aggressive-dog-barking-young-man-angry-491343199?src=hkAIEZJcNnkb0kuV5FIOGQ-1-39">Jaromir Chalabala/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Similar to other animals, we very <a href="https://www.nature.com/articles/nn1968">often learn fear </a>through personal experiences, such as being attacked by an aggressive dog, or observing other humans being attacked by an aggressive dog.</p>
<p>However, an evolutionarily unique and fascinating way of learning in humans is through instruction – we <a href="https://www.ncbi.nlm.nih.gov/pubmed/27089509">learn from the spoken words</a> or written notes! If a sign says the dog is dangerous, proximity to the dog will trigger a fear response.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/191481/original/file-20171023-1746-1t5awtb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/191481/original/file-20171023-1746-1t5awtb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=733&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191481/original/file-20171023-1746-1t5awtb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=733&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191481/original/file-20171023-1746-1t5awtb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=733&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191481/original/file-20171023-1746-1t5awtb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=921&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191481/original/file-20171023-1746-1t5awtb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=921&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191481/original/file-20171023-1746-1t5awtb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=921&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The author and his Great Pyreness, Jasper.</span>
<span class="attribution"><span class="source">Arash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>We learn safety in a similar fashion: experiencing a domesticated dog, observing other people safely interact with that dog or reading a sign that the dog is friendly. </p>
<h2>Why do some people enjoy being scared?</h2>
<p>Fear creates distraction, which can be a positive experience. When something scary happens, in that moment, we are on high alert and not preoccupied with other things that might be on our mind (getting in trouble at work, worrying about a big test the next day), which brings us to the here and now. </p>
<p>Furthermore, when we experience these frightening things with the people in our lives, we often find that emotions can be contagious in a positive way. We are social creatures, able to learn from one another. So, when you look over to your friend at the haunted house and she’s quickly gone from screaming to laughing, socially you’re able to pick up on her emotional state, which can positively influence your own. </p>
<p>While each of these factors - context, distraction, social learning - have potential to influence the way we experience fear, a common theme that connects all of them is our sense of control. When we are able to recognize what is and isn’t a real threat, relabel an experience and enjoy the thrill of that moment, we are ultimately at a place where we feel in control. That perception of control is vital to how we experience and respond to fear. When we overcome the initial “fight or flight” rush, we are often left feeling satisfied, reassured of our safety and more confident in our ability to confront the things that initially scared us. </p>
<p>It is important to keep in mind that everyone is different, with a unique sense of what we find scary or enjoyable. This raises yet another question: While many can enjoy a good fright, why might others downright hate it?</p>
<h2>Why do some people not enjoy being scared?</h2>
<p>Any imbalance between excitement caused by fear in the animal brain and the sense of control in the contextual human brain may cause too much, or not enough, excitement. If the individual perceives the experience as “too real,” an extreme fear response can overcome the sense of control over the situation. </p>
<p>This may happen even in those who do love scary experiences: They may enjoy <a href="http://www.imdb.com/character/ch0002143/bio">Freddy Krueger</a> movies but be too terrified by <a href="http://www.imdb.com/title/tt0070047/">“The Exorcist</a>,” as it feels too real, and fear response is not modulated by the cortical brain. </p>
<p>On the other hand, if the experience is not triggering enough to the emotional brain, or if is too unreal to the thinking cognitive brain, the experience can end up feeling boring. A biologist who cannot tune down her cognitive brain from analyzing all the bodily things that are realistically impossible in a zombie movie may not be able to enjoy <a href="http://www.imdb.com/title/tt1520211/">“The Walking Dead</a>” as much as another person. </p>
<p>So if the emotional brain is too terrified and the cognitive brain helpless, or if the emotional brain is bored and the cognitive brain is too suppressing, scary movies and experiences may not be as fun.</p>
<h2>What are disorders of fear?</h2>
<p>All fun aside, abnormal levels of fear and anxiety can lead to significant distress and dysfunction and limit a person’s ability for success and joy of life. Nearly one in four people experiences a form of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181629/">anxiety disorder</a> during their lives, and nearly 8 percent experience post-traumatic stress disorder (PTSD).</p>
<p>Disorders of anxiety and fear include phobias, social phobia, generalized anxiety disorder, separation anxiety, PTSD and obsessive compulsive disorder. These conditions usually begin at a young age, and without appropriate treatment can become chronic and debilitating and affect a person’s life trajectory. The good news is that we have effective treatments that work in a relatively short time period, in the form of psychotherapy and medications.</p><img src="https://counter.theconversation.com/content/85885/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We may pretend that we do not like fear, but Halloween proves otherwise. Many of us enjoy being scared. But why?Arash Javanbakht, Assistant Professor of Psychiatry, Wayne State UniversityLinda Saab, Assistant Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/820062017-08-20T09:26:27Z2017-08-20T09:26:27ZHow hunger affects the mental health of pregnant mothers<figure><img src="https://images.theconversation.com/files/182596/original/file-20170818-7956-i0c0r4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Bev Meldrum</span></span></figcaption></figure><p>The mental health of pregnant women can be affected by a range of factors, including partner violence and unemployment. But one of the key drivers that adversely affects a pregnant woman’s mental health is food insecurity. Being food insecure is when someone doesn’t have food or has the wrong kinds of food.</p>
<p>This is one of the key findings of <a href="http://pmhp.za.org/wp-content/uploads/Perinatal_Suicidal_Ideation.pdf">our study</a>, conducted in an impoverished community in Cape Town which is also regarded as <a href="http://journals.co.za/docserver/fulltext/crim_v30_n1_a11.pdf?expires=1502974026&id=id&accname=57716&checksum=B324CEE6DE17796BF5BF0C0ECE02FFAB">one of the most violent</a> in South Africa.</p>
<p>We set out to explore the factors that affected common mental health problems in pregnant women. These included intimate partner violence, unemployment and food insecurity. We found that women who don’t get enough to eat when they are pregnant face a high risk of developing mental illnesses like depression and anxiety during pregnancy and after giving birth. And they are likely to have suicidal thoughts during this time too. </p>
