tag:theconversation.com,2011:/global/topics/behavioural-problems-30392/articlesBehavioural problems – The Conversation2023-02-14T19:10:55Ztag:theconversation.com,2011:article/1943362023-02-14T19:10:55Z2023-02-14T19:10:55ZHow to get your kids to talk about their feelings<figure><img src="https://images.theconversation.com/files/508535/original/file-20230207-15-wxxd4r.jpg?ixlib=rb-1.1.0&rect=190%2C595%2C7285%2C4702&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/1wAGVmYBxwQ">Annie Spratt/Unsplash</a></span></figcaption></figure><p><a href="https://www.paulekman.com/universal-emotions/">Emotions</a> are core to our human experience, but seeing “negative” emotions in our children – anger, fear, jealousy, envy, sadness, resentment – can make us uncomfortable. </p>
<p>Strong emotions in our kids may trigger our own emotional reactions, and we may feel lost about the best way to respond. </p>
<p>Many of today’s adults grew up not talking about emotions. But as modern parents, we’re told we need to teach our children about their feelings to build their resilience. So how can you encourage your children to talk about their feelings?</p>
<p>Research shows kids learn about emotions in four key ways: our parenting, how we explicitly teach them, our behaviour and the family environment. </p>
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Read more:
<a href="https://theconversation.com/my-kid-is-biting-hitting-and-kicking-im-at-my-wits-end-what-can-i-do-194639">My kid is biting, hitting and kicking. I’m at my wit’s end, what can I do?</a>
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<h2>1) Our parenting helps kids name, express and manage emotions</h2>
<p>As parents, we play an important role in helping children name, express and manage their emotions. </p>
<p>But this is often not easy. We might be comfortable teaching our children to recognise when they are hungry, tired and thirsty, but be focused on stopping children’s sadness, fears or anger, rather than on teaching about these emotions. </p>
<p>Everyone feels a range of emotions, and the “negative” emotions are not inherently bad. Emotions are signals that are important for our survival and help us to understand ourselves and our world. Children often “act out” their emotions, rather than talking about how they feel. </p>
<figure class="align-center ">
<img alt="Dad talks to his son about emotions" src="https://images.theconversation.com/files/508538/original/file-20230207-17-2ev0fv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508538/original/file-20230207-17-2ev0fv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508538/original/file-20230207-17-2ev0fv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508538/original/file-20230207-17-2ev0fv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508538/original/file-20230207-17-2ev0fv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508538/original/file-20230207-17-2ev0fv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508538/original/file-20230207-17-2ev0fv.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">Everyone feels a range of emotions.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/eyfaunEy9dM">Max Harlynking/Unsplash</a></span>
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</figure>
<p>When we teach kids that all emotions are healthy, they learn to trust themselves, feel more comfortable sharing their feelings, and view emotions as brief experiences that pass. </p>
<p>So, what should we say in the moment?</p>
<ol>
<li><p>Start by describing what you see or observe. “You sound sad/angry?” or “You are looking a little quiet.” </p></li>
<li><p>We often don’t know exactly what our child is feeling. Be tentative and check: “You look frustrated, is that right?”</p></li>
<li><p>Validate: “That situation was really hard, no wonder you’re frustrated.”</p></li>
<li><p>When our child is upset, we don’t need to say much. Try to listen and connect through eye contact and gentle touch. As University of Houston professor of social work and author <a href="https://www.youtube.com/watch?v=KZBTYViDPlQ&ab_channel=DianaSimonPsihoterapeut">Brené Brown</a> reminds us, it is not about having the right words, but instead about offering support and connection.</p></li>
<li><p>Avoid trying to fix (problem-solve) or distract your child when they are emotional. Support kids to acknowledge and “sit with” their feelings.</p></li>
<li><p>Older children and teens may learn how to start masking their emotions, so we might only see their challenging behaviours. Imagine their behaviour is the tip of an iceberg, caused by emotions under the surface. Try connecting with their emotion rather than focusing only on the behaviour, “You slammed your door, are you feeling upset?” </p></li>
</ol>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Picture of an iceberg submerged in water, with the word " src="https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=731&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=731&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=731&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=919&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=919&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508512/original/file-20230206-17-pymzdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=919&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Challenging behaviours are often just the tip of the iceberg. Recognising what lies beneath the surface can help children learn about emotions and identify important needs.</span>
<span class="attribution"><span class="source">Teachers Tuning in to Kids/Tuning in to Teens Whole
School Approach</span></span>
</figcaption>
</figure>
<h2>2) Parents can explicitly teach kids about emotions</h2>
<p>When everyone’s calm (<em>not</em> when you or your child are upset), we can teach kids about emotions. </p>
<p>We can start conversations about emotions based on almost anything your child is interested in, a TV show, video game, movie, or book they’re reading. A great movie for starting the conversation is <a href="https://www.pixar.com/feature-films/inside-out">Inside Out</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/inside-out-shows-well-being-isnt-just-about-chasing-happiness-43629">Inside Out shows well-being isn't just about chasing happiness</a>
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</em>
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<p>Watching emotions in fictional characters normalises emotions as a universal experience and helps kids to recognise more subtle types of emotions and different ways to express and manage emotions.</p>
<p>For older kids who’ve become more self-conscious, try having these discussions when not directly looking at them, in the car, or during an activity (walking, kicking a ball, watching a movie together). Some kids open up more at bedtime. Try to listen more and talk less.</p>
<h2>3) Children watch and learn from us</h2>
<p>Many of us grew up in families where parents did not teach us about emotions, or they were poor role models for expressing emotions in healthy ways. </p>
<p>If this is the case, it’s common to view emotions as bad and unhelpful, and believe it’s not good to dwell on feelings.</p>
<p>As a result, it can be hard to watch our children experiencing strong negative emotions. If you’re feeling triggered by your child’s emotion, it will help to pause. You can leave the room if necessary. It’s healthy to role-model to kids taking a break when we feel overwhelmed. </p>
<figure class="align-right ">
<img alt="Mother and child walk" src="https://images.theconversation.com/files/508533/original/file-20230207-25-n2ozy4.jpg?ixlib=rb-1.1.0&rect=0%2C1388%2C2000%2C1607&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/508533/original/file-20230207-25-n2ozy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508533/original/file-20230207-25-n2ozy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508533/original/file-20230207-25-n2ozy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508533/original/file-20230207-25-n2ozy4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1129&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508533/original/file-20230207-25-n2ozy4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1129&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508533/original/file-20230207-25-n2ozy4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1129&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents can explain how they were feeling in certain situations.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/RRZM3cwS1DU">James Wheeler/Unsplash</a></span>
</figcaption>
</figure>
<p>If we make a mistake as parents and act in ways we’re not proud of, this is a great opportunity to model to our kids how to make amends. </p>
<p>Explain what you were feeling, that your actions were not okay, and apologise. This gives kids a template for making amends themselves, which is a critical relationship skill. </p>
<p>If you often struggle managing your own emotions, learning about emotions is a good start. Two great books are: </p>
<ol>
<li><a href="https://www.marcbrackett.com/">Permission to Feel</a> (Marc Brackett)</li>
<li><a href="https://www.booktopia.com.au/the-a-to-z-of-feelings-andrew-fuller/book/9780645069013.html">The A to Z of Feelings</a> (Andrew Fuller and Sam Fuller). </li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/anxiety-can-look-different-in-children-heres-what-to-look-for-and-some-treatments-to-consider-189685">Anxiety can look different in children. Here's what to look for and some treatments to consider</a>
</strong>
</em>
</p>
<hr>
<h2>4) Kids are affected by relationships in the family</h2>
<p>Emotions are contagious. Kids are affected by other relationships in the family, including conflict between parents. </p>
<p>Remember, conflict is a healthy human experience and cannot be eliminated.
