tag:theconversation.com,2011:/us/topics/attention-deficit-hyperactivity-disorder-adhd-17218/articlesAttention-deficit/hyperactivity disorder (ADHD) – The Conversation2023-08-04T12:30:20Ztag:theconversation.com,2011:article/2060522023-08-04T12:30:20Z2023-08-04T12:30:20ZMore adults than ever have been seeking ADHD medications – an ADHD expert explains what could be driving the trend<figure><img src="https://images.theconversation.com/files/534656/original/file-20230628-23-d348x8.jpg?ixlib=rb-1.1.0&rect=101%2C0%2C5516%2C4211&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">During the height of the COVID-19 pandemic, social media was awash with promotions for ADHD as an explanation for people's overwhelmed state of mind.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/woman-suffers-from-obsessive-thoughts-royalty-free-illustration/1412359050?phrase=ADHD+adults&adppopup=true">useng/iStock via Getty Images Plus</a></span></figcaption></figure><p>As a woman in my 30s who was constantly typing “ADHD” into my computer, I had something interesting happen to me in 2021. I started receiving a wave of advertisements beckoning me to get online help for ADHD, or <a href="https://www.cdc.gov/ncbddd/adhd/facts.html#">attention-deficit/hyperactivity disorder</a>. One was a free, one-minute assessment to find out if I had the disorder, another an offer for a digital game that could help “rewire” my brain. Yet another ad asked me if I was “delivering” but still not moving up at work. </p>
<p>The reason the term ADHD litters my digital life is because I am a clinical psychologist who exclusively treats patients with ADHD. I’m also a <a href="https://psychiatry.uw.edu/profile/maggie-sibley/">psychiatric researcher</a> at the University of Washington School of Medicine who studies ADHD trends across the life span. </p>
<p>But these advertisements were a striking new trend.</p>
<p>The following year, in October 2022, the U.S. Food and Drug Administration announced a <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall">nationwide shortage of mixed amphetamine salts</a>, a drug that is marketed as Adderall. The brand name Adderall and its generic counterparts have become one of the most <a href="https://theconversation.com/misuse-of-adderall-promotes-stigma-and-mistrust-for-patients-who-need-it-a-neuroscientist-explains-the-science-behind-the-controversial-adhd-drug-198223">common medication treatments for ADHD</a>. Over the next several months, additional ADHD medications joined Adderall on the list of prescription drugs in short supply. </p>
<p>As of August 2023, the U.S. is still experiencing a <a href="https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?">shortage of several ADHD medications</a>, with some not expected to be resolved for at least a few more months.</p>
<p>The shortage appears to have been triggered by a combination of <a href="https://www.npr.org/sections/health-shots/2023/02/18/1157832613/adderall-shortage-forces-some-patients-to-scramble-ration-or-go-without">high demand and access to key ingredients</a>. In recent months, millions of Americans have found themselves with no <a href="https://www.nytimes.com/2022/10/13/health/adderall-shortage-adhd.html">guarantee of access to their daily medications</a>. </p>
<p>In March 2023, the U.S. Centers for Disease Control and Prevention reported <a href="https://www.cdc.gov/mmwr/volumes/72/wr/mm7213a1.htm">an unprecedented spike in stimulant prescriptions</a> <a href="https://www.washingtonpost.com/business/2023/03/30/adhd-stimulants-adults/">between 2020 and 2021</a>. Perhaps most surprising was that the demographic showing the greatest increases in stimulant use – an increase of almost 20% in one year – were in women in their 20s and 30s.</p>
<p>The CDC’s findings, along with the stimulant shortage, <a href="https://doi.org/10.1177/10870547231164155">raise some interesting</a> – and still unanswered – questions about what factors are driving these trends.</p>
<p><iframe id="98fSQ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/98fSQ/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>The challenge of diagnosing adult ADHD</h2>
<p>Despite the growth in awareness of ADHD over the past couple of decades, many people with ADHD, <a href="https://doi.org/10.1111/jcpp.13480">particularly women</a> and <a href="https://doi.org/10.1542/peds.2012-2390">people of color</a>, go undiagnosed in childhood. </p>
<p>But unlike depression or anxiety, ADHD is quite complicated to diagnose in adults. </p>
<p>Diagnosing ADHD in either kids or adults first involves establishing that ADHD-like traits, which <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618695/">exist on a continuum</a> and <a href="https://doi.org/10.1176/appi.ajp.2021.21010032">can fluctuate</a>, are severe and chronic enough to prevent a person from living a normal, healthy life.</p>
<p><a href="https://doi.org/10.1111/ijcp.13260">The average person has a couple of symptoms of ADHD</a>, so it can be hard to draw the line between ADHD-like tendencies – such as a tendency to lose keys, having a messy desk or often finding your mind wandering during a dull task – and a diagnosable medical disorder. There is no objective test to diagnose ADHD, so doctors typically conduct a structured patient interview, ask family members to fill out rating scales and review official records to come up with an actual diagnosis.</p>
<p>Diagnostic challenges can also arise for psychiatrists and other health care practitioners because ADHD shares features with many other conditions. In fact, difficulty concentrating is the <a href="https://doi.org/10.31234/osf.io/u56p2">second most common symptom</a> across all psychiatric disorders. </p>
<p>Further complicating things, ADHD is also a <a href="https://doi.org/10.1186/s12888-017-1463-3">risk factor for many of the conditions that it resembles</a>. For example, years of negative feedback may lead some adults with ADHD to develop secondary depression and anxiety. Zeroing in on the correct diagnosis requires a well-trained clinician who is able to take enough time to thoroughly gather necessary patient history.</p>
<h2>Stress of the COVID-19 pandemic</h2>
<p>Looking back, some clear factors have been at play, but it remains unclear the degree to which they are driving the spike in stimulant prescriptions.</p>
<p>In 2021, the U.S. was still deep in the acute phase of the COVID-19 pandemic. People were <a href="https://www.cbpp.org/research/poverty-and-inequality/tracking-the-covid-19-economys-effects-on-food-housing-and">still losing jobs</a>, facing financial strains and juggling work-from-home challenges such as having children at home doing online schooling. Many <a href="https://theconversation.com/losing-a-grandmother-can-have-long-lasting-mental-health-effects-for-kids-and-adolescents-a-new-study-finds-186106">families were losing loved ones</a>, and there was a huge sense of uncertainty over when normal life would return.</p>
<p>The demands of the pandemic took a toll on everyone, but research shows that <a href="https://doi.org/10.1177/15394492221076516">women may have been disproportionately affected</a>. This may have led to a greater proportion of adults seeking stimulant treatments to help them keep up with the demands of daily life.</p>
<p>In addition, without access to in-person recreational spaces, the pandemic increasingly drove many people to spending more time on digital media. </p>
<p>In 2021, a social justice movement focused on “neurodiversity” was gaining momentum online. <a href="https://my.clevelandclinic.org/health/symptoms/23154-neurodivergent#:">Neurodiversity is a nonmedical term</a> that refers to the wide diversity of brain processes that diverge from what has traditionally been considered “typical.” In this moment, #ADHD became the <a href="http://dx.doi.org/10.1136/bmjgh-2021-007648">seventh most popular health topic on TikTok</a>. Relatable anecdotes of missing keys, procrastination, romantic mishaps and secret signs of ADHD began to flood the internet. </p>
<p>But while the internet exploded with ADHD content, researchers in Canada began sorting #ADHD TikTok videos into categories based on their accuracy and helpfulness. They <a href="https://doi.org/10.1177/07067437221082854">reported something important</a>: A majority of #ADHD content was misleading. Only 21% of the posts provided useful and accurate information.</p>
<p>So, amid the growing online community of newly self-diagnosed people with ADHD, many probably did not actually have the condition. For some, <a href="https://doi.org/10.1007/s11920-020-01179-8">cybochondria</a> – or health-focused anxiety after online searching – may have been creeping in. Others may have mistaken ADHD for another condition, which is <a href="https://www.nytimes.com/2022/10/29/well/mind/tiktok-mental-illness-diagnosis.html">surprisingly easy to do</a>. Still others may have had mild attentional issues that do not rise to the severity of ADHD.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two blue and white Adderall capsules lie the in the foreground with a medicine bottle sitting behind them." src="https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537552/original/file-20230714-25-rbv5ib.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">Adderall and its generic counterparts have been in short supply in recent months.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/DrugShortagesExplainer/7383f39153cb40c884c42971b3176711/photo?Query=drug%20shortage&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=180&currentItemNo=1">AP Photo/Jenny Kane</a></span>
</figcaption>
</figure>
<h2>What ADHD care looked like in 2021</h2>
<p>In 2021, the U.S. mental health system was overloaded. Most traditional ADHD providers such as psychiatrists, psychologists, mental health therapists and psychiatric nurse practitioners, had monthslong wait lists for new patients. People who were newly seeking help for ADHD found faster appointments with their primary care providers, who may or may not <a href="https://doi.org/10.1007/s00787-018-1256-3">be comfortable diagnosing and treating adult ADHD</a>. Since demand for ADHD care exceeded capacity, new options were needed to meet patient needs.</p>
<p>Around that time, <a href="https://time.com/6225361/telehealth-startups-cerebral-done-ahead/">online ADHD care startups</a> began to pop up, reaching prospective consumers with <a href="https://www.wsj.com/articles/telehealth-cerebral-done-ads-mental-health-adhd-11672161087">appealing digital ads</a> like the ones I received. </p>
<p>Compared with traditional care, the startup models were <a href="https://www.wsj.com/articles/cerebral-adderall-adhd-prescribe-11654705250">reportedly using cost-cutting methods</a>, such as favoring quick assessments and a low-cost workforce. The startups were also reported to be relying on a uniform care model that did not adequately personalize treatments, often prescribing stimulants over treatments that may have been better indicated.</p>
<p>Some of these companies are now <a href="https://www.wsj.com/articles/cerebral-receives-subpoena-from-federal-prosecutors-11651950307">under investigation</a> by <a href="https://www.businessinsider.com/dea-cerebral-questions-license-issues-2022-5">the federal government</a>.</p>