<p><a href="http://dx.doi.org/10.1136/bmj.39189.662581.55">Several studies</a> have analysed antenatal depression and shown that there are <a href="http://dx.doi.org/10.1186/1742-4755-8-9">higher rates</a> of depression among mothers-to-be in <a href="http://dx.doi.org/10.4314/thrb.v12i1.56276">low socio-economic settings</a>.</p>
<p>The South African Government provides <a href="http://www.sassa.gov.za/index.php/social-grants/child-support-grant">social grants</a> to mothers who meet certain low-income criteria after the birth of their babies. But, based on our findings, we would argue that women should be eligible for poverty alleviation support while they are pregnant. This would benefit them physically and emotionally. <a href="http://dx.doi.org/10.1016/j.neuroscience.2015.09.001">Research</a> from a range of developing countries shows that providing pregnancy support grants benefits mothers and their children.</p>
<p>Based on these findings, and our own research, our view is that mental well-being and food security policies should be rolled out together as part of an <a href="https://theconversation.com/south-africas-child-support-grant-should-start-in-pregnancy-heres-why-70106">antenatal care package for women</a>. This is important because managing the mental health of mothers’ can help children develop better. </p>
<h2>Pressures of poverty</h2>
<p>In South Africa more than 40% of the population lives below the poverty line. This means that many families in poor communities don’t have enough to eat, or don’t have access to healthy food. </p>
<p>Often the food they buy doesn’t last the entire month which means that they skip meals or eat less food because there isn’t money for more. <a href="http://cs2016.statssa.gov.za/wp-content/uploads/2016/07/NT-30-06-2016-RELEASE-for-CS-2016-_Statistical-releas_1-July-2016.pdf">Recent statistics</a> show that two in every ten South African families run out of money for food before the end of the month. </p>
<p>Hanover Park has high rates of unemployment, alcohol and substance abuse, physical and sexual violence, child abuse and neglect. </p>
<p>Our research found that almost half the pregnant women attending the Hanover Park Midwife Obstetric Unit were food insecure. </p>
<p>In the group of nearly 400 pregnant women, about 22% were depressed while 23% had an anxiety disorder; about 10% of women had both common mental disorders. Moderate to high risk levels of suicidal thoughts or behaviours were present in 18%. Being food insecure more than doubled the chance of a pregnant women developing depression or an anxiety disorder and was very strongly associated with previously having attempted suicide. </p>
<p>We also found that many women who had had their second, third or fourth child and lived in families with minimal income felt overwhelmed and hopeless at the prospect of bringing another child into the world. </p>
<h2>The consequences</h2>
<p>There are both short and long-term consequences of untreated mental illness in pregnant mothers. </p>
<p>Women with mental illness may find it challenging to use optimally existing services, including health services. Untreated depression in pregnancy has also been shown to be linked to premature birth and low birth weight. </p>
<p>After giving birth, mothers may have difficulty caring for themselves or their babies. Pregnancy is a critical window of development for a baby. When women develop mental health problems during pregnancy and after birth it may <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724169/">affect</a> this window. If a new mother isn’t able to connect emotionally with her baby, in some cases neglect, or even hostility towards the baby can follow. Breastfeeding may also be affected. </p>
<p>These all matter for the healthy development of a child. If they’re deprived of these inputs they can, in the longer term, develop social, emotional and behavioural problems. </p>
<h2>Solving the problem</h2>
<p>The first big challenge is that public health and social service systems need to be revamped. Public health systems are aimed at decreasing maternal mortality rates. They’re equipped to help pregnant women deal with challenges such as HIV, massive blood loss or high blood pressure. But mental disorders, which occurs in 20-40% of pregnant women <a href="http://www.samj.org.za/index.php/samj/article/view/6009/4741">living in poor communities</a>, often go unattended.</p>
<p>Our view is that common mental health problems should be detected and managed in routine maternity care settings. Non-specialist care providers, who have been properly trained and supervised, could use brief screening tools to detect problems and provide onsite counselling to women who need it.</p>
<p>But helping mothers cope with mental illness also needs government intervention to ensure that they don’t go hungry. This may be addressed by a social grant that begins in the antenatal period. This is only likely to have a meaningful impact if it has all components – the social, the physical and the mental.</p><img src="https://counter.theconversation.com/content/82006/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Zulfa Abrahams receives funding from Harry Crossley Foundation. </span></em></p><p class="fine-print"><em><span>Simone Honikman works for the Perinatal Mental Health Project in the Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town. She receives funding from several philanthropic organisations and the Department for International Development, UK. </span></em></p>Women who don’t get enough to eat while pregnant face a high risk of developing common mental illnesses like depression and anxiety during pregnancy and after giving birth.Zulfa Abrahams, Research Officer, University of Cape TownSimone Honikman, Director of the Perinatal Mental Health Project; Senior researcher, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/639722016-10-13T01:27:02Z2016-10-13T01:27:02ZReading, writing and mental health care: why schools need added services<figure><img src="https://images.theconversation.com/files/139816/original/image-20160929-27014-vep5ec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young students in classroom via Shutterstock.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-243585589/stock-photo-row-of-students-in-a-primary-interracial-classroom-afro-american-girl-paying-attention-to-the-teacher.html?src=Hg4bnMe6xGvDvyNiE2XqJA-1-78">From www.shutterstock.com</a></span></figcaption></figure><p>Students across the country have stepped into their classrooms, filled with excitement to start a new year. In many cases, though, students also bring physical, social, and emotional concerns. </p>
<p>For some students, these concerns are normal back-to-school jitters that will not affect their schoolwork. For others, these worries profoundly detract from their ability to learn.</p>
<p>One in five children in the United States has a diagnosable mental health disorder, but<a href="https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/pages/mentalhealth.aspx"> only 21 percent</a> of those children needing mental health services receive care.</p>
<p>Consider these comments from a parent of a young girl in south Georgia, where the poverty rate is high and high school <a href="http://nces.ed.gov/ccd/tables/ACGR_RE_and_characteristics_2013-14.asp">graduation rates are low</a> compared to the national average:</p>