Instead, it’s important to show kids healthy conflict, where we all express emotions in a respectful way. </p>
<p>It’s also important that kids see healthy conflict resolution. </p>
<h2>Where can you get help?</h2>
<p>Here are three evidence-based parenting programs focused on helping parents teach children about emotions:</p>
<ul>
<li><p><a href="https://tuningintokids.org.au/parents/">Tuning in to Kids/Teens</a> focuses on the emotional connection between parents/carers and their children, from toddlers to teens</p></li>
<li><p><a href="https://partnersinparenting.com.au/">Partners in Parenting</a> is designed to help you raise your teenager 12-17 years to prevent depression and anxiety</p></li>
<li><p><a href="https://thisparentinglife.com.au/circle-of-security-parenting-online/">Circle Of Security Parenting</a> improves child development by strengthening the parent-child attachment when children are aged 0-12 years.</p></li>
</ul><img src="https://counter.theconversation.com/content/194336/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Elizabeth Westrupp receives funding from the National Health and Medical Research Council (NHMRC, GNT2019442)</span></em></p><p class="fine-print"><em><span>Dr Christiane Kehoe is co-author on the Tuning in to Kids suite of programs and receives royalties from the sale of the facilitator manuals used by clinicians who deliver the parenting groups. </span></em></p>Many of us grew up not talking about emotions. But as modern parents, we’re told we need to teach our children about their feelings to build their resilience. So how do we do it?Elizabeth Westrupp, Associate Professor in Psychology, Deakin UniversityChristiane Kehoe, Research manager and program specialist Tuning in to Kids, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1848122022-06-24T15:25:27Z2022-06-24T15:25:27ZBelfast’s silent public health crisis? Why we need widespread testing for lead-contaminated water<p>The water crisis at Flint, a town in Michigan, US in 2014 has focused public attention on the dangers of lead exposure, especially in children. A late 2016 <a href="http://www.reuters.com/investigates/special-report/usa-lead-testing/">investigation</a> found that nearly 3,000 other communities in the US had even worse lead water levels than Flint. A recently published study <a href="https://www.pnas.org/doi/10.1073/pnas.2118631119">claims</a> that “half of US population was exposed to adverse lead levels in early childhood”.</p>
<p>Lead exposure during the critical brain development window between the ages one and five has the most adverse effects on humans, causing irreversible and permanent brain damage. The US <a href="https://www.cdc.gov/about/index.html">Centers for Disease Control and Prevention</a> (CDC) estimates that 500,000 children under the age of six have blood-lead levels that exceed the “reference level”, as it’s called.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/nTpsMyNezPQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>The UK and Ireland have largely escaped the same scrutiny even though lead water pipes were used ubiquitously in homes and community water systems prior to 1970. The early 20th century “<a href="https://mitpress.mit.edu/books/great-lead-water-pipe-disaster">great lead water pipe disaster</a>” in Glasgow was neither particular to the city nor the time.</p>
<p>High lead levels in the city’s water supply were known to scientists as early as 1855, but water regulators ignored them and touted the supply as the “purest water in the world”. But Glasgow’s water supply became associated with negative health effects, from heart and kidney disease to “mental retardation” among children. It wasn’t until 1979 that the water was treated with lime which saw median blood-lead levels drop by 61%. </p>
<p>Here on our doorstep in Belfast, there is a potentially alarming but little-known public health issue growing. As our small-sample <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003174080-1/pedagogy-workshop-nuala-flood-tristan-sturm">water tests</a> make clear, while leaded water lies buried within our infrastructure, children are still being exposed to harmful levels of lead.</p>
<p>We are now about to undertake a bigger investigation that will reveal the extent of lead in Belfast’s water.</p>
<h2>Risks and harms</h2>
<p>There is plenty of evidence to show the physical, emotional, and developmental <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/337733/LEAD_Toxicological_overview__v3.pdf">harms of lead</a>, even at levels well below what is judged to be officially acceptable.</p>
<p>One study found that even for children who tested under 5 µgPb/dL (micrograms per decalitre or parts per billion) – the point that triggers UK level of concern – they could expect <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080614/">significant declines in IQ</a>.</p>
<p>Other studies have found that children under the limit could also expect <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969711012782?via%3Dihub">increased social and behavioural problems</a> such as ADHD, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0013935116301037">juvenile delinquency and criminality</a>, plus an array of <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30043-4/fulltext">physical harms</a> including coordination difficulties, kidney damage, reproductive issues, hearing and speech problems, and even an <a href="https://ehp.niehs.nih.gov/doi/10.1289/ehp.1408171">increased prevalence of cancer</a>.</p>
<p>Studies have correlated above standard blood-lead levels to <a href="http://jamanetwork.com/journals/jamapediatrics/fullarticle/190628">violence</a>. One correlated high violent crime rates in <a href="http://www.motherjones.com/environment/2016/02/lead-exposure-gasoline-crime-increase-children-health">New York</a> in the 1970s and 1980s to lead exposure.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A timeline showing the harmful effects of lead in the human body." src="https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=315&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=315&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=315&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=396&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=396&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470754/original/file-20220624-14-ba1zd6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=396&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The toxic effects of lead in the human body.</span>
<span class="attribution"><span class="source">Queen's University</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Worsening lead levels</h2>
<p>The UK reference level for lead are the necessary product of the ubiquity of “three Ps” of lead in 20th-century urban life: <a href="http://www.bbc.co.uk/news/magazine-27067615">petrol</a>, paint and pipes. While these products have been regulated out of use, their vestiges remain layered in the infrastructure of everyday life in the UK, slowly poisoning people.</p>
<p>As more evidence-based studies make clear, any lead in the body causes observable harm, even levels well below the reference limit act as neuro-toxins, and the effects are permanent. A prominent lead researcher has <a href="http://pediatrics.aappublications.org/content/pediatrics/113/Supplement_3/1016.full.pdf">called such standards</a> a “risk management tool rather than a threshold for intoxity”. In other words, no level is non-toxic or safe for children.</p>
<p>Our preliminary <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781003174080-1/pedagogy-workshop-nuala-flood-tristan-sturm">research</a> randomly sampled water from 35 houses in Belfast. Mindful that the UK reference limit is 10 µgPb/L, we found five test results or 15%, exceeded the reference limit, and four exceeded 50 µgPb/L with a maximum of 95.2 µgPb/L.</p>
<figure class="align-center ">
<img alt="Map showing the location of lead pipe-supplied homes in Belfast." src="https://images.theconversation.com/files/470569/original/file-20220623-60671-jfkljd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470569/original/file-20220623-60671-jfkljd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470569/original/file-20220623-60671-jfkljd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470569/original/file-20220623-60671-jfkljd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470569/original/file-20220623-60671-jfkljd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470569/original/file-20220623-60671-jfkljd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470569/original/file-20220623-60671-jfkljd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Map of lead pipe-supplied homes in Belfast.</span>
<span class="attribution"><span class="source">Jeremy Auerbach</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Notably all tests found some lead in the system. The false economy of safety of water under 10 µgPb/L is one derived from the ubiquity of lead in our urban spaces and the cost of cleansing that environment of it.</p>
<p>No epidemiological study of the prevalence of lead water or poisoning has ever taken place in Northern Ireland. <a href="https://www.gov.uk/government/publications/lead-exposure-in-children-surveillance-reports-from-2021">NI Water</a> told us it bases its level of concern from studies that have taken place in England.</p>
<p>Without a specific study in Northern Ireland it is difficult to gauge the magnitude and scale of the effects lead contaminated water is having in Belfast, though NI Water admits that an <a href="https://www.niwater.com/news-detail/11964/is-your-house-older-than-1970-then-you-might-have-lead-water-pipes/">estimated 100,000</a> homes in Northern Ireland might be receiving water contaminated by lead. These are clustered in older built-up areas of Victorian and Edwardian houses, but one should assume any house built before 1969 has lead pipes and therefore leaded water.</p>
<h2>Raising awareness</h2>
<p>The question is, why is this not a high-profile public health issue? Where are the campaigns to raise awareness and educate people about what they should do?</p>
<p>Given the number of old buildings and homes in Belfast and the UK more generally, this is not an isolated incident. It is estimated that <a href="http://www.wrcplc.co.uk/Data/Sites/1/GalleryImages/WebImages/pdfs/articles/pipeup.pdf">25% of all service pipes</a> in the UK are lead. Ageing pipes, road traffic pollution and drinking water acidity can leach higher lead concentrations into the water.</p>
<p>In short, for adults in Belfast, this isn’t necessarily the water they drank as a child. The city tacitly recognises the severity of the impact of lead pipes on public health as it now systematically, street by street, replaces the lead service pipes over a 20-year period, but only to the property boundary.</p>
<p>It is not doing enough to warn its citizens that they should cautiously drink the water, filter it with activated carbon, or flush the pipes before each use, despite the now-closed <a href="https://www.gov.uk/government/organisations/health-protection-agency">Health Protection Agency</a> (HPA) highlighting its own <a href="https://academic.oup.com/qjmed/article/108/11/849/1903791/Investigating-lead-poisoning-in-children-could">prevention awareness shortcomings</a> in 2009. Under funding of water service providers likely limits such outreach. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/djphiNHncTw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Even if the lead water service pipes are replaced, lead pipelines in homes must still be identified and replaced by the homeowner in NI. Under current regulations, if landlords and homeowners are aware of lead water lines, they do not have to share this information with tenants or during the sale of the home.</p>