<p>Although they were controversial in the medical community, these models may also have reduced barriers to ADHD care for many people.</p>
<h2>The verdict is still out</h2>
<p>Until the CDC releases its 2022 and 2023 stimulant prescription data, researchers like me will not know whether the 2021 trends of increased prescribing to adults and high demand for ADHD medications will continue.</p>
<p>If the trends stabilize, it may mean that patients who have been unable to access care may finally be getting the help they need. </p>
<p>If ADHD prescribing returns to pre-pandemic levels, we may learn that a perfect storm of COVID-19-related factors caused a momentary blip in people seeking ADHD treatment. </p>
<p>What is clear is that the <a href="https://usafacts.org/articles/over-one-third-of-americans-live-in-areas-lacking-mental-health-professionals/#">current shortage of mental health care workers</a> who feel comfortable diagnosing and treating ADHD in adults will continue to affect the ability of new patients to get proper diagnostic evaluation for ADHD.</p><img src="https://counter.theconversation.com/content/206052/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In the past 12 months, Margaret Sibley has consulted with Supernus Pharmaceuticals, Tris Pharma, and Tieffenbacher Pharmaceuticals. She receives funding from the National Institute of Mental Health and the Institute of Education Sciences. She is a professional advisory board member for Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) and the secretary of the American Professional Society for ADHD and Related Disorders (APSARD). </span></em></p>The COVID-19 pandemic may have played a considerable role in the uptick of adults being treated for ADHD. But more data is needed to determine whether the trends will continue.Margaret Sibley, Professor of Psychiatry and Behavioral Sciences, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1934462023-01-08T19:00:28Z2023-01-08T19:00:28ZWhat are ‘masking’ and ‘camouflaging’ in the context of autism and ADHD?<figure><img src="https://images.theconversation.com/files/494311/original/file-20221109-8962-jjhq3g.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4288%2C2837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Many <a href="http://link.springer.com/10.1007/s10803-018-03878-x">autistic</a> people and <a href="https://psychcentral.com/adhd/adhd-masking">ADHD-ers</a> report using “masking” and “camouflaging” in their lives. This is where people <a href="https://www.emeraldinsight.com/doi/10.1108/AIA-09-2018-0036">conceal certain traits</a> and replace them with neurotypical ones to avoid being recognised as neurominorities. </p>
<p>This can <a href="https://www.karger.com/Article/Abstract/524122">involve</a> changing things such as </p>
<ul>
<li><p>tone of voice</p></li>
<li><p>facial expressions</p></li>
<li><p>eye contact</p></li>
<li><p>speech patterns, and</p></li>
<li><p>body language.</p></li>
</ul>
<p><a href="http://link.springer.com/10.1007/s10803-018-03878-x">Autistic</a> people make these changes in an effort to match dominant social norms.</p>
<p>Some <a href="https://www.youtube.com/watch?v=Jk-FtgGV8I8&vl=en%22%22">ADHD</a>-ers also embrace the concept, though <a href="https://psychcentral.com/adhd/adhd-masking">ADHD masking</a> remains under-explored in research. </p>
<p>Masking and camouflaging can cause immense <a href="https://link.springer.com/article/10.1007/s10803-018-03878-x">stress</a> for neurominorities. And they’re different to the adjustments neurotypical people make in response to social cues. While neurotypical people may moderate behaviour to enhance social success, <a href="https://link.springer.com/article/10.1007/s10803-021-04912-1">masking and camouflaging differ</a> as they are used to avoid negative consequences.</p>
<p>Here’s what you need to know.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person's face is covered by a leaf." src="https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494327/original/file-20221109-12-zqnn54.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">Masking and camouflaging are linked to physical, emotional, and intellectual exhaustion.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>How does masking or camouflaging affect neurominorities?</h2>
<p>Masking and camouflaging are linked to:</p>
<ul>
<li><p><a href="https://link.springer.com/article/10.1007/s10803-017-3166-5">physical, emotional, and intellectual exhaustion</a></p></li>
<li><p><a href="https://pubmed.ncbi.nlm.nih.gov/29039208/">anxiety, depression, and poor self-image</a></p></li>
<li><p>negative <a href="https://pubmed.ncbi.nlm.nih.gov/32148068/">self-perception and identity loss</a></p></li>
<li><p><a href="https://doi.org/10.1089/aut.2021.0021%22%22">burnout</a> </p></li>
<li><p><a href="https://link.springer.com/article/10.1007/s10803-019-04323-3">suicidality</a>.</p></li>
</ul>
<p>Yet, without masking and camouflaging many autistic people report experiencing difficulty <a href="https://link.springer.com/article/10.1007/s10803-017-3166-5">getting jobs and qualifications</a> or issues with <a href="https://pubmed.ncbi.nlm.nih.gov/29071566/">social exclusion</a>. They may even risk <a href="https://link.springer.com/article/10.1007/s10803-017-3166-5">verbal and physical assaults</a>. </p>
<p>The consequences of unmasking can be enormous. Disclosing autism can risk <a href="https://theconversation.com/australia-has-kept-disabled-migrant-children-out-for-decades-its-time-we-gave-them-protection-instead-73677">permanent</a> residency <a href="https://www.equaljusticeproject.co.nz/articles/burdens-and-borders-disability-discrimination-in-new-zealand-immigration-law2020">applications</a> being denied, and may lead to unwanted “<a href="https://abcnews.go.com/Nightline/shock-therapy-massachussetts-school/story?id=11047334">treatments</a>”. For autistic people of colour in particular, this can even result in violence from <a href="https://doi.org/10.1089/aut.2020.0077">police</a>. </p>
<h2>Reducing the need for masking and camouflaging</h2>
<p>In my late twenties, I found out I am autistic. Suddenly, things started to make sense. From failing ninth grade, to chronic unemployment, and social isolation, I realised my disorder was causing these poor outcomes – or so I first thought. </p>
<p>This medical model understanding assumes disability is created primarily by a <a href="https://www.cdc.gov/ncbddd/autism/facts.html">medical disorder</a> in the body or brain. That struggles autistic people or ADHD-ers face with social life, employment, or schooling are because their brain doesn’t work the way it “should”. </p>
<p><iframe id="tc-infographic-790" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/790/c3bc862b28fd8bfabcb03a877134e0029e20465e/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The <a href="https://dsq-sds.org/article/%C2%A0view/1065/1254">neurodiversity movement</a> asks us to rethink this. It challenges us to ask how society can change to better include <a href="https://www.amazon.com.au/NeuroDiversity-Birth-Idea-Judy-Singer/dp/064815470X">neurominorities</a> (rather than seeing neurominorities as a problem needing to be “fixed”). </p>
<p>The <a href="https://theautisticadvocate.com/2018/06/takethemaskoff/">#TakeTheMaskOff campaign</a> on Twitter, driven by neurodiversity activists, aims to address anti-autism discrimination and boost social acceptance and inclusion.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1030567928155045888"}"></div></p>
<p>So, how can society prevent poor wellbeing, social, educational, and employment outcomes for neurominorities? And what’s this got to do with masking?</p>
<p>My <a href="https://www.karger.com/Article/Abstract/524122">research</a> suggests a first step is to begin identifying how neurotypical privilege – the cultural and social dominance of neurotypical norms – drives masking and camouflaging. </p>
<p>My work on autism is influenced by the work of activists who have <a href="https://doi.org/10.1002/(SICI)1099-0798(199624)14:1%3c41::AID-BSL223%3e3.0.CO;2-R">paved the way for disability anti-discrimination policy</a>. My recent paper <a href="https://www.karger.com/Article/Abstract/524122">argues</a> for an <a href="https://doi.org/10.1146/annurev-soc-073014-112142">intersectional approach</a> to examining why autistic people use masking and camouflaging and what changes we can make to reduce the need for them to do so. </p>
<p>Intersectionality identifies how forces such as colonialism, racism and patriarchy help reinforce systemic inequity. </p>
<p>For example, might neurominority women in male-dominated settings be under extra pressure to mask in order to “pass” as neurotypical? Might <a href="https://www.amazon.com/All-Weight-Our-Dreams-Racialized/dp/0997504501">autistic people of colour</a> face <a href="https://link.springer.com/chapter/10.1007/978-981-13-8437-0_14">unique risks</a> when unmasking, in ways that most white people do not?</p>
<p>Perhaps one day we will see legal protections for visible neurominorities who cannot mask and camouflage, or choose not to.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman covers her eye with a cardboard piece." src="https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494329/original/file-20221109-26-wxbtt.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">We can begin identifying how neurotypical privilege – the cultural and social dominance of neurotypical norms – drives masking and camouflaging.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-holding-a-cardboard-box-with-a-drawing-7304963/">Photo by Leeloo Thefirst/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In the meantime, you can support <a href="https://www.latrobe.edu.au/mylatrobe/neurodiversity-as-the-next-frontier-part-1-celebrating-all-kinds-of-clever-in-higher-education/">neurodiversity inclusion</a> by:</p>
<ul>
<li><p>learning what <a href="https://au-ti.com/2022/08/22/the-checklist-of-neurotypical-privilege/">neurotypical privilege</a> is and how it is perceived by neurominorities</p></li>
<li><p>acknowledging that unmasking and advocating for change can be <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2021.727542/full">risky</a> for neurominorities</p></li>
<li><p>learning about <a href="https://opal.latrobe.edu.au/articles/educational_resource/Neurodiversity_toolkit/13322981">neurodiversity cultural sensitivity</a></p></li>
<li><p>facilitating remote work and study options, and analysing how working from home during COVID lockdowns <a href="https://www.latrobe.edu.au/mylatrobe/what-learning-teaching-and-working-from-home-can-teach-us-about-neurodiversity/">showed what’s possible</a></p></li>
<li><p>using disability support resources designed by neurominorities. Try <a href="http://neurodiversityhub.org">Neurodiversity Hub</a>, which has resources for universities, employers, and students.</p></li>
</ul>
<p>Schools, workplaces, social circles, and research institutions should address neurotypical privilege. They should empower diverse neurominority leaders, and support them to drive systemic cultural change.</p>