<p><em>“She is continually talking about killing herself and she tells me that I don’t understand,” said the parent of a 12-year-old girl who has been seeing a therapist at a public middle school. “She tells me that ‘my therapist understands me and I can talk to her.’ She can see the school therapist whenever she needs to do so. This not only provides her the support that she needs to stay in school but it reassures me that whenever she has suicidal thoughts, help is nearby. The therapist has helped us find a group for family therapy and has met with us at home, too.”</em></p>
<p>This 12-year-old is not alone. According to school therapist Samantha Boatwright, self-harming behaviors and suicidal thoughts are just two of the concerns often shared with her by the youth and families that she supports in her position at a public middle school in south Georgia.</p>
<p>While some may argue the job of schools is to focus solely on academics, it is difficult to ignore the issues that may impair a child’s ability to focus, engage, and learn.</p>
<p>Children with emotional disturbance <a href="https://www.nami.org/getattachment/Learn-More/Mental-Health-by-the-Numbers/childrenmhfacts.pdf">drop out</a> of high school at high rates and <a href="http://www.childrensdefense.org/library/data/mental-health-factsheet.pdf">have higher rates of absenteeism and suspension </a>or expulsion than their peers. In addition, racial, ethnic and socioeconomic <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011932/">disparities in children’s mental health</a> status and care still exist. </p>
<p>As director and researcher, respectively, at The Center of Excellence for Children’s Behavioral Health at Georgia State University, we have extensively studied these issues and examined potential ways to address them. We know this is a serious public health problem that affects the children involved, their families and society as a whole. We are supporting solutions by partnering with state agencies to promote optimal care for youth with behavioral health difficulties. </p>
<h2>Increasing access through school-based mental health</h2>
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<img alt="" src="https://images.theconversation.com/files/139822/original/image-20160929-27026-uiaoq0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/139822/original/image-20160929-27026-uiaoq0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/139822/original/image-20160929-27026-uiaoq0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/139822/original/image-20160929-27026-uiaoq0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/139822/original/image-20160929-27026-uiaoq0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/139822/original/image-20160929-27026-uiaoq0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/139822/original/image-20160929-27026-uiaoq0.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">Some students have a desire to self-harm via Shutterstock.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-343217441/stock-photo-teenage-girl-self-harming-with-knife-blade.html?src=BIhFdKH-w0o0mSA-x4IVTw-1-3">From www.shutterstock.com</a></span>
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<p>School-based mental health programs were first introduced in the 1980s. According to the most recent data, over one-third of<a href="http://youth.gov/youth-topics/youth-mental-health/school-based"> school districts </a> in the U.S. used school or district staff and over one fourth used outside agencies to provide mental health services in the schools. </p>
<p>Recently, there has been <a href="http://link.springer.com/article/10.1007%2Fs10802-005-7645-3">increased interest</a> and momentum in integrating behavioral health services into the school environment due to several factors. Recent federal legislation targets <a href="https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/pages/mentalhealth.aspx">access to mental health</a> services, and there have been education <a href="http://www.ed.gov/essa">reforms</a> focused on outcomes, early intervention, and flexible learning supports. </p>
<p>The Affordable Care Act has been a boost, allocating funding to support improved and expanded services at <a href="http://www.ncsl.org/portals/1/documents/health/HRSBHC.pdf">school-based health centers</a> and community-school health partnerships.</p>
<p>Evidence from existing state programs shows school-based mental health initiatives increase access to needed mental health services and promote earlier identification of and intervention for mental health needs of <a href="http://ghpc.gsu.edu/files/2016/04/COE_SBMH_Brief_Final.pdf">individual students </a>. Additionally, these programs foster a better school climate with increased attendance and academic performance, and <a href="http://ghpc.gsu.edu/files/2016/04/COE_SBMH_Brief_Final.pdf">fewer discipline referrals and classroom disruptions</a>.</p>
<h2>Helping nearly 1,000 students a month</h2>
<p>In Georgia, the Office of Children, Young Adults and Families (CYF) in the state’s Department of Behavioral Health and Developmental Disabilities initiated and funded the Georgia Apex Program, during the 2015-2016 school year to increase school-based mental health services. </p>
<p>The intent, according to CYF Director Danté McKay, is “to provide early detection of mental health needs, increase access to services, and spark increased collaboration between community mental health service providers and schools.”</p>
<p>In its first year the school-based mental health program provided more than $9.5 million in state grants to embed therapists from 29 community service provider agencies into schools across the state. The goal was to promote universal prevention and to provide early intervention and services for at-risk students and their families. </p>
<p>Preliminary results from the first year of the Georgia Apex Program show the program served an average of 951 students each month over the school year. It also provided services to more than 2,400 first-time recipients referred to school-based mental health services. </p>
<p>Providers began serving 104 schools in August, 2015 and eventually served 136 schools by May, 2016.</p>
<p>There were challenges, such as space and family engagement. There were also successes, such as expansion of access and enhanced partnerships between providers and schools. These findings mirror those from <a href="http://ghpc.gsu.edu/files/2016/04/COE_SBMH_Brief_Final.pdf">school-based mental health programs</a> implemented in other parts of the country. </p>
<p>There are notable examples of individual student successes, including at-risk students graduating high school, better school attendance, fewer discipline referrals, and improved grades among program participants.</p>
<p>But, like most new endeavors, support for the program must be built. Initially, increasing awareness and obtaining buy-in from local school officials is critical, as is engaging families because a lack of parental involvement can delay or prevent students from receiving services.</p>
<p>However, with reports of early success, more Georgia schools are requesting therapists and provider agencies plan to increase the number of participating schools during the 2016-2017 school year. </p>
<h2>Developing community partnerships key</h2>
<p>To make sure all children learn and progress, schools must address the developmental and mental health needs of children. This is particularly true for those at <a href="http://www.nccp.org/publications/pub_929.html">high risk</a>, including children living in areas of high poverty or grappling with community violence.</p>