<p>With rising inflation and the associated increased construction costs, supply chain issues and low supply of contractors, homeowners may postpone or indefinitely hold off testing their water and replacing home lead water lines thereby further concealing the problem.</p>
<p>Lead contaminated water is a silent crisis. And our cities are complicit in producing the next generation of children who might underperform, be prone to violence, or suffer debilitating bodily harm. The US has been having this conversation about exposure to lead in water for a decade; it is time we did too.</p><img src="https://counter.theconversation.com/content/184812/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tristan Sturm receives funding from an ESRC Impact Grant. </span></em></p><p class="fine-print"><em><span>Jeremy Auerbach receives funding from the QUB/ESRC Impact Acceleration Account.</span></em></p><p class="fine-print"><em><span>Nuala Flood receives funding from the QUB/ESRC Impact Acceleration Account. </span></em></p>Belfast needs to rid its infrastructure of lead water pipes and raise public awareness of the serious health issues caused by excess levels of lead in the water.Tristan Sturm, Senior Lecturer of Geography, Queen's University BelfastJeremy Auerbach, Assistant Professor, University College DublinNuala Flood, Senior Lecturer/Associate Professor in Architecture, Queen's University BelfastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1044812018-10-16T19:11:29Z2018-10-16T19:11:29ZStressed about managing your child’s behaviour? Here are four things every parent should know<figure><img src="https://images.theconversation.com/files/240723/original/file-20181016-165909-ku8uvh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Praising and encouraging your children will likely make you feel less stressed about your parenting duties.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/TMpQ5R9mbOc">Caroline Hernandez/Unsplash</a></span></figcaption></figure><p>Around one-quarter of Australian parents feel stressed by their child’s behaviour every day and more than one-third are overwhelmed by it. These are some of the findings released today from our latest <a href="https://www.rchpoll.org.au/">Royal Children’s Hospital National Child Health Poll</a> – an online quarterly survey of a nationally representative sample of 2,000 Australian households with children. </p>
<p>The poll also reveals many parents are confused about how often their children should be on their best behaviour and that a concerning number of parents use physical discipline to manage their children.</p>
<p>Parenting is a tough gig and perfection is an unrealistic goal. It’s important for parents to remember they are not alone, and there are always strategies that can help. Here are four things the poll shows us each parent should know.</p>
<h2>1. Parenting is stressful</h2>
<p>Our poll found one in four parents (27%) feel stressed by their child’s behaviour every day, with two-thirds (69%) feeling stressed at least once a week. Almost half of parents (45%) said they spent a lot of time thinking about how to manage their child’s behaviour and a third (32%) said they often felt overwhelmed by the issue. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240725/original/file-20181016-165903-5r2gzd.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">You’re not alone if you feel stressed about you child’s behaviour.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>All parents experience stress as they attempt to meet the challenges of caring for their children. But high levels of parenting stress can also make child behaviour problems worse. Parenting websites such as <a href="https://raisingchildren.net.au/grown-ups/looking-after-yourself/anger-anxiety-stress/stress-grown-ups">raisingchildren.net.au</a> contain tips on ways to recognise and reduce stress, which can help parents cope with the daily challenges of parenthood.</p>
<p>Almost half of parents (45%) said they were not confident they would know where to get help managing their child’s behaviour if they needed it. Advice and support from the GP, child health nurse or another health professional can help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-i-dont-wanna-wahhhh-a-parents-guide-to-managing-tantrums-87175">'No, I don't wanna... wahhhh!' A parent's guide to managing tantrums</a>
</strong>
</em>
</p>
<hr>
<h2>2. Your child may be acting their age, not misbehaving</h2>
<p>Children behave in different ways depending on their age, temperament, developmental stage and the situation. Yet one third of parents believe children should always be on their best behaviour, suggesting they have unrealistic expectations about a child’s capacity to behave in certain ways.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=757&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=757&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=757&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=952&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=952&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240726/original/file-20181016-165924-p87kgp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=952&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Toddlers have different emotional responses to preschoolers.</span>
<span class="attribution"><span class="source">from shutter</span></span>
</figcaption>
</figure>
<p>It is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/icd.677">normal for a toddler</a> to have difficulty regulating their emotions and have tantrums in response to overwhelming situations. Testing limits, like having strong opinions about eating or resisting bedtime, is also a normal developmental stage for preschoolers.</p>
<p>As teenagers journey towards becoming independent, they will challenge parent opinion and negotiate around decision-making. </p>
<p>Even adults cannot be expected to be on their best behaviour all the time, so we certainly can’t expect this of our children.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-discipline-your-children-without-rewards-or-punishment-39178">How to discipline your children without rewards or punishment</a>
</strong>
</em>
</p>
<hr>
<h2>3. Praise works better than punishment</h2>
<p>Our study found that most parents use positive strategies such as praise and rewards to promote “good” behaviour. No matter how old children are, praise and encouragement will <a href="https://books.google.com.au/books?id=5Y5oBAAAQBAJ&pg=PT4&lpg=PT4&dq=Positive+discipline:+The+first+three+years:+From+infant+to+toddler+%E2%80%93+laying+the+foundation+for+raising+a+capable,+confident+child.+New+York:+Harmony+Books&source=bl&ots=I8ibbNrmHj&sig=ggYXLJwqjT8no3ZptumtZptre7Q&hl=en&sa=X&ved=2ahUKEwitzqb96oreAhWHa94KHRfnA5QQ6AEwC3oECAIQAQ#v=onepage&q=Positive%20discipline%3A%20The%20first%20three%20years%3A%20From%20infant%20to%20toddler%20%E2%80%93%20laying%20the%20foundation%20for%20raising%20a%20capable%2C%20confident%20child.%20New%20York%3A%20Harmony%20Books&f=false">help them feel good</a> about themselves. This boosts their self-esteem and confidence. </p>
<p>Praise works best to encourage desired behaviour when it is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/cdep.12171">genuine and task specific</a> – that is, when you tell your child exactly what it is they have done well. This is sometimes called “<a href="https://www.kidsmatter.edu.au/mental-health-matters/social-and-emotional-learning/motivation-and-praise-encourage">descriptive praise</a>”. Saying “I like the way you shared your toys with your brother” is more effective than non-specific praise such as: “You’re a good girl”.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=866&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=866&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=866&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1088&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1088&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240751/original/file-20181016-165900-o2gv85.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1088&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Physical discipline is not the best way to manage a child’s behaviour.</span>
<span class="attribution"><span class="source">Royal Children's Hospital</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>A concerning proportion of parents report using negative or punitive strategies to manage their child’s behaviour. According to parent’s reports in our study, 4% of children have been physically disciplined “quite a lot or most of the time” in the past month, 13% “some of the time” and a further 24% “rarely”. </p>
<p>Physical discipline was defined as anything done to cause physical pain or discomfort to a child in response to their behaviour including smacking, hitting, spanking, slapping, pinching or pulling. </p>
<p><a href="http://www.cmaj.ca/content/early/2012/02/06/cmaj.101314">Research shows</a> physical discipline can be harmful to a child’s physical and psychological well-being. Research also shows children who experience physical punishment are <a href="https://www.ncbi.nlm.nih.gov/pubmed/12081081">more likely to develop</a> aggressive behaviour themselves. </p>
<p>Physical discipline is also a less effective strategy for encouraging desired behaviour because it focuses on what not to do rather than modelling or reinforcing desired behaviour.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-wake-up-call-for-parents-who-smack-their-children-16461">A wake-up call for parents who smack their children</a>
</strong>
</em>
</p>
<hr>
<h2>4. Lots of parents lose their cool, but saying sorry helps</h2>
<p>Almost half of parents (48%) said they became impatient too quickly, and one in three (36%) said they often lost their temper and later felt guilty. These feelings were more common among parents who reported using physical discipline more often. </p>
<p>When things are getting heated, it can be helpful to hit the pause button. Take a minute to breathe, step back, even walk away if possible. Try to see things from your child’s point of view and understand they don’t have the ability to reason and rationalise things like an adult. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240752/original/file-20181016-165885-hmb6bx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not every parent is perfect.</span>