<p>This is how we can remove barriers to unmasking, and improve life for neurominorities at work, school and in broader society.</p><img src="https://counter.theconversation.com/content/193446/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Radulski sits on the advisory board for Untapped.</span></em></p>Masking or camouflaging is where people conceal certain traits and replace them with neurotypical ones to avoid being recognised as visibly neurodiverse.Beth Radulski, PhD Candidate and Neurodiversity Project Manager, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1923802022-10-17T12:30:31Z2022-10-17T12:30:31ZAnxiety detection and treatment in early childhood can lower risk for long-term mental health issues – an expert panel now recommends screening starting at age 8<figure><img src="https://images.theconversation.com/files/489609/original/file-20221013-13-iqoxtv.jpg?ixlib=rb-1.1.0&rect=372%2C40%2C6337%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People who experience anxiety in childhood are more likely to deal with it in adulthood too.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/worried-mom-comforting-depressed-teen-daughter-royalty-free-image/1221847312?phrase=anxiety%20kids&adppopup=true">fizkes/iStock via Getty Images Plus</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention, issued a final recommendation on Oct. 11, 2022, <a href="https://doi.org/10.1001/jama.2022.16936">published in the journal JAMA</a>, stating that all children and adolescents between the ages of 8 and 18 should be screened for anxiety, regardless of whether they have symptoms. The recommendation follows a systematic review that evaluated the potential harms and benefits of screening.</em> </p>
<p><em>The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s recommendations and what they might mean for kids, parents and providers.</em></p>
<h2>1. Why is the task force recommending young kids be screened?</h2>
<p>Nearly 80% of chronic mental health conditions <a href="https://doi.org/10.1097/YCO.0b013e32816ebc8c">emerge in childhood</a>, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and <a href="https://doi.org/10.1097/CHI.0b013e318160e3a0">that parents</a> and <a href="https://doi.org/10.1007/s12310-014-9125-9">teachers</a> are not always skilled at correctly identifying problems or knowing how to respond.</p>
<p>Anxiety is the <a href="https://dx.doi.org/10.1176%2Fappi.focus.20150029">most common</a> mental health problem affecting children and adolescents. Epidemiological studies indicate that <a href="https://doi.org/10.1016/j.jpeds.2018.09.021">7.1% of children are diagnosed with anxiety disorders</a>. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as <a href="https://childmind.org/wp-content/uploads/2021/09/CMI_2018CMHR.pdf">30% of children</a> experience moderate anxiety that interferes with their daily functioning at some time in their life.</p>
<p>This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is a <a href="https://doi.org/10.1080/15374416.2015.1046177">well-established evidence base</a> for treating childhood anxiety. </p>
<p>The task force evaluated the best available research and concluded that, while there are gaps in the evidence base, the benefits of screening are clear. Untreated anxiety disorders in children <a href="https://doi.org/10.1007/s10802-007-9194-4">result in added burdens</a> to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible. </p>
<p>The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for <a href="https://doi.org/10.1016/j.jaac.2010.05.017">anxiety is among the earliest</a> of all childhood mental health diagnoses. The panel also pointed to a lack of accurate screening instruments available to detect anxiety among younger children; as a result, it concluded that there is not sufficient evidence to recommend screening children age 7 or younger. </p>
<p>Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders <a href="https://doi.org/10.1111/j.1469-7610.2007.01812.x">like depression</a> and an overall diminished quality of life. The task force considered these long-term impacts in making its recommendations, noting that screening in children as young as 8 may alleviate a preventable burden for families.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dT_W9LFJxx0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The US task force’s recommendations include screening for all children beginning at age 8, regardless of whether they show symptoms of anxiety.</span></figcaption>
</figure>
<h2>2. How can care providers identify anxiety in young kids?</h2>
<p>In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings – such as a pediatrician’s office – the research literature also supports <a href="https://doi.org/10.1177/10598405211056647">in-school screening for mental health problems</a>, including anxiety. </p>
<p>Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including the child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community. </p>
<p>Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.</p>
<p>Among the youths who are actually treated for mental health problems, nearly two-thirds <a href="https://www.nasponline.org/resources-and-publications/resources-and-podcasts/mental-health/school-psychology-and-mental-health/comprehensive-school-based-mental-and-behavioral-health-services-and-school-psychologists">receive those services at school</a>, making school-based screening a logical practice. </p>
<h2>3. How would the screening be carried out?</h2>
<p>Universal screening for all children, including those with no symptoms or diagnoses, is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention. </p>
<p>In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equate to a diagnosis, something that the task force highlighted in its recommendation statement. </p>
<p>Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary-care setting may involve completion of short questionnaires by the child and/or parent, similar to how <a href="https://doi.org/10.1542/peds.2011-2654">pediatricians frequently screen kids</a> for <a href="https://theconversation.com/what-causes-adhd-and-can-it-be-cured-170179">attention-deficit/hyperactivity disorder, or ADHD</a>. </p>
<p>The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, care providers were advised to consider the evidence in the task force’s recommendation and apply it to the particular child or situation. The task force did point to multiple available screening tools such as the <a href="https://www.pediatricbipolar.pitt.edu/resources/instruments">Screen for Child Anxiety Related Emotional Disorders</a> and the <a href="https://www.phqscreeners.com/select-screener">Patient Health Questionnaire Screeners</a> for generalized anxiety disorder, which accurately identify anxiety. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WAg8keGdbQk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A discussion of the differences between normal worry and anxiety.</span></figcaption>
</figure>
<h2>4. What are care providers looking for when screening for anxiety?</h2>
<p>A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category. </p>
<p>But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.</p>
<p>Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through <a href="https://doi.org/10.1016/j.cbpra.2007.08.003">identification of children with medically unexplained physical symptoms</a>.</p>
<p>The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do the symptoms interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful. </p>
<h2>5. What are the recommendations for supporting kids with anxiety?</h2>
<p>The key to an effective screening process is that it be connected to evidence-based care. </p>
<p>The good news is that we now have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medications or therapeutic approaches like cognitive behavioral therapy, which <a href="https://doi.org/10.1016/j.jaac.2020.05.005">studies show to be safe and effective</a>.</p>
<p><em>This is an updated version of an <a href="https://theconversation.com/why-a-us-task-force-is-recommending-anxiety-screening-in-kids-8-and-older-181562">article originally published on May 13, 2022</a>.</em></p><img src="https://counter.theconversation.com/content/192380/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elana Bernstein has received funding from her organization to examine school-based practices for youth with anxiety. She is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for emotional well-being in teens. This project was recently funded through the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut via their Mechanisms Underlying Mind-Body Interventions & Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (Grant #: NIH U24AT011281).</span></em></p>Anxiety is the most common mental health issue facing children and adolescents. But research shows that early screening – including in school settings – can identify children who are at risk.Elana Bernstein, Assistant Professor of School Psychology, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1847272022-06-24T11:54:10Z2022-06-24T11:54:10Z5 tips for parents of new kindergartners who are younger than their classmates<figure><img src="https://images.theconversation.com/files/469557/original/file-20220617-11-2gkr6s.jpg?ixlib=rb-1.1.0&rect=8%2C26%2C5982%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In kindergarten, it can be apparent to teachers and parents alike that some students are younger than others.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakMasksinSchools/8b95eff745a24d0293f0a88edb4120f1/photo">AP Photo/Marcio Jose Sanchez</a></span></figcaption></figure><p>A good kindergarten experience sets kids up for success in school and into adulthood. Students in <a href="https://doi.org/10.1093/qje/qjr041">smaller kindergarten classes</a> are more likely to go to college than students from larger classes. And by age 27, students who had more experienced kindergarten teachers were <a href="https://doi.org/10.1093/qje/qjr041">earning more money than their peers</a> who had less-experienced teachers in kindergarten.</p>
<p>One factor many parents consider is their child’s age when starting kindergarten, based on how close their age is to the cutoff date for enrollment. The ages at which kids are eligible to start kindergarten differ <a href="https://nces.ed.gov/programs/statereform/tab5_3.asp">across the United States</a> and <a href="https://data.worldbank.org/indicator/se.prm.ages?view=map">in other countries</a>. Most commonly in the U.S., a child who <a href="https://nces.ed.gov/programs/statereform/tab5_3.asp">turns 5 on or before Sept. 1</a> of a given year can start kindergarten that year. But most states don’t actually require a child to start school until later, <a href="https://nces.ed.gov/programs/statereform/tab5_3.asp">even age 7 or 8</a>.</p>
<p>Evidence shows that children who are relatively young for their kindergarten class – those who are only a few weeks or months older than the cutoff rules require – are at increased risk for <a href="https://doi.org/10.3390/ijerph18178966">doing worse in school</a>, <a href="https://doi.org/10.1002/pam.22135">being held back a grade</a>, and having <a href="https://doi.org/10.1080/2372966X.2020.1717368">lower social-emotional skills</a>. </p>