<p>This places greater demands on K-12 schools. Therefore, schools weave together a basket of resources from the school district and broader community to ensure students who need additional supports receive these services.</p>
<p>Yet, mental health concerns are often <a href="http://www.nccp.org/publications/pub_929.html">overlooked</a> and under-resourced. In some communities, this is simply because of the lack of available resources. However, other barriers exist for families seeking mental health supports including shortages of mental health providers, financial challenges, transportation, scheduling, and stigma-related concerns. Providing mental health services within the school setting can help to address some of these challenges.</p><img src="https://counter.theconversation.com/content/63972/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Center of Excellence for Children's Behavioral Health at Georgia State University receives funding from the Georgia Department of Behavioral Health and Developmental Disabilities. </span></em></p><p class="fine-print"><em><span>The Center of Excellence for Children's Behavioral Health at Georgia State University receives funding from the Georgia Department of Behavioral Health and Developmental Disabilities.</span></em></p>A small minority of children with mental health issues is getting the help they need. School-based mental health is essential to keep students engaged.Ann DiGirolamo, Director, Center of Excellence for Children's Behavioral Health, Georgia Health Policy Center, Georgia State UniversityDeana Farmer, Senior Research Associate, Georgia Health Policy Center, Georgia State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/643332016-08-25T10:29:09Z2016-08-25T10:29:09ZIs social media to blame for the worsening mental health of teenage girls?<figure><img src="https://images.theconversation.com/files/135313/original/image-20160824-30249-ocl2mq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-298283600/stock-photo-filtered-photo-of-two-friends-using-their-smart-phones-outdoors-lifestyle.html?src=3ufjIuUxwnE-ar3up_CStA-1-78">Kaponia Aliaksei/Shutterstock</a></span></figcaption></figure><p>New <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/540563/LSYPE2_w2_research_report.pdf">research</a> by the Department of Education has found that the mental well-being of teenage girls in the UK is worsening. The survey, which took the views of 30,000 14-year-old pupils in 2005 and 2014, found that 37% of girls suffer from psychological distress, up from 34% in 2005. (This compares with 15% for boys in 2014, down from 17% a decade earlier.) The report’s authors noted that one of the things that has changed between 2005 and 2014 is the “advent of the social media age”.</p>
<p>The adolescent years are a time of rapid physical, cognitive and emotional development. Teenagers interact with people in order to learn how to become competent adults. In the past they would engage with parents, teachers and other adults in their community as well as extended family members and friends. Now we can also add social media to that list of social and emotional development. But why should the advent of social media be a problem?</p>
<p>Research indicates that girls may be at higher risk than boys from the <a href="http://christopherjferguson.com/BodyImageProspective.pdf">negative aspects</a> of social media. Young girls, with their limited capacity for self-regulation and susceptibility to peer pressure, are at risk of having bad experiences online that could negatively affect their development into healthy adults, and could lead to depression and anxiety disorders.</p>
<p>During adolescence, people develop traits such as confidence and self-control. Because teenage brains have not fully developed, and won’t fully develop until they reach young adulthood, they lack the cognitive ability of awareness and privacy and can post inappropriate messages, pictures and videos without understanding the long-term ramifications. What they are posting may not stay in their small circle of friends and can be circulated far and wide with devastating consequences. </p>
<p>Unlike their male peers, girls are more likely to over share personal information or post false information about themselves or others, increasing the possibility of experiencing a bad reaction from peers such as bullying or negative comments. </p>
<h2>False ideals</h2>
<p>Social media also gives the “X Factor” generation aspirations of celebrity status and impossible expectations. Social media sites are filled with photographs of stunning models for teenage girls to aspire to. Body image for the young adolescent girl is shaped by emotions (need to be liked), perceptions (adequate breast size) and is further influenced by cultural messages and societal standards. Social media allows girls to make comparisons among friends as well as celebrities and then provides them with “solutions” such as extreme dieting tips and workouts to reach their goals. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.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">Trying to attain the ‘perfect’ body can lead to body dysmorphic disorder.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-237891442/stock-photo-sport-fitness-lifestyle-technology-and-people-concept-young-woman-with-smartphone-taking-mirror-selfie-in-gym.html?src=JJOOnCxYJ8ubj6DEw0I9Sw-1-66">Syda Productions/Shutterstock</a></span>
</figcaption>
</figure>
<p>Research has indicated that adolescent girls are at risk of developing eating disorders as well as body dysmorphic disorder (the need to <a href="https://www.researchgate.net/publication/236948797_NetGirls_The_Internet_Facebook_and_body_image_concern_in_adolescent_girls">surgically correct a perceived imperfection</a>, such as small breasts). Concerns about body image can negatively impact their quality of life preventing them from having healthy relationships and taking up time that could be better spent developing other aspects of their personalities. </p>
<p>Social media can also have a negative impact on puberty encouraging young girls to join the “adult” world and become sexually active before they are mature enough to cope with all of the ramifications that this can have on their lives. Sexting has become a common occurrence with 20% of adolescents sending or <a href="http://pediatrics.aappublications.org/content/129/1/13.full">posting nude or seminude photographs or videos</a> of themselves to other adolescents. People who have been betrayed face the humiliation of having their picture shared far and wide by someone they trusted with intimate information. The extreme emotional distress these girls have felt has been widely documented as have the accompanying mental health conditions that result. </p>
<p>Adolescence is also a time when people begin to develop advanced reasoning skills and further expand their cognitive development. This is a time when they begin to think about how they are perceived by others. Adolescent girls have a tendency to obsess over the mundane, going over and over actions and thoughts because they are attempting to assimilate and process the information. This is healthy, but research is finding that when it is combined with social media it can intensify into an unhealthy activity and become a <a href="http://www.psych.rochester.edu/research/starrlab/wp-content/uploads/2014/08/1-s2.0-S0140197108001139-main.pdf">precursor to depression and depressive symptoms</a>. </p>
<p>Social media can be a friend or foe and instead of constantly focusing on the negative aspects we should instead use it as a tool to help adolescent girls to understand that the images that are constantly being projected on social media do not reflect the average person and that there is a wide diversity in physical appearance and rates of development. We should encourage girls to think critically about social media. </p>