<span class="attribution"><span class="source">Royal Children's Hospital</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>And if you do cross the line, take the time to reflect on what happened so you can recognise when things are heading this way again and intervene. It’s OK to say sorry to your child if you have lost your cool, as this will help them understand what has happened and it is modelling respectful behaviour too.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-swear-in-front-of-our-kids-46331">Should we swear in front of our kids?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/104481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthea Rhodes 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 survey of Australian parents has found many are overwhelmed by the stress of managing their child’s behaviour.Anthea Rhodes, Paediatrician and Lecturer in Child and Adolescent Health, Department of Paediatrics, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1000952018-07-20T05:44:53Z2018-07-20T05:44:53ZResearch Check: are phone-obsessed teens at greater risk of ADHD?<figure><img src="https://images.theconversation.com/files/228361/original/file-20180719-142408-lxq4jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hyperactivity and inattentiveness doesn't mean you have ADHD.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/PH8dIIP0ljY">Ant Rozetsky</a></span></figcaption></figure><p>This week, news outlets across the world reported a study from the <a href="https://jamanetwork.com/journals/jama/article-abstract/2687861">Journal of the American Medical Association</a> (JAMA) linking digital media exposure to reduced attention spans and attention deficit/hyperactivity disorder (ADHD): </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1019665618239410176"}"></div></p>
<p>But while the study found a link between high rates of digital media use and inattention and hyperactivity, it didn’t find that one <em>caused</em> the other. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/clearing-up-confusion-between-correlation-and-causation-30761">Clearing up confusion between correlation and causation</a>
</strong>
</em>
</p>
<hr>
<p>Nor did it look specifically at clinically diagnosed ADHD – it used a survey to ask students about ADHD-<em>related</em> symptoms. </p>
<h2>What is ADHD?</h2>
<p>ADHD is a neurodevelopmental disorder, which means it originates in early childhood and affects the brain’s development. Around <a href="https://www.ncbi.nlm.nih.gov/pubmed/25733754">7.2% of children worldwide</a> have a diagnosis of ADHD.</p>
<p>Symptoms include inattentive, hyperactive and impulsive behaviour. Although characteristic of ADHD, these behaviours exist on a continuum. So attention difficulties can be experienced, though at a lesser degree, by children and adolescents who don’t have ADHD. </p>
<p>These behaviours may fluctuate due to factors such as age (they’re more common in childhood) and levels of stress.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/imaging-study-confirms-differences-in-adhd-brains-73117">Imaging study confirms differences in ADHD brains</a>
</strong>
</em>
</p>
<hr>
<h2>How was the study conducted?</h2>
<p>The new JAMA study, from researchers at the University of Southern California, investigated the link between digital media use and the development of ADHD-related behaviours among 15- and 16-year-olds. </p>
<p>Just over 2,500 Californian high school students without ADHD completed a survey about their frequency of digital media use: many times a day, 1-2 times a day, 1-2 times a week, never. </p>
<p>The survey asked about 14 different types of use, including texting, checking social media sites, chatting online and streaming television on computers, smartphones and consoles. Participants rated their use for each type of media over the past week.</p>
<p>Every six months over the following two years, from 2014 to 2016, the students rated how frequently they experienced ADHD-related behaviours. </p>
<p>The researchers used an 18-question self-report scale, based on the criteria for diagnosing ADHD from the <a href="https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890420249.dsm-iv-tr">Diagnostic and Statistical Manual of Mental Disorders – 4th Edition</a> (DSM-IV). Questions covered a range of difficulties, such as making careless mistakes, having difficulty sustaining attention, feeling restless, and interrupting others.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/228363/original/file-20180719-142435-16kv55u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/228363/original/file-20180719-142435-16kv55u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/228363/original/file-20180719-142435-16kv55u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/228363/original/file-20180719-142435-16kv55u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/228363/original/file-20180719-142435-16kv55u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/228363/original/file-20180719-142435-16kv55u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/228363/original/file-20180719-142435-16kv55u.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">Teens commonly report high use of various digital media.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/GwVmBgpP-PQ">Steinar Engeland</a></span>
</figcaption>
</figure>
<h2>What did they find?</h2>
<p>Most students (80.9%) reported high-frequency use (three or more times a day) of at least one type of digital media. Checking social media sites was the most common, with 54% of the teens checking in many times a day.</p>
<p>Over the first six months of the study, 6.9% of students reported they had experienced ADHD symptoms. This rate dropped to 5.9% over the last six months of the study. </p>
<p>Teens who reported no high-use digital media activity had lower rates of experiencing ADHD-related behaviour over the 24-month study period, at a rate of 4.6%. </p>
<p>High-frequency engagement with more digital activities was associated with higher odds of experiencing ADHD-related behaviour. Among those who reported high use of seven activities, 9.5% experienced ADHD-type behaviours. Those reporting high use of all 14 digital media activities had the highest rates, at 10.5%. </p>
<p>Not all high-frequency digital media activities were associated with ADHD symptoms. Texting, chatting online, playing games with friends or family on a console, computer or smartphone, and posting photos or blogs had no association.</p>
<p>Activities that had the strongest association with ADHD symptoms include a high frequency of checking of social media sites, liking or commenting on other statuses, playing games alone on a console, computer or smartphone, and video chatting. </p>
<p>Two other factors – delinquent behaviour and depressive symptoms – were associated with higher rates of ADHD-related behaviours. But the link between high frequency of use of digital media and higher odds of ADHD symptoms held, even when taking these other factors into account. </p>
<h2>What does it all mean?</h2>
<p>This study highlights a potential association between digital media and behavioural symptoms typically associated with ADHD. But this work is unable to show <em>causation</em>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-parents-and-teens-can-reduce-the-impact-of-social-media-on-youth-well-being-87619">How parents and teens can reduce the impact of social media on youth well-being</a>
</strong>
</em>
</p>
<hr>
<p>It’s not possible to determine whether digital media use exacerbates ADHD-related behaviour, or whether those with ADHD-related behaviours find digital media more attractive, and use it more frequently. </p>
<p>Despite a link between digital media use and behaviours that are common in ADHD, ADHD is a complex neurodevelopmental disorder, and these findings in no way suggest digital media can <em>cause</em> ADHD. </p>
<p>There is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/19715710">strong genetic basis</a> for ADHD. In other words, people with the disorder are more likely than their peers to have parents and siblings with ADHD. </p>
<p>It’s also important to note an increase in inattention and hyperactivity in adolescence does not mean the young person would be diagnosed with ADHD.</p>
<h2>What else do we need to take into account?</h2>
<p>More research is needed to fully understand the potential long-term negative and positive impacts digital media has on the way we think and behave. </p>
<p>For people who may be more likely to engage with digital media, such as those with ADHD, it’s important to assess whether this type of technology exacerbates existing clinical attention difficulties. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/228376/original/file-20180719-142426-7421u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/228376/original/file-20180719-142426-7421u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/228376/original/file-20180719-142426-7421u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/228376/original/file-20180719-142426-7421u7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/228376/original/file-20180719-142426-7421u7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/228376/original/file-20180719-142426-7421u7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/228376/original/file-20180719-142426-7421u7.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">ADHD has a strong genetic basis.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/jVwb9LjxJ08">Ryan Tauss</a></span>
</figcaption>
</figure>
<p>As is the case with most longitudinal studies (tracking large groups of participants over time), it’s difficult to control for all potential confounding factors. Significant life changes such as moving house, starting a new school, or bereavement can influence our behaviours and cognition. </p>
<p>The JAMA study did highlight two factors that impacted on the prevalence of ADHD symptoms – depression and delinquency – but it’s difficult to rule out other things that may be responsible. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-teens-use-fake-instagram-accounts-to-relieve-the-pressure-of-perfection-92105">How teens use fake Instagram accounts to relieve the pressure of perfection</a>
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</em>
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<p>It’s also possible digital media itself may not be directly causing negative effects but, rather, the time spent using entertainment-based digital media detracts from time spent on learning or leisure activities. </p>
<p>The current study only examined social and entertainment-based digital media. We need further investigations that examine the effect of a wider range of digital media on our health. <strong>– Hannah Kirk</strong></p>
<hr>
<h2>Blind peer review</h2>
<p>This Research Check is a fair and accurate assessment of the research demonstrating a link between digital media use and ADHD, highlighting the need for future research that identifies the direction and mechanism of causality. <strong>– Lisa Williams</strong></p>
<hr>
<p><em><a href="https://theconversation.com/research-check-can-tea-towels-cause-food-poisoning-98152">Research Checks</a> interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one academic not involved with the study, and reviewed by another, to make sure it’s accurate.</em></p><img src="https://counter.theconversation.com/content/100095/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Kirk receives funding from a National Health and Medical Research Council (NHMRC) Fellowship, and is an investigator on two research grants funded by the NHMRC and the Department of Industry, Innovation and Science. Dr Kirk is the co-inventor of TALI Train, a tablet-based training intervention designed to improve attention and learning in children with developmental disorders such as autism and Down syndrome. TALI Train is owned by medical technology company, TALI Health, whom Dr Kirk consults with to provide scientific advice and guidance. </span></em></p><p class="fine-print"><em><span>Lisa A Williams receives funding from the Australian Research Council (DP130102110, DP130104468, LP140100034).</span></em></p>While the study found a link between high rates of digital media use and inattention and hyperactivity, it didn’t find that one caused the other. Nor did it look specifically at clinically diagnosed ADHD.Dr Hannah Kirk, Research Fellow in Psychology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/906952018-02-13T19:07:32Z2018-02-13T19:07:32ZAlmost every young person in WA detention has a severe brain impairment<figure><img src="https://images.theconversation.com/files/205891/original/file-20180212-58335-1xexcmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If youths with brain impairment had been identified and supported early, their entry into the justice system could have been avoided entirely.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Nine out of ten people in Western Australian youth detention are severely impaired in at least one area of brain function such as memory, language, attention, and executive function (planning and understanding consequences). Such deficits would strongly impact on their ability to conform with legal instructions, and with other aspects of the justice system such as being interviewed in court.</p>