<p>Students who start kindergarten younger are also more likely to be rated by teachers as <a href="https://doi.org/10.1016/j.jhealeco.2010.06.003">exhibiting symptoms of attention-deficit/hyperactivity disorder</a> in kindergarten and <a href="https://doi.org/10.1007/s00787-018-1229-6">to be treated with medication for ADHD</a>. </p>
<p>When younger kids fare worse than older kids in the same, single-grade classroom, and older kids are viewed as more advanced, it’s often because adults tend to compare children to one another. The relatively older children may appear to behave better than the relatively younger children, especially as <a href="https://doi.org/10.1177/2332858415616358">kindergarten classrooms focus more on academics</a> and offer less time to play. Together these differences are called the “<a href="https://doi.org/10.1006/drev.2000.0516">relative age effect</a>.”</p>
<p>As a result, some families choose to <a href="https://www.washingtonpost.com/lifestyle/on-parenting/redshirting-your-kindergartner-is-it-the-right-choice-in-the-long-run/2019/10/07/f335fff0-d976-11e9-ac63-3016711543fe_story.html">delay their child’s entry into kindergarten</a>, <a href="https://doi.org/10.3102%2F0162373713482764">particularly those who can afford to do so</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=BRXERkMAAAAJ&hl=en&oi=ao">clinical psychologist</a> who studies how to best support children in school settings, particularly those at risk for behavioral challenges like ADHD. Here are five ways families can help support their kindergartners, especially those who are relatively younger than their classmates.</p>
<h2>1. Learning opportunities</h2>
<p>Relatively older students have had more time to <a href="https://doi.org/10.3368/jhr.44.3.641">learn academic skills</a>. To help younger kindergartners catch up with their older classroom peers, families can offer additional learning experiences. This includes <a href="https://doi.org/10.1177%2F0956797615581493">engaging the children in more conversations</a> and <a href="https://doi.org/10.1007/s10566-021-09598-1">shared book reading</a>. This can be started during the preschool years and throughout kindergarten. </p>
<h2>2. Be positive</h2>
<p>Parents and educators can direct focus as much as possible on <a href="https://doi.org/10.1016/j.jsp.2018.12.007">encouraging and praising the positive performance</a> of relatively younger children in the classroom. If the feedback is mostly negative – in which the relatively younger child is always told to “hurry up,” “pay attention,” “do it the right way,” and all other variations of directives that include words like “no,” “don’t” or “stop” – they may <a href="https://doi.org/10.1093/oxfordhb/9780199324552.013.2">eventually shut down and stop trying</a> to follow instructions. To combat this, educators and parents can focus on emphasizing all the things the child is doing right, rather than wrong. A good goal is to be mindful of directing at least <a href="https://doi.org/10.1016/j.jsp.2013.10.001">three positive statements to the child for every correction or redirection</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A child in a yellow shirt places a small turtle in the mud next to some water" src="https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469559/original/file-20220617-23-86f16f.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">A New Jersey kindergartner releases a turtle into the wild after it was raised from an egg when its mother was struck and killed by a car.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/RescuedBabyTurtles/6d184514f9314378af6e4dc582371948/photo">AP Photo/Wayne Parry</a></span>
</figcaption>
</figure>
<h2>3. Set tailored goals</h2>
<p>Parents of relatively younger children can meet with their child’s teacher early in the school year to discuss individual goals for the child. That meeting can discuss the child’s current strengths and skills, as well as areas in need of growth. The adults can establish reasonable, achievable goals for the child each week or month. That can help offset possible relative comparisons that <a href="https://doi.org/10.1007/s00787-018-1229-6">may mask individual progress</a>. </p>
<h2>4. Track progress</h2>
<p>To follow up with the goals set at the beginning of the year, a <a href="https://doi.org/10.1177%2F1098300712440451">daily or weekly check-in</a> on behavioral or academic progress can help parents and teachers work best together. Waiting until the end of the school year is too long and leaves no time to change course if goals need to be modified. Frequent check-ins also provide opportunities to reward and praise the child for success.</p>
<h2>5. Keep perspective</h2>
<p>Educators and parents may find it useful to remember that kindergarten is only one year of what is almost two decades of education for children on a college track – and <a href="https://doi.org/10.1002/pam.22135">age differences matter less and less in academic performance</a> as children get older.</p><img src="https://counter.theconversation.com/content/184727/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gregory Fabiano works on research studies that have received funding from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Institute for Education Sciences. He receives royalties from Guilford Publications and consultant payments from FastBridge Learning. </span></em></p>Kindergartners who are relatively younger than their classroom peers are at risk for doing less well in school. A clinical psychologist explains how to reduce those problems.Gregory Fabiano, Professor of Psychology, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1815622022-05-13T12:14:57Z2022-05-13T12:14:57ZWhy a US task force is recommending anxiety screening in kids 8 and older<figure><img src="https://images.theconversation.com/files/461359/original/file-20220504-15-ddxih1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5615%2C3741&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anxiety is the most common mental health problem affecting U.S. children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/upset-problem-child-sitting-on-staircase-royalty-free-image/469612008?adppopup=true">Brian A. Jackson/iStock via Getty Images</a></span></figcaption></figure><p><em>The U.S. Preventive Services Task Force issued <a href="https://www.uspreventiveservicestaskforce.org/uspstf/public-comments-and-nominations/opportunity-for-public-comment">a draft statement</a> in April 2022 recommending screening for anxiety in children and adolescents between the ages of 8 and 18. This recommendation – which is still open for public comment – is timely, given the impact of the <a href="https://www.cdc.gov/media/releases/2022/p0331-youth-mental-health-covid-19.html">COVID-19 pandemic on children’s mental health</a>. The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s new draft recommendations and what they might mean for kids, parents and providers.</em></p>
<h2>1. Why is the task force recommending young kids be screened?</h2>
<p>Nearly 80% of chronic mental health conditions <a href="https://doi.org/10.1097/YCO.0b013e32816ebc8c">emerge in childhood</a>, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and <a href="https://doi.org/10.1097/CHI.0b013e318160e3a0">that parents</a> and <a href="https://doi.org/10.1007/s12310-014-9125-9">teachers</a> are not always skilled at correctly identifying problems or knowing how to respond.</p>
<p>Anxiety is the <a href="https://dx.doi.org/10.1176%2Fappi.focus.20150029">most common</a> mental health problem affecting children and adolescents. Epidemiological studies indicate that <a href="https://doi.org/10.1016/j.jpeds.2018.09.021">7.1% of children are diagnosed with anxiety disorders</a>. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as <a href="https://childmind.org/wp-content/uploads/2021/09/CMI_2018CMHR.pdf">30% of children</a> experience moderate anxiety that interferes with their daily functioning at some time in their life.</p>
<p>This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is an <a href="https://doi.org/10.1080/15374416.2015.1046177">established evidence base</a> for treating childhood anxiety. </p>
<p>The opportunity to prevent potentially chronic lifelong mental health conditions through a combination of early identification and evidence-based treatment certainly informed the task force’s recommendation. Untreated anxiety disorders in children <a href="https://doi.org/10.1007/s10802-007-9194-4">result in added burdens</a> to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible. </p>
<p>The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for <a href="https://doi.org/10.1016/j.jaac.2010.05.017">anxiety is among the earliest</a> of all childhood mental health diagnoses. </p>
<p>Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders <a href="https://doi.org/10.1111/j.1469-7610.2007.01812.x">like depression</a> and an overall diminished quality of life. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WAg8keGdbQk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A discussion of the differences between normal worry and anxiety.</span></figcaption>
</figure>
<h2>2. How can care providers identify anxiety in young kids?</h2>
<p>Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community. </p>
<p>Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.</p>
<p>In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings, the research literature also supports <a href="https://doi.org/10.1177/10598405211056647">in-school screening for mental health problems</a>, including anxiety.</p>
<p>Among the youths who are actually treated for mental health problems, nearly two-thirds <a href="https://www.nasponline.org/resources-and-publications/resources-and-podcasts/mental-health/school-psychology-and-mental-health/comprehensive-school-based-mental-and-behavioral-health-services-and-school-psychologists">receive those services at school</a>, making school-based screening a logical practice. </p>
<h2>3. How would the screening be carried out?</h2>
<p>Universal screening for all children is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention. </p>
<p>In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equal a diagnosis. Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary care setting may involve completion of short questionnaires by the child and/or parent, similar to how <a href="https://doi.org/10.1542/peds.2011-2654">pediatricians frequently screen kids</a> for <a href="https://theconversation.com/what-causes-adhd-and-can-it-be-cured-170179">attention-deficit/hyperactivity disorder, or ADHD</a>. </p>
<p>The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, it pointed to multiple tools such as <a href="https://www.pediatricbipolar.pitt.edu/resources/instruments">The Screen for Child Anxiety Related Emotional Disorders</a> and the <a href="https://www.massgeneral.org/psychiatry/treatments-and-services/pediatric-symptom-checklist/">Pediatric Symptom Checklist</a>. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/F1NePiyFLV8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A youth anxiety psychologist who experienced severe anxiety as a child talks about how to raise kids who can overcome anxiety.</span></figcaption>