<p>Adolescent girls spend a great deal of their time online, simply attempting to ban or control this behaviour will only push them into secretive online activities. Instead parents should become more involved in helping their teenagers negotiate social media obstacles and promote a healthy self-confidence.</p><img src="https://counter.theconversation.com/content/64333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pam Ramsden 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>Psychological distress among teenage girls has risen by 4% in the past decade.Pam Ramsden, Lecturer in Psychology, University of BradfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/548902016-02-24T19:03:51Z2016-02-24T19:03:51ZDoes cannabis cause mental illness?<figure><img src="https://images.theconversation.com/files/112091/original/image-20160219-12655-w40hdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One in three adults have smoked pot at some point in their lives.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hippie/2701078196/">Philippa Willitts/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Cannabis is the most <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549848">commonly used illicit drug</a> in Australia, with one in three adults using it at some point in their life. It’s legal in some places around the world, and offered medicinally in others. But what does smoking pot do to your mental health? </p>
<p>The potential harms associated with using cannabis depend on two things above all others. </p>
<p>The first is the <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12703/full">age at which you first begin</a> to use cannabis, particularly if it’s before 18. Using cannabis during <a href="http://www.sciencedirect.com/science/article/pii/S0163725814002095">key stages</a> of brain development <a href="http://www.sciencedirect.com/science/article/pii/S0163725814002095">can impact</a> on synaptic pruning (when old neural connections are deleted) and the development of white matter (which transmits signals in the brain). </p>
<p>The second is the patterns of use: the frequency, dose and duration, particularly if you’re using at least weekly. The bigger or more potent the dose, the more tetrahydrocannabinol (THC) you are ingesting. THC is the main psychoactive component of cannabis and appears to act on areas of our brain involved in the regulation of our emotional experiences. </p>
<h2>Depression and anxiety</h2>
<p>Many studies of the relationship between cannabis use and mental illnesses such as <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9156179&fileId=S0033291713001438">depression</a> and <a href="http://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-136">anxiety</a> have suffered from methodological issues by not controlling for related factors.</p>
<p>The few longitudinal studies that have been conducted have mixed findings. </p>
<p>A 2014 review of the existing research <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9156179&fileId=S0033291713001438">concluded</a> that using cannabis placed an individual at moderate risk of developing depression. </p>
<p>Unfortunately it was not within the scope of the research to determine if cannabis use was <em>causing</em> depression or if the relationship instead reflects the association between cannabis use and social problems. Cannabis use is associated with other factors that increase risk of depression such as school dropout and unemployment. </p>
<p>The relationship between cannabis use and anxiety is also complex. Many people use cannabis for its euphoric and relaxing effects. But some people also experience feelings of anxiety or paranoia when intoxicated. As such, cannabis could be used to relieve anxiety or stress for some while causing others to feel anxious. </p>
<p>A 2014 review of the available research <a href="http://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-136">concluded</a> that using cannabis placed an individual at a small risk of developing anxiety. But the authors noted that while the weight of evidence supported the coexistence of cannabis use and anxiety, there was relatively little evidence to suggest that cannabis <em>caused</em> anxiety. </p>
<p>Not included in these previous reviews of depression and anxiety disorders were two <a href="http://www.sciencedirect.com/science/article/pii/S0924977X15004204">recent investigations</a> of cannabis use in the <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=2491944">United States</a> using data from 2001-2002 and 2004-2005. These included a host of variables such as demographic status and family environment.</p>
<p>Each found a significant association between cannabis use and the onset of depression and anxiety disorders. But this association was no longer significant when considering the impact of the included variables. </p>
<p>Clearly, the relationship between cannabis use and depression and anxiety disorders is complex and involves the individual’s reasons for cannabis use and external situations. That is, cannabis may be used to help cope with social problems that were not necessarily caused by cannabis use.</p>
<h2>Schizophrenia</h2>
<p>In contrast, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17662880">relationship</a> between cannabis use and risk of developing symptoms of psychosis has been <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=211301">well established</a> in many different review articles. </p>
<p>This research has found that <a href="http://link.springer.com/article/10.1007%2Fs40429-014-0018-7">early and frequent cannabis use</a> is a component cause of psychosis, which interacts with other risk factors such as family history of psychosis, history of childhood abuse and expression of the COMT and AKT1 genes. These interactions make it <a href="http://www.ncbi.nlm.nih.gov/pubmed/19783132">difficult to determine</a> the exact role of cannabis use in causing psychosis that <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033190">may not have otherwise occurred</a>. </p>
<p>Regardless, the connection between cannabis use and psychosis is not surprising. There is a <a href="http://search.proquest.com/docview/217290288?pq-origsite=gscholar">strong resemblance</a> between the acute and transient effects of cannabis use and symptoms of psychosis, including impaired memory, cognition and processing of external stimuli. This combines to make it hard for a person to learn and remember new things but can also extend to the experience of deluded thinking and hallucinations.</p>
<p>We also know that cannabis use by people with established psychotic disorder <a href="http://www.ncbi.nlm.nih.gov/pubmed/18978312">can exacerbate symptoms</a>. </p>
<p>Overall, the evidence suggests cannabis use will <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=211301">bring forward diagnosis</a> of psychosis by an average of 2.7 years. </p>
<p>The risk of developing schizophrenia <a href="http://www.ncbi.nlm.nih.gov/pubmed/17662880">increases with the duration and dose</a> of cannabis use. Regular cannabis users have double the risk of non-users. Those who have used cannabis at some point in their life have a 40% increased risk compared with non-users. </p>
<p>That said, it is important to view this increased risk in context. The proportions of individuals with psychosis among the population and among cannabis users are low. <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12703/full">Current estimates</a> suggest that if frequent long-term cannabis use was known to cause psychosis, the rates of incidence would increase from seven in 1,000 in non-users to 14 in 1,000 cannabis users.</p>