<p>Our new research, conducted in WA’s only detention centre and published today in the journal <a href="http://bmjopen.bmj.com/content/8/2/e019605">BMJ Open</a>, also found one in three of the young people assessed had fetal alcohol spectrum disorder (FASD). This is a lifelong and severe disorder of brain development that occurs as a result of exposure to alcohol in the womb. This is the highest known rate of FASD among any population involved in the justice system worldwide.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/indigenous-youth-with-foetal-alcohol-spectrum-disorder-need-indigenous-run-alternatives-to-prison-56615">Indigenous youth with foetal alcohol spectrum disorder need Indigenous-run alternatives to prison</a>
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<p>While we know damage to the brain occurs from prenatal exposure to alcohol with FASD, the causes of other impairments responsible for the high rate of functional deficits we found are complex. They can include accidents, infection and nutritional problems. </p>
<p>Most impairments had never been recognised or managed appropriately by any of the agencies these young people had previously been involved with – including health, education and child protection services. We recommend every individual be comprehensively assessed at first contact with the justice system, and provided with a management plan for effective intervention.</p>
<h2>Who are the young people in detention?</h2>
<p>Our team from the Telethon Kids Institute assessed 99 youths in detention for nine areas of function. These were: academic function (such as reading, writing, spelling and maths), attention and sensory processing, executive function, language, memory and learning, motor skills, cognition (intellectual ability), brain structure (determined by a clinical investigation), and daily living skills (adaptive function). </p>
<p>Adaptive function is difficult to assess in detention settings, so the levels reported here are an underestimate.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=521&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=521&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=521&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=655&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=655&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206153/original/file-20180213-44657-1nrcvtb.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=655&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">Telethon Kids Institute</span></span>
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<p>The <a href="http://bmjopen.bmj.com/content/bmjopen/6/6/e012184.full.pdf">assessments were conducted</a> by a paediatrician, neuropsychologist, speech pathologist and occupational therapist. A research officer also collected background health, education and well-being information from multiple sources.</p>
<p>We found, regardless of whether the young person had FASD, 89% were severely impaired in at least one area of functioning. Some 65% were impaired in three or more areas. While the majority of the participants in the study (74%) were Aboriginal, the impairments were found across all young people.</p>
<p>Many participants displayed problems with remembering and recalling information, such as struggling to remember instructions. Others had difficulty understanding what was being said to them and being able to express themselves verbally, focusing their attention and being able to switch focus between tasks when required. </p>
<p>Impairments may come across in behaviours with young people appearing wilfully naughty, defiant, or lazy, when in reality they may been be struggling to remember, understand or comprehend what is required of them. </p>
<p>Many of the young people had a history of trauma, early school disengagement and early substance misuse. </p>
<p>It is likely the extensive amount of impairment, <a href="http://www.jahonline.org/article/S1054-139X(13)00524-7/fulltext">along with</a> <a href="http://www.justicehealth.nsw.gov.au/publications/2015YPICHSReportwebreadyversion.PDF">poor mental and physical health</a>, <a href="https://www.ccyp.wa.gov.au/media/2411/final-speaking-out-youth-justice-web-version-december-2016.pdf">histories of trauma</a>, and the lack of adequate processes in place to support them, is contributing significantly to the high rates of youth crime and the increase in serious incidents in Australian detention centres.</p>
<h2>The end of the line</h2>
<p>Juvenile detention is currently the end of the line for the most vulnerable, injured and disadvantaged young people who may have repeatedly slipped through cracks in the systems responsible for their welfare. For instance, of the 36 young people we diagnosed as having FASD, only two had previously been diagnosed. </p>
<p>These young people may have avoided the justice system altogether if such issues had been identified early and appropriate support put in place.</p>
<p>We recommend each young person be assessed upon entry into the justice system, and preferably much earlier. Our study’s assessment process gave us an understanding of each young person’s cognitive strengths and difficulties, which was useful for the youths, their families and those working with them. </p>
<p>If more programs and services were based around the strengths of these young people, this may lead to better education and employment opportunities and a more hopeful future.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-offenders-must-be-screened-for-fetal-alcohol-spectrum-disorders-before-sentencing-48659">Young offenders must be screened for fetal alcohol spectrum disorders before sentencing</a>
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</em>
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<p>We also found juvenile justice staff, at least in WA, are enthusiastic for research-informed training to provide appropriate support for young people in their care. Equipping all staff who work with these vulnerable young people (be it in detention, community justice, education, child protection or health settings) with knowledge, resources and support is critical for the well-being of everyone involved.</p>
<p>We also need to take a national approach to this problem, sharing our knowledge of what works, so government and researchers can move forward together to inform best practice nationwide.</p><img src="https://counter.theconversation.com/content/90695/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hayley M Passmore receives funding from an Australian Postgraduate Award and Stan and Jean Perron Award for Postgraduate Excellence. She is enrolled through The University of Western Australia. This research was conducted with the assistance of the Western Australian Department of Justice. However this article cannot be considered as either endorsed by the Department or an expression of the policies or views of the Department.
</span></em></p><p class="fine-print"><em><span>Carol Bower receives funding from National Health and Medical Research Council. </span></em></p><p class="fine-print"><em><span>Raewyn Mutch receives funding from National Health and Medical Research Council.</span></em></p>New research assessing young people in WA detention found 89% were severely impaired in at least one area of brain function. One in three had fetal alcohol spectrum disorder (FASD).Hayley M Passmore, PhD Candidate and Researcher, Telethon Kids InstituteCarol Bower, Senior Principal Research Fellow in Epidemiology of Birth Defects, including Fetal Alcohol Spectrum Disorders, Telethon Kids InstituteRaewyn Mutch, Clinical Associate Professor and Paediatrican, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/739562017-03-09T05:37:54Z2017-03-09T05:37:54ZResearch Check: will using lice products give my children behavioural problems?<figure><img src="https://images.theconversation.com/files/159495/original/image-20170306-943-9wvkvo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pyrethroids can be found in some head-lice products.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><a href="http://www.smh.com.au/business/consumer-affairs/pyrethroid-insecticides-linked-to-abnormal-behaviour-in-children-study-shows-20170301-guo1dd.html">Reports of a French study claimed</a> last week that exposure to certain insecticides during pregnancy were linked to “abnormal behaviour” in children. </p>
<p>Called pyrethroids, these chemicals are present in some common treatments for <a href="https://www.nettopet.com.au/fido-s-pyrethrin-shampoo-500ml.html?gclid=CMWQmMv8wNICFQoQvQod0yUGCA">dog ticks</a> and head lice. The <a href="http://www.dailymail.co.uk/health/article-4273614/Poor-behaviour-linked-head-lice-treatments.html#ixzz4aVrYSBVO">Daily Mail</a> zeroed in on this fact with the headline: </p>
<blockquote>
<p>Poor behaviour is linked to head lice treatments: Chemicals used to tackle the problem may effect [sic] nerve activity in the brain.</p>
</blockquote>
<p>The study’s lead author, Professor Jean-François Viel, told The Conversation he was surprised media reporting focused on head-lice treatment rather than “the overall exposure to pyrethroid insecticides we attempted to address”. You can view his full response at the end of the article.</p>
<p>Published in the <a href="http://oem.bmj.com/content/early/2017/02/02/oemed-2016-104035">Occupational and Environmental Medicine</a> journal, the study suggests an association between exposure to pyrethroids in pregnancy and behavioural issues in six-year-olds. But an association isn’t the same as causation – and as far as associations go, the one in this study was pretty weak.</p>
<p>We asked a chemistry expert to explain, and a toxicologist to review the analysis.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/160116/original/image-20170309-21026-7gc4of.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/160116/original/image-20170309-21026-7gc4of.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=831&fit=crop&dpr=1 600w, https://images.theconversation.com/files/160116/original/image-20170309-21026-7gc4of.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=831&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/160116/original/image-20170309-21026-7gc4of.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=831&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/160116/original/image-20170309-21026-7gc4of.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1045&fit=crop&dpr=1 754w, https://images.theconversation.com/files/160116/original/image-20170309-21026-7gc4of.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1045&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/160116/original/image-20170309-21026-7gc4of.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1045&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"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<h2>What are pyrethroids?</h2>