</figure>
<h2>4. What are care providers looking for when screening for anxiety?</h2>
<p>A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category. </p>
<p>But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.</p>
<p>Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through <a href="https://doi.org/10.1016/j.cbpra.2007.08.003">identification of children with medically unexplained physical symptoms</a>.</p>
<p>The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do they interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful. </p>
<h2>5. What are the recommendations for supporting kids with anxiety?</h2>
<p>The key to an effective screening process is that it be connected to evidence-based care. One strategy that is clearly <a href="http://doi.org/10.1007/s12310-013-9109-1">supported by research</a> is for schools to establish a continuum of care that involves universal screening, schoolwide prevention programming and evidence-based treatment options. </p>
<p>The good news is that we have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medical and nonmedical interventions like cognitive behavioral therapy, which <a href="https://doi.org/10.1016/j.jaac.2020.05.005">studies show to be safe and effective</a>.</p><img src="https://counter.theconversation.com/content/181562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elana Bernstein has received funding from her organization to examine school-based practices for youth with anxiety. She is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for emotional well-being in teens. This project was recently funded through the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut via their Mechanisms Underlying Mind-Body Interventions & Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (Grant #: NIH U24AT011281).</span></em></p>Up to 20% of US children have an anxiety disorder, and many suffer in silence.Elana Bernstein, Assistant Professor of School Psychology, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1779852022-04-07T12:26:45Z2022-04-07T12:26:45ZMental health problems come with an added ‘cost’ of poorer cognitive function – a neuropsychologist explains<figure><img src="https://images.theconversation.com/files/455334/original/file-20220330-5678-1x2xdee.jpg?ixlib=rb-1.1.0&rect=120%2C86%2C5630%2C3707&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The cognitive difficulties that accompany mental health disorders can potentially lead to misdiagnoses and improper treatment.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/backlit-teenager-sitting-in-a-dark-indoor-doorway-royalty-free-image/1281225732?adppopup=true">Elva Etienne/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>All types of mental disorders come with a hidden cost in the form of cognitive dysfunction, including deficits in memory, attention, executive functions and processing speed, according to a <a href="https://doi.org/10.1016/j.cpr.2021.102007">comprehensive study</a> that my colleagues and I published in June 2021 in the journal Clinical Psychology Review. </p>
<p>We found that both diagnosable mental disorders, as well as some common symptoms such as anxiety and worry, carry a so-called “cognitive price.” We termed this phenomenon “The C Factor” – short for cognitive dysfunction. This can be defined either as lower performance on cognitive tests or reduction in cognitive abilities such as attention and memory. Our analysis suggests that it can be <a href="https://doi.org/10.1007/s00127-014-1001-2">found across disorders</a> and that it constitutes an integral part of poorer mental health.</p>
<p>Our team analyzed data from all existing meta-analyses and systematic reviews of cognitive function across all disorders recognized by the <a href="https://www.psychiatry.org/psychiatrists/practice/dsm">Diagnostic and Statistical Manual of Mental Disorders</a>. We included 97 meta-analyses covering 29 disorders. Overall, our study incorporated data from more than 200,000 individuals.</p>
<h2>Why it matters</h2>
<p>In recent decades, mental disorders have become <a href="https://blogs.scientificamerican.com/observations/mental-illness-is-far-more-common-than-we-knew/">increasingly prevalent in the U.S.</a> and around the world, particularly in young adults and adolescents. Even before the pandemic, <a href="https://www.nami.org/mhstats#">1 in 5 Americans suffered from a mental disorder</a>. </p>
<p>In fact, the most comprehensive study to date examining the worldwide prevalence of mental disorders projected that 55% of Americans will <a href="https://pubmed.ncbi.nlm.nih.gov/18188442/">meet criteria for at least one mental disorder</a> over the course of their lifetime. Notably, that study – which was conducted 15 years ago – examined diagnosable disorders. But, in fact, the prevalence of lifetime experience of clinically meaningful symptoms in the general population is much higher. For example, one study found that although only about 20% of Americans will meet formal criteria for major depressive disorder in their lifetime, <a href="https://doi.org/10.1146/annurev-publhealth-031912-114409">62% of Americans will experience meaningful symptoms of depression</a>.</p>
<p>Since our findings demonstrate that poorer mental health is associated with at least some degree of cognitive dysfunction, this type of deficiency may be far more common than previously thought. </p>
<p>These findings are important because some mental disorders may be misdiagnosed based on cognitive dysfunction. For instance, a college student who struggles with <a href="https://doi.org/10.1016/j.jocrd.2012.09.001">obsessive-compulsive disorder</a> should be expected to have some difficulties in areas such as concentration, organization, time management and memory. However, in such a case, these cognitive challenges do not stem from conditions such as dyslexia or attention deficit hyperactivity disorder, but rather from OCD. This potential confusion may lead to a misdiagnosis. </p>
<p>Indeed, ADHD, a disorder characterized by deficits in executive functions, <a href="https://www.pghr.org/post/the-global-misdiagnosis-of-adhd-and-the-devastating-long-term-effects">is one of the most misdiagnosed disorders</a> across all age groups. According to one 2010 study, about 20% of youths diagnosed with ADHD and receiving medications <a href="https://doi.org/10.1016/j.jhealeco.2010.06.003">are misdiagnosed</a>. In addition, there is evidence that doctors all too readily prescribe <a href="https://doi.org/10.1542/peds.2014-1500">stimulant medications for symptoms of inattention</a>, even without a complete or formal diagnosis of ADHD. </p>
<p>Therefore, lack of knowledge about cognitive dysfunctions associated with OCD in the example above could lead to inappropriate treatment. Indeed, stimulant medication <a href="https://doi.org/10.4088/jcp.15r10601">may increase irritability and anxiety</a> and exacerbate cognitive dysfunction in such individuals. So it is crucial that mental health professionals gain a better understanding of how mental health and cognitive dysfunction go hand in hand, particularly in the context of misinterpretation of cognitive symptoms.</p>
<h2>What still isn’t known</h2>
<p>Two major questions arise from the results of our study. First, why does any significant mental health issue come with a cost in the form of cognitive dysfunction? That seems surprising given that various mental health disorders differ significantly in terms of symptoms and type of interventions. Our team is working to unravel the factors that can have a negative impact on cognitive functioning, including reduced motivation, low effort and lower self-efficacy.</p>
<p>Second, what is the actual mechanism underlying this phenomenon? For example, if we find that general suffering is common to all mental disorders, what is the specific mechanism by which suffering hinders performance on cognitive tests? More research is needed to examine these questions.</p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-youresmart">You can read us daily by subscribing to our newsletter</a>.]</p><img src="https://counter.theconversation.com/content/177985/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amitai Abramovitch does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While only about 20% of people would qualify for a formal diagnosis of a mental disorder, more than 60% express symptoms of those disorders – and those symptoms can lead to cognitive difficulties.Amitai Abramovitch, Associate Professor of Psychology, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1735052022-01-04T13:07:30Z2022-01-04T13:07:30ZWhy does experiencing ‘flow’ feel so good? A communication scientist explains<figure><img src="https://images.theconversation.com/files/438296/original/file-20211218-25-1ktuz4s.jpg?ixlib=rb-1.1.0&rect=87%2C227%2C2868%2C1623&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows that people who have flow as a regular part of their lives are happier and less likely to focus on themselves.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/winter-holidays-in-ski-resort-royalty-free-image/1280113636?adppopup=true">Yulkapopkova/E+ via Getty Images</a></span></figcaption></figure><p>New years often come with new resolutions. Get back in shape. Read more. Make more time for friends and family. My list of resolutions might not look quite the same as yours, but each of our resolutions represents a plan for something new, or at least a little bit different. As you craft your 2022 resolutions, I hope that you will add one that is also on my list: feel more flow.</p>
<p>Psychologist Mihály Csíkszentmihályi’s <a href="https://www.harpercollins.com/products/flow-mihaly-csikszentmihalyi">research on flow</a> started in the 1970s. He has called it the “<a href="https://www.ted.com/talks/mihaly_csikszentmihalyi_flow_the_secret_to_happiness">secret to happiness</a>.” Flow is a state of “optimal experience” that each of us can incorporate into our everyday lives. One characterized by immense joy that makes a life worth living.</p>
<p>In the years since, researchers have gained a vast store of knowledge about what it is like to be in flow and how experiencing it is important for our overall mental health and well-being. <a href="https://doi.org/10.1007/978-3-030-53468-4_1">In short</a>, we are completely absorbed in a highly rewarding activity – and not in our inner monologues – when we feel flow. </p>
<p>I am an <a href="https://communication.ucdavis.edu/people/rwhuskey">assistant professor of communication and cognitive science</a>, and I have been studying flow for the last 10 years. My <a href="https://cogcommscience.com/">research lab</a> investigates what is happening in our brains when people experience flow. Our goal is to better understand how the experience happens and to make it easier for people to feel flow and its benefits.</p>
<figure class="align-center ">