<p>If you or a family member or friend have problems or concerns about cannabis, visit <a href="http://www.ncpic.org.au">www.ncpic.org.au</a> or access the free national Cannabis Information and Helpline on 1800 30 40 50.</p><img src="https://counter.theconversation.com/content/54890/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The National Cannabis Prevention and Information Centre receives funding from the Department of Health. </span></em></p>The potential harms associated with using cannabis depend, above all others, on two things: the age at which you first begin to use cannabis and the frequency, dose and duration of use.Peter Gates, Senior Research Officer, National Drug & Alcohol Research Centre, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/504102015-11-26T04:32:44Z2015-11-26T04:32:44ZSouth Africa isn’t managing mental illness, particularly for the poor<figure><img src="https://images.theconversation.com/files/103174/original/image-20151125-23833-afwxoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A child from a special care centre in Cape Town celebrating international kite day. In South Africa mental health services are not a priority. </span> <span class="attribution"><span class="source">Epa/Nic Bothma </span></span></figcaption></figure><p>Mental health conditions, disorders and diseases are rarely on the frontline of health regulations and international health agendas. But global institutions such as the World Health <a href="http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf">Organisation</a> have been engaging with governments to improve mental health systems.</p>
<p><a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001178">Research</a> shows there are several barriers blocking improving mental health care. These include diminished civil society support, a lack of global consensus on mental illness and its treatment, missed policy opportunities and limited evidence on the delivery of mental health interventions.</p>
<p>But in the last two decades increased attention has been given to mental health as a global priority. Civil society has become more active. In addition, high impact journals such as <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000160">PLoS Medicine</a> and <a href="http://www.thelancet.com/series/global-mental-health-2011">The Lancet</a> have raised the profile of mental health. </p>
<p>The new sustainable development goals have also put mental health and wellbeing firmly on the agenda, although there has been <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001846">criticism</a> that the goals fall short of their true potential. </p>
<p>It is estimated that globally between 12% and 48% of people suffer from mental <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001178">disorders</a>. Over 70% of this burden lies in low and middle income countries. </p>
<p>In South Africa, as in many developing countries, mental health doesn’t feature as a public health <a href="http://www.dailymaverick.co.za/article/2015-07-15-psychiatry-in-distress-how-far-has-south-africa-progressed-in-supporting-mental-health/#.VlWQR3YrLIU">priority</a>. In <a href="http://www.who.int/mental_health/evidence/south_africa_who_aims_report.pdf">rural</a> communities mental health is not supported at all. </p>
<p>One of the consequences is that trauma is common in South African society. This is evident from unusually high interpersonal <a href="https://africacheck.org/2014/09/17/comment-why-is-crime-and-violence-so-high-in-south-africa-2/">violence</a>, including homicide, rape and domestic violence.</p>
<h2>Low levels of care</h2>
<p>At least 15% of those interviewed for the South African Stress and Health <a href="http://www.ncbi.nlm.nih.gov/pubmed/18245026">Study</a> - the first nationally representative survey of psychiatric disorders in an African country - said they suffered from anxiety disorders. These could include obsessive compulsive disorder, post traumatic stress disorders and panic disorders. Nearly 10% suffered from mood disorders such as depression or bipolar disorders. Another 9% suffer from substance abuse disorders. Nearly a third of the respondents reported a lifetime history of at least one psychiatric disorder. </p>
<p>But only about a quarter of those who needed treatment were getting access. This is partly because expenditure on mental health is <a href="http://www.who.int/mental_health/evidence/south_africa_who_aims_report.pdf">pitiful</a>. On average, provinces spend less than 3% of their health budgets on mental health, mostly on psychiatric hospitals which, in any case, should be the last resort in the chain of treatment. </p>
<p>There are several other reasons for this dismal provision. These include:</p>
<ul>
<li><p><a href="http://www.who.int/mental_health/policy/services/integratingmhintoprimarycare/en/">vast distances</a> to access specialized services,</p></li>
<li><p>the chronic <a href="http://www.ncbi.nlm.nih.gov/pubmed/2499642">stigma</a> barrier in public health facilities, </p></li>
<li><p>inequality and poverty. People suffering from mental illness are caught in a “cycle of <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960754-X/abstract">poverty</a>”, which leaves little prospect of escape.</p></li>
</ul>
<h2>Where are the carers</h2>
<p>South Africa’s mental health <a href="http://www.ncbi.nlm.nih.gov/pubmed/19506789">workforce</a> is woefully inadequate. There are only 0.3 psychiatrists, 0.3 psychologists and 0.4 social workers for every 100 000 residents. <a href="http://www.who.int/mental_health/evidence/atlas/profiles/bra_mh_profile.pdf">Brazil</a> has 3.07 psychiatrists, 9.60 psychologists and 1.02 social workers for every 100 000 residents.</p>
<p>South Africa has 800 registered psychiatrists and nearly 8 000 psychologists, mostly working in private <a href="http://www.health-e.org.za/2015/10/12/mental-health-the-poor-neglected-stepchild/">health</a>.</p>
<p>Although the government has made significant strides creating <a href="http://www.health-e.org.za/wp-content/uploads/2014/10/National-Mental-Health-Policy-Framework-and-Strategic-Plan-2013-2020.pdf">policy</a> and passing <a href="http://www.gov.za/sites/www.gov.za/files/38182_rg10309_gon874_0.pdf">legislation</a> to provide mental health services, implementation has been a problem. This is because:</p>
<ul>
<li><p>Most of the groups supporting people with mental disorders are non-profit organisations that survive on shoestring budgets. </p></li>
<li><p>A shortage of state resources for the specialised and complex needs of psychiatric disorders.</p></li>
</ul>
<p>There should be strong collaboration between the service providers, particularly non-profit organisations, and the private sector. This does not happen. </p>
<p>Recent developments are not promising. The Gauteng Department of Health <a href="http://www.gov.za/speeches/gauteng-health-terminates-life-healthcare-esidimeni-contract-21-oct-2015-0000">announced</a> it will end its contractual relationship with Life Healthcare – South Africa’s largest and longest running public-private partnership. This will result in more than 2000 patients with chronic mental illness being discharged from Life Esidimeni, which means “place of dignity”. </p>
<p>In the absence of proper community care, people who need care often end up homeless or in jail as has been shown in the <a href="http://www.ncbi.nlm.nih.gov/pubmed/6479924">US</a>. In addition, pressure increases on under-funded non-profit organisations.</p>