<p>Pyrethroids are synthetic versions of the naturally occurring insecticide, pyrethrin. They are widely used in agriculture and also in the home to control fleas and head lice. </p>
<p>Pyrethroids are neurotoxins (nerve poisons) that work by making cell membranes more permeable (easy to cross for various molecules). This can impair nerve transmission in insects, as well as humans. Most people are <a>widely exposed to pyrethroids</a>, mainly through diet (as they are used in agriculture) and indoor use. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=898&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=898&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=898&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1129&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1129&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159721/original/image-20170307-14946-tc7pj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1129&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pyrethroids are found in some products used to kill head lice.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>Pyrethroids enter the body through food, skin and the airways. Once absorbed, they are quickly broken down into byproducts called metabolites. These are excreted through urine and their presence indicates a person has been exposed to pyrethroids.</p>
<p>Earlier work, by the <a href="http://dx.doi.org/10.1016/j.envint.2015.05.009">same group of researchers</a> as the study in question, had shown that the presence of pyrethroid metabolites in children, but not in their mothers when pregnant, was negatively associated with children’s verbal comprehension scores. </p>
<p>Several years ago, Canadian research reported that some pyrethroid metabolites – found in 97% of 779 children aged six to 11 years – were associated with parent-reported behavioural problems.</p>
<h2>How was this study conducted?</h2>
<p>The study had two aims. The first was to test the effect of children’s exposure to pyrethroids <em>in utero</em>; the second tested for exposure to pyrethroids during childhood.</p>
<p>Researchers randomly selected 571 pregnant women from a sample of 3,421 women from an agricultural region of France, who were <a href="http://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-9-71">recruited for a broader study</a>. Of the 571 pregnant women selected, 287 agreed to a neurological (nervous system) and chemical and psychological follow-up when their children were six years old.</p>
<p>Mothers completed a list of 25 questions, drawn from a French version of the <a href="http://www.sdqinfo.com/">International Strengths and Difficulties Questionnaire</a>, to describe their children’s behaviour over the previous six months. Children’s behaviours were also assessed by visiting psychologists.</p>
<p>Researchers tested mothers’ urine at weeks six to 19 of gestation, and their children’s at age 5.99 to 6.27 years. They analysed the urine samples for pyrethroid metabolites.</p>
<p>Pyrethroid metabolites were absent from the urine of 82 mothers and four of their children. So the study only reported results for the remaining 205 women and 283 children. Metabolite concentrations in these women and children were very low – typically in the region of sub-micrograms per litre. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159716/original/image-20170307-14957-1dkp3wx.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>
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<span class="caption">Psychologists performed assessments on the children.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>One metabolite (<em>cis</em>-DCCA) was detected in almost all the women and children. Another (3-phenoxy benzoic acid) was detected in some samples, but its concentrations were very low. And in as many as 36% of the childhood urine samples, its levels were not detectable. </p>
<p>Different metabolites arise from different pyrethroids, so the presence or absence of a metabolite is likely to be a consequence of exposure to different pyrethroids rather than different metabolism.</p>
<p>Psychologists assessed children for altruism (social behaviour), internalising disorders (inability to share problems and ask for help) and externalising disorders (defiant and disruptive behaviour). Mothers also sent in reports on their children’s behaviour.</p>
<h2>What were the results?</h2>
<p>Concentrations of the most commonly observed metabolite (<em>cis</em>-DCCA) in the urine of pregnant mothers in the first trimester was positively correlated with internalising difficulties – such as being anxious or withdrawn – of their six-year-olds.</p>
<p>The variant of <em>cis</em>-DCCA, called <em>trans</em>-DCCA, in the urine of the six-year-olds was associated with reduced externalising behaviours – such as being aggressive or defiant. This is a counter-intuitive finding for which the researchers had no explanation.</p>
<p>Authors also report childhood exposure to the metabolite 3-phenoxy benzoic acid was associated with “increased odds of behavioural disorders”. But this was the metabolite that, in 36% of the urine samples, was below the level of detection.</p>
<h2>What are the issues with this study?</h2>
<p>There’s a possibility the sample is biased because only about half of the chosen pregnant women agreed to participate. No explanation was offered as to why mothers might have declined the invitation. </p>
<p>Reasons that would affect the study’s validity would include mothers declining due to feeling the research didn’t apply to them as they had never been exposed to pyrethroids, or that participation might lead to revelations of bad parenting.</p>
<p>To their credit, the authors themselves describe the associations they sought in this research as “limited” and advance a number of factors that could have affected them. These included that stored maternal urine samples could have degraded over the six years between their collection and that of the childhood samples.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159720/original/image-20170307-14973-1t5n3oj.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">High concentrations of one metabolite in pregnant mothers’ urine were associated with internalising behaviours in children, such as being withdrawn.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Second, the authors don’t have a distinct way of knowing whether the behavioural issues seen in some of the children were a direct result of exposure to pyrethroids <em>in utero</em>. Authors used statistical analyses to link childhood behaviour to their potential exposure <em>in utero</em>, but this is not an exact science.</p>
<p>Third, children differ in their ability to metabolise pyrethroids, which makes it difficult to compare like for like. And, finally, there is the possibility of “reverse causality” – children with behavioural problems such as hyperactivity might increase their exposure to pesticides, through deliberately disobeying parents’ orders, for instance.</p>
<p>There is also <a href="http://eprints.qut.edu.au/56403/">some evidence</a> that the developing fetus may susceptible to “poisoning” by a particular pesticide for only short windows of time during gestation. If this were true of the pyrethroids and their metabolites, one might not expect to see strong correlations with general measures of exposure like urinary metabolites. </p>
<p>Pyrethroid metabolites are cleared from the body within a few days. This means “snapshots” of their presence at one point in time in children – such as those used in this study – may not serve as good indicators of repeated exposure.</p>
<h2>So, what’s the verdict?</h2>
<p>Cause and effect is very hard to establish, despite efforts of researchers to control for other factors. And it’s terribly hard to link behaviours back to chemicals. So this study did not establish causation between exposure to pyrethroids and behavioural problems. It only suggested an association. </p>
<p>If parents are concerned about head-lice treatments, they should know there is a <a href="https://theconversation.com/health-check-how-do-you-catch-and-get-rid-of-head-lice-43699">non-chemical method</a> of controlling these pests. It uses a fine-tooth comb to separate them from the hair, repeated over a week or so.</p>
<p>As for insect sprays that contain pyrethroids, it is wise to use them sparingly if you are concerned about health impacts. <strong>– Ian Rae</strong></p>
<hr>
<h2>Peer Review</h2>
<p>Pyrethroid-based pesticides have largely replaced older pesticides, such as DDT, at least in part because they are much less toxic to humans. They are between 1,000 to 30,000 times <a href="http://onlinelibrary.wiley.com/doi/10.1002/ps.3881/full">less toxic to mammals</a> than insects. But they are <a href="http://www.sciencedirect.com/science/article/pii/S0378427416333549">neurotoxins</a> and there is concern long-term exposure to pyrethroids could affect development of parts of the nervous system. </p>
<p>The observational study published in the <a href="http://oem.bmj.com/content/early/2017/02/02/oemed-2016-104035">Occupational and Environmental Medicine</a> journal sought to address this issue. This Research Check fairly covers the research in question and highlights most of its strengths and limitations. </p>
<p>A strength of the study is that psychologists performed independent tests of child behaviour, rather than self-reports, which are open to bias. </p>
<p>The Research Check correctly points out that what was found is an <em>association</em> between the pyrethroid metabolites and some behaviour, rather than a <em>causal</em> relationship. </p>
<p>The association between the pyrethroid metabolites is weak and does not appear to be dependent on exposure. That is, children with the highest exposure levels do not seem to have more effects on behaviour than those with mid-level exposure. </p>
<p>Importantly, statistical tests performed to link behaviours with exposure were not corrected for the mathematical effects of doing multiple tests. This means the associations may be false positives. </p>
<p>The researchers’ statement that there is “no current explanation for the counter-intuitive association observed between childhood high trans-DCCA concentrations and reduced externalising disorders” is consistent with these results being false positives. </p>
<p>This Research Check’s overall verdict is appropriate. <strong>– Ian Musgrave</strong></p>
<hr>
<h2>Full response from study author on media reports</h2>
<p>Some headlines refer to “head lice killer” or “chemicals used to kill lice”.</p>
<p>It is true that pyrethroid insecticides are used to treat head lice (but also scabies) in humans and fleas in pets. But they are also used to control pests in residential and agricultural settings.</p>
<p>In our paper, we assessed pyrethroid exposure through concentrations of pyrethroid metabolites in urine (and not through specific usages collected from questionnaires). As a result, we cannot identify and quantify the various sources of exposure. Therefore, this focus on head lice is somewhat surprising to me.</p>
<p>Many pictures show a child with long hair. In the same way, these pictures refer to a single source of exposure (head lice treatment) and not to the overall exposure to pyrethroid insectides that we have attempted to assess. </p>