<img alt="A man paints on canvas in a studio." src="https://images.theconversation.com/files/438884/original/file-20211222-21-jswvjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438884/original/file-20211222-21-jswvjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438884/original/file-20211222-21-jswvjh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438884/original/file-20211222-21-jswvjh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438884/original/file-20211222-21-jswvjh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438884/original/file-20211222-21-jswvjh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438884/original/file-20211222-21-jswvjh.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">Flow can arise when playing games or engaged in artistic pursuits, like writing, photography, sculpting and painting.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-asian-male-woman-paint-drawing-acrylic-color-royalty-free-image/1314904308?adppopup=true">Somyot Techapuwapat/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>What it is like to be in flow?</h2>
<p>People often say flow is like “being in the zone.” Psychologists Jeanne Nakamura and Csíkszentmihályi <a href="https://doi.org/10.1007/978-94-017-9088-8_16">describe it</a> as something more. When people feel flow, they are in a state of intense concentration. Their thoughts are focused on an experience rather than on themselves. They lose a sense of time and feel as if there is a merging of their actions and their awareness. That they have control over the situation. That the experience is not physically or mentally taxing.</p>
<p>Most importantly, flow is what researchers call an autotelic experience. Autotelic derives from two Greek words: autos (self) and telos (end or goal). Autotelic experiences are things that are worth doing in and of themselves. Researchers sometimes call these intrinsically rewarding experiences. Flow experiences are intrinsically rewarding.</p>
<h2>What causes flow?</h2>
<p>Flow occurs when a task’s <a href="https://doi.org/10.1007/978-94-017-9088-8_16">challenge is balanced with one’s skill</a>. In fact, both the task challenge and skill level have to be high. I often tell my students that they will not feel flow when they are doing the dishes. Most people are highly skilled dishwashers, and washing dishes is not a very challenging task.</p>
<p>So when do people experience flow? Csíkszentmihályi’s <a href="https://www.wiley.com/en-us/Beyond+Boredom+and+Anxiety%3A+Experiencing+Flow+in+Work+and+Play%2C+25th+Anniversary+Edition-p-9780787951405">research in the 1970s</a> focused on people doing tasks they enjoyed. He studied swimmers, music composers, chess players, dancers, mountain climbers and other athletes. He went on to study how people can find flow in more <a href="https://www.basicbooks.com/titles/mihaly-csikszentmihalhi/finding-flow/9780465024117/">everyday experiences</a>. I am an avid snowboarder, and I regularly feel flow on the mountain. Other people feel it by practicing yoga – not me, unfortunately! – by riding their bike, cooking or going for a run. So long as that task’s challenge is high, and so are your skills, you should be able to achieve flow.</p>
<p>Researchers also know that people can experience flow by using <a href="https://doi.org/10.1111/j.1468-2885.2004.tb00318.x">interactive media</a>, like <a href="https://doi.org/10.1177/0146167207310026">playing a video game</a>. In fact, <a href="https://www.wiley.com/en-us/Beyond+Boredom+and+Anxiety%3A+Experiencing+Flow+in+Work+and+Play%2C+25th+Anniversary+Edition-p-9780787951405">Csíkszentmihályi said</a> that “games are obvious flow activities, and play is the flow experience par excellence.” <a href="https://www.penguinrandomhouse.com/books/305501/reality-is-broken-by-jane-mcgonigal/">Video game developers</a> are very familiar with the idea, and they think hard about how to <a href="https://www.oreilly.com/library/view/theory-of-fun/9781449363208/">design games so that players feel flow</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of the relationship between difficulty of a challenge, skill level and the experience of flow." src="https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439289/original/file-20220104-19-82f3iv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Flow occurs when a task’s challenge – and one’s skills at the task – are both high.</span>
<span class="attribution"><span class="source">Adapted from Nakamura/Csíkszentmihályi</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Why is it good to feel flow?</h2>
<p>Earlier I said that Csíkszentmihályi called flow “the secret to happiness.” Why is that? For one thing, the experience can help people <a href="https://doi.org/10.1521/soco.2021.39.4.526">pursue their long-term goals</a>. This is because research shows that taking a break to do something fun can help enhance one’s <a href="https://doi.org/10.1177/0146167220941998">self-control, goal pursuit and well-being</a>. </p>
<p>So next time you are feeling like a <a href="https://doi.org/10.1111/jcom.12107">guilty couch potato</a> for playing a video game, remind yourself that you are actually doing something that can help set you up for long-term success and well-being. Importantly, quality – and not necessarily quantity – matters. Research shows that spending a lot of time playing video games only has a <a href="https://doi.org/10.1098/rsos.202049">very small influence</a> on your overall well-being. Focus on finding games that help you feel flow, rather than on spending more time playing games.</p>
<p>A recent study also shows that flow helps people <a href="https://doi.org/10.1016/j.neubiorev.2020.05.005">stay resilient</a> in the face of adversity. Part of this is because flow can help <a href="https://doi.org/10.1037/emo0000479">refocus thoughts</a> away from something stressful to something enjoyable. In fact, studies have shown that experiencing flow can help guard against <a href="https://doi.org/10.1016/j.jad.2017.09.017">depression and burnout</a>.</p>
<p>Research also shows that people who experienced <a href="https://doi.org/10.1371/journal.pone.0242043">stronger feelings of flow had better well-being</a> during the COVID-19 quarantine compared to people who had weaker experiences. This might be because feeling flow helped distract them from worrying. </p>
<h2>What is your brain doing during flow?</h2>
<p>Researchers have been studying flow for nearly 50 years, but only recently have they begun to decipher what is going on in the brain during flow. One of my colleagues, media neuroscientist René Weber, <a href="https://doi.org/10.1111/j.1468-2885.2009.01352.x">has proposed</a> that flow is associated with a specific brain-network configuration. </p>
<p><a href="https://doi.org/10.1016/bs.pbr.2017.06.012">Supporting Weber’s hypothesis</a>, studies show that the experience is associated with <a href="https://doi.org/10.1016/j.neuroimage.2013.08.019">activity in brain structures</a> implicated in <a href="https://doi.org/10.1093/scan/nsr021">feeling reward</a> and <a href="https://doi.org/10.1093/scan/nsv133">pursuing our goals</a>. This may be one reason why flow feels so enjoyable and why people are so focused on tasks that make them feel flow. Research also shows that flow is associated with <a href="https://doi.org/10.3389/fnbeh.2016.00169">decreased activity</a> in brain structures implicated in self-focus. This may help explain why feeling flow can help distract people from worry.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=weekly&source=inline-weeklybest">Sign up for our weekly newsletter</a>.]</p>
<p><a href="https://www.medianeuroscience.org/">Weber</a>, <a href="https://www.jacobtfisher.com/">Jacob Fisher</a> and I have developed a video game called <a href="https://github.com/asteroidimpact/asteroid_impact_py3">Asteroid Impact</a> to help us better study flow. In my own research, I have participants <a href="https://doi.org/10.3758/s13415-018-0612-6">play Asteroid Impact</a> while having their brain scanned. My work has shown that flow is associated with a specific brain network configuration that has <a href="https://doi.org/10.1093/joc/jqy043">low energy requirements</a>. This may help explain why we do not experience flow as being physically or mentally demanding. I have also shown that, instead of maintaining one stable network configuration, the brain actually <a href="https://doi.org/10.1093/joc/jqab044">changes its network configuration</a> during flow. This is important because <a href="https://doi.org/10.1038/nn.3470">rapid brain network reconfiguration</a> helps people adapt to difficult tasks.</p>
<figure class="align-center ">
<img alt="Asteroid Impact" src="https://images.theconversation.com/files/438518/original/file-20211220-18663-1qo5axk.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438518/original/file-20211220-18663-1qo5axk.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438518/original/file-20211220-18663-1qo5axk.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438518/original/file-20211220-18663-1qo5axk.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438518/original/file-20211220-18663-1qo5axk.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438518/original/file-20211220-18663-1qo5axk.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438518/original/file-20211220-18663-1qo5axk.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A player controls a spaceship to collect crystals and avoid asteroids in a video game called Asteroid Impact.</span>
<span class="attribution"><span class="source">Jacob Fisher via https://github.com/asteroidimpact/asteroid_impact_py3</span></span>
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</figure>
<h2>What more can the brain tell us?</h2>
<p>Right now, researchers do not know how brain responses associated with flow contribute to well-being. With very <a href="https://doi.org/10.1007/s00221-018-5378-0">few exceptions</a>, there is almost no research on how brain responses actually cause flow. Every neuroscience study I described earlier was correlational, not causal. Said differently, we can conclude that these brain responses are associated with flow. We cannot conclude that these brain responses cause flow.</p>
<p><a href="https://doi.org/10.1016/j.neubiorev.2020.05.005">Researchers think</a> the connection between flow and well-being has something to do with three things: suppressing brain activation in structures associated with thinking about ourselves, dampening activation in structures associated with negative thoughts, and increasing activation in reward-processing regions.</p>
<p>I’d argue that testing this hypothesis is vital. Medical professionals have started to use video games in <a href="https://www.akiliinteractive.com/">clinical applications</a> to help treat attention-deficit/hyperactivity disorder, or ADHD. Maybe one day a clinician will be able to help prescribe a Food and Drug Adminstration-approved video game to help bolster someone’s resilience or help them fight off depression. </p>