<h2>Glimmers of hope</h2>
<p>There are some promising initiatives in the pipeline to strengthen mental healthcare in the country and in parts of the continent. </p>
<p>This includes groups that empower practitioners and policy makers enabling them to <a href="http://www.cpmh.org.za/">lobby</a> for mental health services. There are also consortia that investigate cost effective <a href="http://www.affirm.uct.ac.za/">interventions</a> for mental health disorders, how to <a href="http://www.prime.uct.ac.za/">scale up</a> mental health services and enhance the health systems to deliver mental health services adequately. </p>
<p>The state has a responsibility to provide mental illness treatment and to promote mental health. But the reality is that it will need to tap into human resources from non-profit organisations as well as private sector funding. This collaboration can only happen if the state renews its focus on how it can deliver mental health services.</p><img src="https://counter.theconversation.com/content/50410/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>André Janse van Rensburg is affiliated with the University of Stellenbosch (Department of Political science) and Ghent University (Department of Sociology) as a doctoral candidate, and with the Centre for Health Systems Research & Development, University of the Free State, as a researcher.</span></em></p>While the global health community has made mental healthcare a priority, South Africa is not following suite. The impact is felt most acutely by poor people suffering from mental health disorders.André Janse van Rensburg, Researcher at the Centre for Health Systems Research & Development, University of the Free StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/485782015-10-08T04:03:53Z2015-10-08T04:03:53ZBlame it on biology: how explanations of mental illness influence treatment<figure><img src="https://images.theconversation.com/files/97722/original/image-20151008-9675-1vah277.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who believe their problems have biogenetic causes tend to opt for biomedical treatments.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/timcaynes/4895714866/">Tim Caynes/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Every mental health problem has a biological dimension. How could it not? All our experience and behaviour, normal or abnormal, is founded on our neurobiology. </p>
<p>Researchers have taken great strides towards understanding these foundations and the public has taken note. Increasingly, we explain our problems as products of heredity, brain disease and chemical imbalance, rather than life experiences, adversities and ways of thinking.</p>
<p>Regrettably, these scientific advances have a dark side. As a <a href="http://psych.unimelb.edu.au/sites/live-1-14-1.msps.moatdev.com/files/Haslam/CDPS%20haslam%20&%20kvaale.pdf">recent review</a> shows, people who hold biogenetic (biological and genetic) explanations of mental health disorders tend to have some <a href="https://theconversation.com/brains-genes-and-chemical-imbalances-how-explanations-of-mental-illness-affect-stigma-28324">negative perceptions</a> of those who experience them. They view these people as relatively dangerous, unpredictable and unlikely to recover, and seek greater distance from them. </p>
<p>The consequences of these perceptions extend beyond stigma; they also have troubling implications for treatment. </p>
<p>The <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/">“therapeutic alliance”</a> between clinician and client is a key ingredient in successful treatment, responsible for better clinical outcomes and lower rates of dropout. Biogenetic explanations held by clinicians can impair the therapeutic relationship and those held by clients can impede their recovery. </p>
<p><a href="http://www.pnas.org/content/111/50/17786.full.pdf">Studies</a> by Matt Lebowitz and Woo-kyoung Ahn at Yale University, for example, found that biogenetic explanations reduce empathy among clinicians. </p>
<p>Clinicians read descriptions of people suffering from mental health conditions, whose problems were given biogenetic or psycho-social (psychological and social) explanations. An anxious client’s troubles, for instance, were attributed either to neurochemical imbalances and genes, or to bullying and parental neglect. The clinicians consistently reported feeling less empathy for clients whose problems were ascribed to biogenetic causes. </p>
<p>Empathy was lower among clinicians who had undergone medical training.</p>
<p>In Lebowitz’s <a href="http://isp.sagepub.com/content/early/2015/02/26/0020764015573086.abstract">later work</a>, clients judged clinicians who espoused biogenetic views of mental health disorders as less warm than those who espoused psycho-social views. If clinicians feel less empathy for clients, and clients see them as lacking warmth, the therapeutic relationship has two strikes against it.</p>
<p>Like any other members of the public, clients vary in the extent to which they believe that genes, chemical imbalances and brain abnormalities cause their problems. These explanations influence how they approach treatment.</p>
<p>People who believe their problems have biogenetic causes tend to opt for biomedical treatments. Although psychological treatments are effective alternatives for most mental health disorders, and often have fewer side effects, people who believe their troubles are rooted in their biology tend to disfavour these treatments.</p>
<p><a href="http://www.uw-anxietylab.com/uploads/7/6/0/4/7604142/chemical_imbalance_test_brat.pdf">One study</a>, by the University of Wollongong’s Brett Deacon and colleagues, gave a bogus cheek swab test to a sample of depressed people. Half were told that the test revealed a serotonin deficiency and the other half that their serotonin levels were normal. People who believed they had a chemical imbalance preferred medication over psychotherapy (talk-based therapy). </p>
<p>This phenomenon is playing out on a societal scale. In recent decades, lay people’s explanations of mental health problems have <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2012.01826.x/abstract">become increasingly biogenetic</a>. This is contributing to steep increases in the use of psychiatric medication and <a href="http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2010.10040570">declining rates of psychotherapy</a>.</p>
<p>Clients who attribute their mental health problems to biology tend to believe that they have limited control over their problems. They are also relatively pessimistic about their prognosis. In the cheek swab study, depressed people who were told they had a chemical imbalance were less confident they could regulate their negative moods and less optimistic about recovery.</p>
<p>These twin perceptions can hamper successful treatment. Believing one has limited control over one’s difficulties may weaken active engagement in overcoming them. Similarly, pessimism undermines the positive expectations that promote successful treatment and underlie the <a href="http://www.drdgoodman.com/uploads/6/0/8/8/6088462/fordyce_placebo_effect.pdf">powerful placebo effect</a>.</p>
<p>Biogenetic explanations have some worrying implications for treatment. So what can be done about this medicalisation of mental illness?</p>
<p>We cannot ignore the scientific evidence that neurobiological and genetic factors contribute to mental health problems. To do so would be to throw the psychiatric baby out with its bathwater. But we need to be mindful that biogenetic explanations have a dark side when it comes to treatment, as they do for public stigma.</p>