<p><strong><em>Professor Jean-François Viel, Department of Epidemiology and Public Health, University of Rennes France</em></strong></p><img src="https://counter.theconversation.com/content/73956/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adverse reactions to herbal medicines and has previously been funded by the Australian Research Council to study potential natural product treatments for Alzheimer's disease. He is co-investigator of a grant to explore the metabolism of rodenticides.</span></em></p><p class="fine-print"><em><span>Ian Rae 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>An association isn’t the same as causation – and as far as associations go, the one in this study was pretty weak.Ian Rae, Honorary Professorial Fellow, School of Chemistry, The University of MelbourneIan Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/448442016-10-05T02:50:36Z2016-10-05T02:50:36ZTo stop domestic violence, we need to change perpetrators’ behaviour<figure><img src="https://images.theconversation.com/files/116569/original/image-20160329-10194-s9pxst.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The logic is that violence is a choice, so men can be reasonably expected to stop.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-110533634/stock-photo-stressed-man-emotion-portrait.html?src=1turt8AvYForkdHvolGj-A-1-56">luxorphoto/Shutterstock</a></span></figcaption></figure><p>Behaviour change programs for domestically violent men are designed to address abusive and violent behaviour. Unlike anger management programs, the focus is on changing the perpetrator’s desire to control his partner by targeting his attitudes and behaviours. </p>
<p>The long-term effects are difficult to measure, as very few men are followed up after treatment. But <a href="http://ncfm.org/libraryfiles/Children/DV/Evaluating%20Batterer%20Programs--CDC%20summary-fin.pdf">international studies indicate</a> behaviour change programs can reduce the rate of further assaults and other abuses. Still, around <a href="https://global.oup.com/academic/product/coercive-control-9780195384048?cc=au&lang=en&">5% of participants</a> continuously re-assault, regardless of any effort to intervene. </p>
<p>Australian states and territories have behaviour change programs in place in both prison and community settings. But they are <a href="http://www.theguardian.com/australia-news/2015/jul/25/family-violence-commission-five-things-weve-learned-about-perpetrators">often underfunded</a> and under-resourced. Though many jurisdictions are placing more priority on new perpetrator programs, thousands of men sit on waiting lists every year.</p>
<h2>What types of programs are used?</h2>
<p>Behavioural change services in Australia use a <a href="http://websearch.aic.gov.au/firstaicPublic/fullRecord.jsp?recnoListAttr=recnoList&recno=13818">mix of approaches</a>: </p>
<ol>
<li><p>The <a href="http://www.theduluthmodel.org/">Duluth model</a>: court-mandated programs with a focus on power and control</p></li>
<li><p>The feminist socio-political model: a focus on men’s violence as a product of gender inequities</p></li>
<li><p>Psycho-educational approaches: a focus on individuals and learning better impulse-control using cognitive behavioural approaches </p></li>
<li><p><a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">Cognitive behavioural therapy</a> (CBT) models: targeting relationships between thinking feelings and behaviour.</p></li>
</ol>
<p>Work with Aboriginal men has included a focus on restorative justice and healing. It acknowledges the impacts – historical and ongoing – of colonisation on these communities.</p>
<p>Behavioural change program approaches that include a mix of the above have been shown to be <a href="http://ncfm.org/libraryfiles/Children/DV/Evaluating%20Batterer%20Programs--CDC%20summary-fin.pdf">most effective</a> and appropriate for most perpetrator programs. These models allow facilitators to focus on both the context of individual perpetrators’ lives and how this might affect their offending, while acknowledging the social and political influences of gender inequality. </p>
<p>As well as variation in the content of programs, they also vary in length – from 12 to 26 weeks – and intensity. </p>
<p>Ideally, the program intensity (and duration) should be matched with a perpetrator’s assessed level of risk.</p>
<p><a href="http://www.rmit.edu.au/news/all-news/2015/march/family-violence-report-aims-to-interrupt-cycle/">Perpetrator interventions that show</a> the greatest effectiveness internationally are those with robust lines of communication between all agencies involved. This includes ongoing assessments of perpetrator risk, feedback mechanisms if any safety concerns arise, and “swift and certain” criminal sanctions when protection orders are violated. </p>
<h2>How do you judge effectiveness?</h2>
<p>Evaluations that just measure a single outcome, such as violent re-offending, are rarely useful. “Family and domestic violence” covers a continuum of abusive behaviours that are devastating for women, but may not be in fact illegal. Though physical violence may reduce or cease, other forms of abuse either <a href="http://www.ncbi.nlm.nih.gov/pubmed/19850959">may continue</a> or escalate. </p>
<p><a href="http://vaw.sagepub.com/content/15/12/1509.short">Research indicates</a> that men who maintain a desire to control their female partners continue to use other <a href="https://global.oup.com/academic/product/coercive-control-9780195384048?cc=au&lang=en&">coercive forms of abuse</a> such as making unreasonable and non-negotiable demands, stalking, restricting her daily activities or destroying her relationships with friends, family or co-workers. </p>
<p>There is <a href="http://jiv.sagepub.com/content/early/2012/10/11/0886260512459381">some evidence</a> that matching perpetrator intervention intensity to specific “stages of change” promotes greater effectiveness. This means men could be placed in programs based on: their suitability for treatment; their levels of risk; whether they’re dealing with other problems such as housing, mental health, drug and alcohol abuse. But success in this area is contested. </p>
<p>Researchers have argued it’s problematic to measure success solely in terms of individual men’s behaviour change. Success can also <a href="http://bjsw.oxfordjournals.org/content/early/2012/04/16/bjsw.bcs049">mean many things</a> for women: it could, but doesn’t necessarily include, the cessation of all forms of violence by the perpetrator. </p>
<p>On the other hand, “effectiveness” can be judged by a woman as being able to leave safely, or the man abiding by a court order. </p>
<h2>Addressing other problems in men’s lives</h2>
<p>Violence against women is a gendered phenomenon and perpetrators are fully responsible for the decision to assault. </p>
<p>But trying to engage a man to address his behaviour is <a href="https://www.dss.gov.au/sites/default/files/documents/09_2013/literature_review_on_domestic_violence_perpetrators.pdf">extremely difficult</a> when co-existing factors – such as significant mental health concerns, drug and alcohol misuse, unemployment and/or homelessness – are also present.</p>
<p>Though none of these factors is either a necessary or sufficient cause of family and domestic violence, in such cases, even experienced workers can struggle to maintain a focus on perpetrator accountability and women’s safety. </p>
<p>Perpetrator programs have the potential to assist men to have more emotionally enriching lives through attitudinal and behaviour change. But these are secondary aims. The primary focus must be on the steps necessary to maintain the victim’s safety.</p>
<p>While perpetrator programs are no panacea, they’re more likely to be effective if they are part of well-integrated responses to domestic and family violence that include police, courts and corrective services and program providers. </p>
<p>As with many social problems, significant increases in women’s safety will require sustained and increased funding for best practice programs nationally. </p>
<hr>
<p><em>Tony Fletcher will be online for an Author Q&A between 10:30 and 11:30am AEDT on Thursday, 6 October, 2016. Post your questions in the comments below.</em></p><img src="https://counter.theconversation.com/content/44844/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tony Fletcher is affiliated with South Australian Department of Correctional Services as a Senior Clinician with the Rehabilitation Programs Branch</span></em></p><p class="fine-print"><em><span>Sarah Wendt receives funding from the ARC and ANROWS. She is a member of the Board for Women’s Safety Services South Australia.</span></em></p>Thousands of Australian men are sitting on waiting lists every year to get help to end their violent behaviour – even though behaviour change programs can reduce their likelihood of offending again.Tony Fletcher, PhD Candidate/Senior Clinician, University of South AustraliaSarah Wendt, Professor of Social Work, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/639942016-08-19T03:28:29Z2016-08-19T03:28:29ZResearch Check: does paracetamol in pregnancy cause child behavioural problems?<figure><img src="https://images.theconversation.com/files/134571/original/image-20160818-12292-1bm0kx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The use of paracetamol in pregnancy is low risk.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-353346353/stock-photo-pregnancy.html?src=HflySInMSlKDzRaMb2FhWA-1-75">Svetlana Iakusheva/Shutterstock</a></span></figcaption></figure><p>Paracetamol is widely used in all stages of pregnancy to reduce a high temperature and relieve pain. It should be taken only when needed, but is generally considered safe for the baby. </p>
<p>A <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=2543281">study published on Tuesday</a> in the journal JAMA Pediatrics linked the drug to behavioural problems in childhood, generating alarming headlines such as <a href="http://www.businessinsider.com.au/science-says-taking-paracetamol-when-pregnant-can-lead-to-hyperactive-children-2016-8">“Science says taking paracetamol when pregnant can lead to hyperactive children”</a> and <a href="http://www.mirror.co.uk/lifestyle/health/pregnant-women-could-put-babies-8636929">“Pregnant women ‘could put babies at risk of developing behavioural problems if they take paracetamol after 18 weeks’ ”</a>.</p>
<p>So, are the headlines right?</p>
<p>The short answer is no. This paper does not provide any evidence that paracetamol causes childhood behavioural problems. </p>
<p>A more practical question is whether pregnant women and their doctors should change their use of paracetamol (also known as acetaminophen in the United States) on the basis of this paper. The answer to this is also no.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/134746/original/image-20160819-12292-pag6pz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134746/original/image-20160819-12292-pag6pz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1012&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134746/original/image-20160819-12292-pag6pz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1012&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134746/original/image-20160819-12292-pag6pz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1012&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134746/original/image-20160819-12292-pag6pz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1272&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134746/original/image-20160819-12292-pag6pz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1272&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134746/original/image-20160819-12292-pag6pz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1272&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>How was the study conducted?</h2>