<p>That is probably several years into the future, <a href="https://doi.org/10.31234/osf.io/8cxyh">if it is even possible at all</a>. Right now, I hope that you will resolve to find more flow in your everyday life. You may find that this helps you achieve your other resolutions, too.</p><img src="https://counter.theconversation.com/content/173505/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Huskey does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that people with more flow in their lives had a higher sense of well-being during the COVID-19 pandemic. Scientists are beginning to explore what happens in the brain during flow.Richard Huskey, Assistant Professor of Communication and Cognitive Science, University of California, DavisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1701792021-10-25T12:34:20Z2021-10-25T12:34:20ZWhat causes ADHD and can it be cured?<figure><img src="https://images.theconversation.com/files/427619/original/file-20211020-19033-1mqhonn.jpg?ixlib=rb-1.1.0&rect=70%2C70%2C6639%2C4094&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">On average, two students in every U.S. classroom have ADHD.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bored-young-school-girl-studying-at-home-royalty-free-image/1291247838?adppopup=true"> damircudic/E+ via Getty Images</a></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&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>
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</figure>
<p><em><a href="https://theconversation.com/us/topics/curious-kids-us-74795">Curious Kids</a> is a series for children of all ages. If you have a question you’d like an expert to answer, send it to <a href="mailto:curiouskidsus@theconversation.com">curiouskidsus@theconversation.com</a>.</em></p>
<hr>
<blockquote>
<p><strong>What causes ADHD and can it be cured? – Geneva B., age 17, Philippines</strong></p>
</blockquote>
<hr>
<p><a href="https://www.cdc.gov/ncbddd/adhd/data.html">Attention-deficit hyperactivity disorder</a> is a common, yet <a href="https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Myths-and-Misconceptions.aspx">often misunderstood</a>, mental health condition.</p>
<p>Symptoms include <a href="https://doi.org/10.1177/0022219412464350">inattention, overactivity and impulsivity</a> – behaviors everyone experiences at one time or another. For people with ADHD, these behaviors happen frequently and interfere with everyday life at <a href="https://doi.org/10.1542/peds.2019-2528">school, at home and everywhere else</a>.</p>
<p>ADHD affects more than <a href="https://www.cdc.gov/ncbddd/adhd/data.html">6 million U.S. children</a>. People who have ADHD <a href="https://dx.doi.org/10.1176%2Fappi.ajp.2009.09060796">develop symptoms by age 12</a>, and it usually <a href="https://doi.org/10.1542/peds.2019-2528">continues into adolescence and young adulthood</a>. The condition can affect people throughout their whole life.</p>
<p>On average, <a href="https://doi.org/10.1080/15374416.2017.1417860">two students in every U.S. classroom</a> have it. It is important to note that ADHD is just one way of defining a person’s behavior. It has nothing to do with how smart you are or whether you can make friends or excel at sports, music or art, or about any other strengths.</p>
<h2>What does and doesn’t cause ADHD</h2>
<p>Nobody really knows exactly what causes ADHD. Scientists think that <a href="https://www.additudemag.com/is-adhd-hereditary-yes-and-no/">genes may play a role</a>, but no one knows exactly how at this point. Based on years of research findings, scientists attribute this condition to a combination of how someone’s <a href="https://doi.org/10.1146/annurev-devpsych-060320-093413">brain works and their personal environment</a>. </p>
<p>Research has cast more light on what does not cause ADHD. For example, findings do not support the widespread theories that <a href="https://doi.org/10.1016/j.jad.2018.09.051">excessive sugar</a> or <a href="https://doi.org/10.1073/pnas.1611611114">too much time on electronics</a> are responsible for <a href="https://doi.org/10.2165/00023210-200216020-00005">growth in the number of children diagnosed</a> with the condition since 1990 – when it was detected in less than 2% of all U.S. children.</p>
<p>Today, at least <a href="https://www.cdc.gov/ncbddd/adhd/data.html">9.4% of kids</a> have this diagnosis. Based on <a href="https://scholar.google.com/citations?user=BRXERkMAAAAJ&hl=en&oi=ao">all the research I’ve conducted</a> and the other findings I’ve reviewed, I think this increase is caused by <a href="https://www.cdc.gov/ncbddd/adhd/timeline.html">better identification and more awareness of ADHD in general</a>, rather than an overall increase in ADHD. </p>
<p>How parents interact with their child, likewise, does not cause ADHD. But children and adolescents with ADHD have many behaviors that require more parental involvement than their peers. </p>
<h2>Changing behaviors as therapy</h2>
<p>Most psychologists think about ADHD as a characteristic that, like eye color or height, <a href="https://pediatrics.aappublications.org/content/144/4/e20192528">can’t be changed</a>. Doctors can’t cure ADHD, just like they can’t double the length of your legs. </p>
<p>If someone had a hard time reaching a high shelf, would you tell them they just need to be taller? Of course not. But you could suggest they use a stepladder. </p>
<p>The good news is there are ways that people with ADHD can overcome the challenges this condition brings. Evidence supports two distinct kinds of treatments.</p>
<p>Behavioral therapy is typically implemented by <a href="https://psycnet.apa.org/fulltext/2013-08376-003.pdf">parents and teachers working together</a>. It includes setting clear goals and giving feedback on progress toward those goals, <a href="https://doi.org/10.1177%2F0014402917706370">usually on a daily basis</a>. Another feature is providing rewards or privileges when people with ADHD meet their goals.</p>
<p><a href="https://doi.org/10.3102/00346543211025092">Among the most effective treatments</a> is teaching parents how to pay more attention when their children do their schoolwork and chores and generally behave well. Parents and teachers can help kids by “<a href="https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/behavioral-support-catching-your-child-being-good">catching them being good</a>” – rather than through correction and punishment. As they get older, children and teens with ADHD can set goals for themselves and work hard to <a href="https://psycnet.apa.org/doi/10.1037/ccp0000057">learn ways to keep organized and manage their day</a>. </p>
<p>Behavioral therapy makes a difference because ADHD works like a light operated by a dimmer switch. Rather than simply being turned on or off, it can be turned up to a bright level or dialed down to a faint glimmer. ADHD symptoms, similarly, can increase or decrease in response to particular situations and interactions.</p>
<h2>Medications can help</h2>
<p>Prescription <a href="https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd">stimulant drugs</a>, such as <a href="https://my.clevelandclinic.org/health/treatments/11766-attention-deficit-hyperactivity-disorder-adhd-stimulant-therapy">Adderall and Ritalin</a>, can help many people with ADHD focus longer. Like with all medications, however, some people can’t take them due to <a href="https://www.understood.org/articles/en/adhd-medication">side effects</a>. Some <a href="https://pediatrics.aappublications.org/content/144/4/e20192528">nonstimulant drugs</a> are available, but they generally are less effective.</p>
<p>Researchers have found that the best approach is when <a href="https://doi.org/10.1080/15374416.2015.1105138">behavior therapy begins first</a>, especially <a href="https://chadd.org/adhd-weekly/cdc-recommends-behavior-therapy-as-first-line-of-treatment-for-young-children-with-adhd/">for young children with ADHD</a>. </p>
<p>ADHD can hinder big transitions. In childhood and young adulthood, that includes <a href="https://dx.doi.org/10.1037%2Fccp0000106">starting middle school or high school</a>, <a href="https://doi.org/10.1016/j.cbpra.2010.04.002">learning to drive</a>, <a href="https://psycnet.apa.org/buy/2021-10914-003">going to college</a> or <a href="https://doi.org/10.1007/s10567-019-00274-4">entering the workforce</a>. I believe that extra attention and treatment are usually required at those times. </p>
<p><a href="https://scholar.google.com/citations?user=BRXERkMAAAAJ&hl=en&oi=ao">Many years of research</a> have led me to believe people with ADHD can be successful in the long run when they, their families and their teachers work as hard as is necessary to build skills and <a href="https://doi.org/10.1207/s15374424jccp3503_3">change behavior patterns that complicate everyday life</a>. It also helps when they get that support for as long as is needed.</p>
<hr>
<p><em>Hello, curious kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to <a href="mailto:curiouskidsus@theconversation.com">CuriousKidsUS@theconversation.com</a>. Please tell us your name, age and the city where you live.</em></p>
<p><em>And since curiosity has no age limit – adults, let us know what you’re wondering, too. We won’t be able to answer every question, but we will do our best.</em></p><img src="https://counter.theconversation.com/content/170179/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gregory Fabiano has led projects in the last three years that have received research funding from the Department of Education, Institute of Education Sciences, National Institutes of Health, the Centers for Disease Control and Prevention, and Adlon Therapeutics. He has received royalty payments for published books from Guilford Publications and consultant payments from FastBridge/Illuminate. </span></em></p>Even when the condition lasts a lifetime, there are behavioral treatments and prescription drugs that make it easier for people with attention-deficit hyperactivity disorder to thrive.Gregory Fabiano, Professor of Psychology, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1688202021-10-01T19:17:35Z2021-10-01T19:17:35ZTylenol could be risky for pregnant women – a new review of 25 years of research finds acetaminophen may contribute to ADHD and other developmental disorders in children<figure><img src="https://images.theconversation.com/files/424065/original/file-20210930-22-wgb0x.jpg?ixlib=rb-1.1.0&rect=123%2C22%2C1993%2C1387&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly 100 scholars and health care professionals are urging women to limit their use of acetaminophen during pregnancy. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-pregnant-woman-holding-her-belly-royalty-free-image/1310443783?adppopup=true"> Oscar Wong/Moment via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A mounting body of evidence shows that the use of acetaminophen - widely known by its brand name Tylenol - during pregnancy may pose risks to the fetus and to early childhood development. That was the conclusion of a <a href="https://doi.org/10.1038/s41574-021-00553-7">new review study</a> on which I was a lead author. </p>
<p>Acetaminophen, which has the chemical name paracetamol, is a go-to over-the-counter medication that is widely recommended by doctors to relieve pain and reduce fever.</p>
<p>Our study, based on an assessment of 25 years of research in the areas of human epidemiology, animal and in-vitro studies, concludes that prenatal acetaminophen exposure may increase the risks of reproductive organs developing improperly. We identified a heightened risk of <a href="https://doi.org/10.1111/ppe.12632">neurodevelopmental disorders</a>, primarily attention deficit hyperactivity disorder and related behaviors, but also autism spectrum disorder, as well as language delays and decreased IQ. </p>