<p>The challenge for clinicians and clients alike is to overcome the tendency to view suffering individuals as broken mechanisms. Mental health problems have a biological component, but that fact does not dissolve the person’s subjective experience and individuality.</p><img src="https://counter.theconversation.com/content/48578/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Haslam receives funding from the Australian Research Council. </span></em></p>Biological and genetic explanations of mental illness can weaken people’s sense of control and optimism, and create a bias against effective psychological interventions.Nick Haslam, Professor of Psychology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/469662015-09-03T05:36:10Z2015-09-03T05:36:10ZThe anxiety puzzle: why are women in deprived areas more likely to suffer?<figure><img src="https://images.theconversation.com/files/93648/original/image-20150902-6144-6sjk34.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bleak house.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/arthurjohnpicton/4764639823/sizes/o/">SomeDriftwood/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>A major survey of more than 20,000 people in the UK <a href="http://www.iph.cam.ac.uk/blog/women-poor-areas-twice-likely-develop-clinical-anxiety-men/">has found</a> that women living in poor areas are almost twice as likely to develop clinical anxiety as women in richer areas. Interestingly, living in poorer or richer areas made no difference to the levels of generalised anxiety disorder experienced by men. </p>
<p>Generalised anxiety disorder (GAD) is <a href="http://www.cambridge.org/gb/academic/subjects/medicine/mental-health-psychiatry-and-clinical-psychology/anxiety-disorders-theory-research-and-clinical-perspectives">one of the most common mental health conditions</a> in modern society. It is debilitating, and associated with a high use of health services. If untreated, it can lead to the development of major depression and substance abuse, and it places individuals at a high risk of suicide.</p>
<h2>Environmental impacts</h2>
<p>Despite these serious risks, very little research has been done on the factors in society that give rise to this disorder. Much of the work on mood and mental illness has focused on depression, while anxiety has been largely neglected. Those studies which have looked at the risk factors for anxiety disorders have tended to focus on the effect of low personal income, low levels of education, or poor health behaviours (such as smoking, drinking and physical inactivity). </p>
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<img alt="" src="https://images.theconversation.com/files/93651/original/image-20150902-6169-1c7o8ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/93651/original/image-20150902-6169-1c7o8ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/93651/original/image-20150902-6169-1c7o8ks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/93651/original/image-20150902-6169-1c7o8ks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/93651/original/image-20150902-6169-1c7o8ks.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/93651/original/image-20150902-6169-1c7o8ks.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/93651/original/image-20150902-6169-1c7o8ks.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&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">The root of our ills?</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>So far, very little work has been done on the impact of the environment in relation to anxiety, even though it is <a href="http://www.who.int/social_determinants/strategy/en/Marmot-Social%20determinants%20of%20health%20inqualities.pdf">widely recognised</a> as an important contributor to health in general, and can affect a very large number of people. In particular, living in poverty <a href="http://ukcatalogue.oup.com/product/9780198565895.do">has been linked</a> to a range of chronic medical conditions – <a href="http://www.archpublichealth.com/content/69/1/3">including depression</a> – and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21106285">mortality</a>. So could there be a link between poverty and anxiety?</p>
<p>Now, for the first time, I and researchers in the Department of Public Health and Primary Care at the University of Cambridge <a href="http://www.iph.cam.ac.uk/blog/women-poor-areas-twice-likely-develop-clinical-anxiety-men/">have shown</a> that British women living in deprived areas are almost twice as much at risk of experiencing GAD, compared with women living in areas that are not deprived. This association persisted even after we accounted for individual circumstances, such as socio-economic status and existing medical conditions. It is also remarkable that the link between deprivation and clinical anxiety does not seem to exist among men. </p>
<h2>Why is it so?</h2>
<p>These findings are intriguing, and several explanations can be put forward. Deprivation – which we measured based on factors such as the local unemployment rate, barriers to housing and services, crime, and other dimensions – can lead to stress, which can trigger mental health problems. It may be that women are more affected by the stress that comes with living in poverty, compared with men. </p>
<p>Women tend to be more embedded in their local communities and spend more time in the surrounding environment than men, perhaps due to their <a href="http://www.huffingtonpost.co.uk/2014/10/06/women-housework-compared-men-poll_n_5937536.html">greater uptake</a> of part-time work and domestic or child-rearing duties. This means that they may be more exposed to the strain and stresses that come with living in deprived conditions. </p>
<p>Women may also perceive the environment differently from men. Neighbourhood safety and fear of being assaulted seem to be much more of a concern for women. If women perceive a neighbourhood to be unsafe, they <a href="http://www.ncbi.nlm.nih.gov/pubmed/16698978">may restrict leisure activities</a>, such as walking, and this can have further negative effects on their mental health. </p>
<p>Finally, both genders may experience and manifest the effects of stress in different ways. One study <a href="http://www.ncbi.nlm.nih.gov/pubmed/3498453">has shown</a> that women who are highly distressed tend to develop internalising disorders, while men are more prone to drinking abuse and antisocial problems. </p>
<p>The <a href="https://www.nice.org.uk/advice/lgb4/chapter/introduction">National Institute for Health and Care Excellence</a> (NICE) and the <a href="http://www.who.int/social_determinants/thecommission/finalreport/en/">World Health Organisation</a> (WHO) have emphasised the need to reduce social and health inequalities. Our findings add detail to this call, showing that environmental characteristics should inform mental health policy, but also that investments made to improve local areas will not benefit all parts of the population in the same way. Gender is clearly an important factor when it comes to assessing the impacts of our environment, and promoting good mental health.</p><img src="https://counter.theconversation.com/content/46966/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olivia Remes received a PhD studentship from the UK National Institute for Health Research (NIHR). </span></em></p>A new study has produced puzzling results about how the environment affects men’s and women’s mental health.Olivia Remes, PhD Candidate, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.