<p>The researchers studied pregnant women who had taken paracetamol during pregnancy and the behaviour of their children at seven years of age. </p>
<p>The study tracked 7,796 mothers enrolled between 1991 and 1992 together with their children and partners in the Avon Longitudinal Study of Parents and Children (ALSPAC). </p>
<p>At 18 and 32 weeks of pregnancy, the mothers were asked to recall if they had used paracetamol in the preceding three months. </p>
<p>The mothers weren’t asked about dose or duration of treatment but were asked to recall the reason for taking paracetamol. These included: muscle and joint problems, infections (including cold or flu, urinary or other infections), migraine or headaches. </p>
<p>However, these reasons were not analysed separately in relation to the behavioural outcomes in the children. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/134716/original/image-20160819-12284-vj6zv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134716/original/image-20160819-12284-vj6zv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134716/original/image-20160819-12284-vj6zv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134716/original/image-20160819-12284-vj6zv8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134716/original/image-20160819-12284-vj6zv8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134716/original/image-20160819-12284-vj6zv8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134716/original/image-20160819-12284-vj6zv8.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">Women reported on their paracetamol use in the previous three months.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-282560084/stock-photo-forefront-of-a-white-medicine-pills-in-blister-pack.html?src=I9DEzVBuMUmkdeNbMYcOXQ-2-95">pedrosala/Shutterstock</a></span>
</figcaption>
</figure>
<p>When the children were 61 months (five years) old, the mothers and their partners were asked the same questions about paracetamol use in the previous three months. </p>
<p>When the children were aged seven, the mothers completed the <a href="http://www.sdqinfo.org/a0.html">Strengths and Difficulties Questionnaire</a> (SDQ) about their children’s behaviour to determine whether they exhibited problems in five domains: </p>
<ul>
<li>emotional symptoms (for example, “nervous or clingy in new situations”)</li>
<li>conduct problems (“often has temper tantrums or hot tempers”)</li>
<li>hyperactivity symptoms (“constantly fidgeting or squirming”) </li>
<li>peer relationship problems (“rather solitary, tends to play alone”) </li>
<li>prosocial behaviours (“shares well with other children”).</li>
</ul>
<p>Each item is scored as Not True (0/2 points, depending on whether the behaviour is negative or positive), Somewhat True (1 point) or Certainly True (2/0 points). </p>
<p>The scores from four of the domains (20 questions excluding the prosocial scale) are then combined to give a single SDQ total of 0-40. Children with scores of 17 and above are deemed to have a behavioural problem. </p>
<h2>What were the results?</h2>
<p>At 18 weeks, 4,415 (53%) mothers and at 32 weeks 3,381 (42%) mothers reported having taken paracetamol. The paper doesn’t say if any mother had taken paracetamol during both periods, or if they had taken any other medications. </p>
<p>The authors reported that 5% of the seven-year-olds whose mothers had ingested paracetamol at 18 or 32 weeks exhibited behavioural problems. </p>
<h2>What’s the problem?</h2>
<p>It’s possible to find <a href="https://www.amazon.com/Spurious-Correlations-Tyler-Vigen/dp/0316339431">associations between all sorts of things</a>. Spending in the US on science, space and technology, for instance, is estimated to have a 99.79% correlation with suicides by hanging, strangulation and suffocation. But this correlation is meaningless. US spending on science doesn’t cause these forms of suicide.</p>
<p>Maternal paracetamol use in pregnancy causing behavioural problems in children is a plausible association. But based on this research, it’s not possible to say one causes the other. Proving causation requires an entirely different set of scientific experiments. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/134718/original/image-20160819-12284-1s5as0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134718/original/image-20160819-12284-1s5as0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134718/original/image-20160819-12284-1s5as0j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134718/original/image-20160819-12284-1s5as0j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134718/original/image-20160819-12284-1s5as0j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134718/original/image-20160819-12284-1s5as0j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134718/original/image-20160819-12284-1s5as0j.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">The study suggests a link but doesn’t show one thing causes another.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-311664224.html">Nadezhda1906/Shutterstock</a></span>
</figcaption>
</figure>
<p>The authors mention that 5% of children whose mother took paracetamol had behavioural problems. They don’t mention that nearly as many children of mothers who had never taken paracetamol also showed behavioural problems at the same age of seven. (The actual figures are not in the paper but are in the <a href="http://archpedi.jamanetwork.com/data/Journals/PEDS/0/POI160049supp1_prod.pdf">supplementary etables</a>.)</p>
<p>For paracetamol use at 18 weeks’ gestation, the total incidence of behavioural difficulties (abnormal SDQ scores) at age seven was 5.6% compared with 4.8% for children whose mothers had not taken paracetamol (eTable 1). </p>
<p>At 32 weeks, the figures were 6.3% for the paracetamol group and 4.3% for the non-paracetamol group (eTable 1). </p>
<p>For the mothers’ use of paracetamol when their child was aged five, the percentages of behavioural problems weren’t much different: 5.3% for the mothers who took paracetamol and 4.1% for the children of mothers who did not take paracetamol (eTable 1). </p>
<p>It’s hard to imagine how a mother’s or partner’s paracetamol use when the children were five – and presumably not breastfeeding – could have any effect on their behaviour two years later. </p>
<p>The similarity of the percentages at the three reporting points suggests the mothers’ paracetamol use in pregnancy was unlikely to be involved in the behavioural problems of the children.</p>
<p>Even if it was accepted that paracetamol might be having an effect, only a very small number of children would be affected. At 18 weeks, for example, the difference between children whose mothers had taken paracetamol and those who had not was 0.8%, or one child in 125. </p>
<p>The study also has some technical problems, such as discrepancies between figures in the text and tables. </p>
<h2>What does it all mean?</h2>
<p>All medication is a balance between risks of side-effects and potential benefits. </p>
<p>In this case, providing paracetamol is used for a good clinical reason, at the dose specified and for the shortest possible time, the risk is low. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/134722/original/image-20160819-12274-az5rz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134722/original/image-20160819-12274-az5rz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134722/original/image-20160819-12274-az5rz0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134722/original/image-20160819-12274-az5rz0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134722/original/image-20160819-12274-az5rz0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134722/original/image-20160819-12274-az5rz0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134722/original/image-20160819-12274-az5rz0.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">Paracetamol should be used for the shortest time and at the specified dose.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-166682585/stock-photo-pregnant-woman-taking-pills.html?src=-9JtEq04xpa4WSQA0n6-Vg-1-44">nata-lunata/Shutterstock</a></span>
</figcaption>
</figure>
<p>The lack of evidence of a causal relationship and the marginal differences in incidence between paracetamol and non-paracetamol groups suggest that this report should be consigned to the large black hole of inadequate research. <strong>– Norman Saunders and Mark Habgood</strong></p>
<hr>
<h2>Peer review</h2>
<p>This Research Check accurately summarises the key finding of the JAMA Pediatrics paper, and correctly identifies the technical issues that will be of most concern to pregnant women. </p>
<p>It also fairly translates the paper into terms that are more understandable to the lay reader. </p>
<p>If anything, the Research Check fails to convey the frustration that even experienced researchers would have trying to derive actual numbers of affected children in the control and paracetamol arms. </p>
<p>The Research Check correctly states that the actual proportion of children with behavioural issues were very similar between mothers who had never consumed paracetamol and those who did, and that the increased risk was small. </p>
<p>One aspect that was not emphasised is the statistics. There is a lot of variation in the data, and some of the behaviours reported as being increased are of marginal significance, especially the 18-week results.</p>
<p>The Research Check notes there is no information on the amount of paracetamol ingested and how often. This makes interpreting the risk due to paracetamol even more problematic. </p>
<p>The Research Check correctly states that even if there is an effect of paracetamol, it is very small. The relevance of these findings to modern paracetamol usage is also limited. </p>
<p>The JAMA Pediatrics study took place in the 1990s in the United Kingdom. In 1998, the UK changed its regulations on pack sizes to reduce accidental and deliberate overdose. This move was successful and women in the UK are now less likely to be exposed to as much paracetamol as they were in the 1990s. </p>
<p>The current Australian recommendations on amount of paracetamol to take and the length of time to take it, as well as the modern pack sizes, mean pregnant women in Australia are potentially exposed to less paracetamol than in the JAMA Pediatrics study. <strong>– Ian Musgrave</strong></p><img src="https://counter.theconversation.com/content/63994/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adulterants and contaminants of herbal medicines, and has received past funding from the Australian Research Council to study nutracueticals and amyloid toxicity.</span></em></p><p class="fine-print"><em><span>Mark Habgood and Norman Saunders do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some of the headlines are alarming but pregnant women and their doctors should not change their current use of paracetamol on the basis of this paper.Norman Saunders, Professorial Fellow in Neuroscience, The University of MelbourneMark Habgood, Senior Research Fellow, Developmental Neuroscience and Neurotrauma, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.