<p>In our consensus statement – a broad agreement by our multidisciplinary international panel of experts – published in Nature Reviews Endocrinology in September 2021, 91 clinicians and researchers are calling for caution and additional research.</p>
<h2>Why it matters</h2>
<p>Acetaminophen is an active ingredient in <a href="https://www.chpa.org/our-issues/otc-medicines/acetaminophen">over 600 prescription and over-the-counter medications</a>, including Tylenol. It is used by more than <a href="https://doi.org/10.1002/aur.1591">50% of pregnant women</a> worldwide and at least <a href="https://doi.org/10.1016/j.ajog.2005.02.100">65% of pregnant women</a> in the U.S. Research suggests that acetaminophen is an endocrine disruptor and may interfere with the hormones essential for healthy neurological and <a href="https://doi.org/10.1289/EHP2478">reproductive development</a>.</p>
<p>A spokeswoman for Johnson & Johnson, which makes Tylenol, <a href="https://www.cnn.com/2021/09/23/health/acetaminophen-pregnancy-wellness/index.html">told CNN</a> in September that the product label tells women who are pregnant or breastfeeding to ask a health care professional before using it.</p>
<p>Current <a href="https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/">guidance recommends</a> acetaminophen as the pain reliever of choice during pregnancy, as <a href="https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/aspirin-during-pregnancy/faq-20058167">other pain relievers</a> such as <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic">ibuprofen and aspirin are not considered safe</a> after <a href="https://mothertobaby.org/fact-sheets/ibuprofen-pregnancy/">midpregnancy</a>.</p>
<p>Rates of <a href="https://doi.org/10.1152/physrev.00017.2015">reproductive disorders</a> and neurodevelopmental disorders, <a href="https://www.cdc.gov/ncbddd/adhd/timeline.html">such as ADHD</a> and <a href="https://autismsciencefoundation.org/what-is-autism/how-common-is-autism/">autism spectrum disorder</a>, have <a href="https://doi.org/10.1542/peds.2019-0811">been increasing</a> over the last 40 years. </p>
<p>Over the same time period, the use of acetaminophen during pregnancy <a href="https://doi.org/10.1016/j.ajog.2005.02.100">has gone up</a>. We conclude that because <a href="https://doi.org/10.1016/j.annepidem.2017.09.003">acetaminophen is so commonly taken during pregnancy</a>, if its use is responsible for even a small increase in individual risk, it could contribute substantially to these disorders in the <a href="https://doi.org/10.1136/bmj.k757">overall population</a>.</p>
<h2>What still isn’t known</h2>
<p>It’s unethical to do experiments that could harm a human life, so to gain a better understanding of the direct effects of acetaminophen during pregnancy, we must rely on human observational and experimental studies to assess the possibility of causal connections. But to really get at these questions, we need human cohort studies that can precisely capture when and why acetaminophen is taken during pregnancy. Additionally, we would like to see research that gives us a better understanding of the biologic pathways. </p>
<p>Notably, acetaminophen is also the medication <a href="https://doi.org/10.1542/peds.2008-2869">most commonly</a> <a href="https://doi.org/10.1016/j.jped.2014.03.004">given to infants</a>. More research is needed to determine whether this practice is safe for the developing brain. </p>
<h2>What’s next</h2>
<p>The current near-ubiquitous use of acetaminophen during pregnancy is due in part to the <a href="https://doi.org/10.2174/1381612825666190321110420">widespread perception</a> – even among doctors – that it has limited side effects and negligible risk. But a growing body of research suggests that the <a href="https://doi.org/10.1016/j.yhbeh.2018.01.003">indiscriminate use</a> of acetaminophen during pregnancy – especially for conditions such as <a href="https://doi.org/10.1111/bcpt.12527">chronic pain</a>, <a href="https://doi.org/10.1002/14651858.CD012230">low back pain</a> and <a href="https://doi.org/10.1002/14651858.CD011889.pub2">headaches</a> – may be unwarranted and unsafe.</p>
<p>In our consensus statement, we urge education of health professionals and pregnant women about the risks and benefits of acetaminophen use during pregnancy.</p>
<p>Based on our extensive review of the evidence – and the recognition that there are limited alternatives for the necessary treatment of high fever and severe pain – we recommend that pregnant women refrain from using acetaminophen unless it is medically recommended by a doctor. Women should also minimize risk to the fetus by using the lowest effective dose for the shortest possible time.</p>
<p><em>This article was updated on Oct. 4, 2021, to include a statement from Johnson & Johnson.</em></p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ann Z. Bauer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tylenol has long been considered a go-to medication for low to moderate pain and for fever reduction, even during pregnancy. But mounting evidence suggests that it is unsafe for fetal development.Ann Z. Bauer, Postdoctoral Fellow in Epidemiology, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1648592021-09-08T04:12:19Z2021-09-08T04:12:19ZNeurodiversity can be a workplace strength, if we make room for it<figure><img src="https://images.theconversation.com/files/416249/original/file-20210816-17-1is8xri.jpg?ixlib=rb-1.1.0&rect=0%2C413%2C3500%2C1723&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">igor kisselev/Shutterstock</span></span></figcaption></figure><p>Emma can recognise patterns within complex code. James can develop several different solutions when faced with complicated problems. But it is unlikely either will find a job where they can put their specialist skills to work — or any job, actually. </p>
<p>Emma has dyslexia. James has been diagnosed with attention deficit hyperactivity disorder. These conditions mean communicating can be a challenge, particularly in a stressful situation such as a job interview. They may also find it difficult to work in a typical office environment with noise and bright lights. </p>
<p>But often the significant challenge is other people assuming they will be less capable or difficult to work with.</p>
<p>About 15-20% of the <a href="https://academic.oup.com/bmb/article/135/1/108/5913187">global population</a> are “neurodiverse”. This term, coined by Australian <a href="https://www.autismawareness.com.au/news-events/aupdate/in-conversation-with-judy-singer/">sociologist Judy Singer</a> in 1998, conveys <a href="https://autismawarenesscentre.com/un-adopts-new-goals-disabilities/">the idea</a> that the neurological differences shaping how people think and interact are natural variations to the human genome. Neurodiversity therefore isn’t something to be “fixed” but understood and accommodated.</p>
<p>Despite this understanding, and the gains made more generally in promoting workplace diversity, prejudices keep the employment prospects for neurodiverse individuals shockingly low. </p>
<p>The cost is personal — denying individuals the chance to do meaningful work — as well as social, sending individuals to the dole queue. It also means workplaces are failing to benefit from highly valuable employees, and missing the opportunity to become better organisations in the process.</p>
<h2>What neurodiversity covers</h2>
<p>Neurodiversity is often referred to as an ‘invisible disability’ and covers a range of conditions. The most common are:</p>
<ul>
<li><p><strong>Attention Deficit Hyperactivity Disorder</strong> (or ADHD) manifests as inattention, distractability and impulsivity. It affects about <a href="https://www2.deloitte.com/au/en/pages/economics/articles/social-economic-costs-adhd-Australia.html">4% of children and 3% of adults</a>.</p></li>
<li><p><strong>Autism Spectrum Disorder</strong> (or ASD) typically involves degrees of difficulty in communicating with others and sensory overload. About <a href="https://www.autism-society.org/what-is/facts-and-statistics/">1% of the global population</a> is estimated to be on the spectrum, with higher rates being diagnosed among children.</p></li>
<li><p><strong>Dyslexia</strong> involves difficulties with reading and spelling. There is no agreed diagnosis. Estimates of its prevalence range from 3% to 20% (with <a href="https://dyslexiaassociation.org.au/dyslexia-in-australia/">10-15%</a> commonly cited).</p></li>
<li><p><strong>Dyspraxia</strong> involves challenges with coordinating physical movements, including muscles for speaking. About 2% of the population are severely affected, with <a href="https://adc.bmj.com/content/archdischild/92/6/534.full.pdf?casa_token=s2n80xJNuhAAAAAA:kzF2QsFQRlR_rmpi80YkV9N8Lp8YT9bIXb1cwOEbaiZUm3f5KfRO4xPk8_F2YoXm6-bM7rHANPkqIQ">6-10%</a> estimated to be affected to some degree.</p></li>
<li><p><strong>Dyscalculia</strong> involves challenges with numbers. It affects <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461157/">up to 10%</a> of the population, with <a href="https://www.dyslexia.uk.net/specific-learning-difficulties/dyscalculia/">3-6%</a> commonly cited.</p></li>
<li><p><strong>Tourette syndrome</strong> causes involuntary physical and vocal “tics”. It affects an estimated <a href="https://tourette.org/spectrum-tourette-syndrome-tic-disorders-consensus-scientific-advisors-tourette-association-america/">0.6% of the population</a>.</p></li>
</ul>
<h2>High unemployment</h2>
<p>The capabilities of neurodivergent people can vary considerably from severely challenged to gifted. Some are nonverbal and fully reliant on care givers. Others have special abilities in things such as <a href="https://hbr.org/2017/05/neurodiversity-as-a-competitive-advantage">pattern recognition, memory or mathematics</a>.</p>
<p>Yet even those with exceptional talents find it hard to get and hold a job. While unemployment estimates are imprecise, they suggest these conditions are the least accepted in the working world.</p>
<p>For autistic adults aged 16-64, for example, UK statistics suggest <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/disability/articles/outcomesfordisabledpeopleintheuk/2020">78% are unemployed</a>. This is the highest unemployment rate of any group, compared with 48% for all disabled people and 19% for all adults.</p>
<p>Australian statistics put the unemployment rate for people with autism <a href="https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary-findings/latest-release">at 34%</a>. That’s still more than three times the unemployment rate of 10% for people with disabilities and almost eight times the 4.6% rate for people without disabilities.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/expecting-autistic-people-to-fit-in-is-cruel-and-unproductive-value-us-for-our-strengths-103888">Expecting autistic people to 'fit in' is cruel and unproductive; value us for our strengths</a>
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<h2>Supporting neurodiversity at work</h2>
<p>One problem, as Joanna Szulc and her fellow researchers at the University of Huddersfield <a href="https://pure.hud.ac.uk/en/publications/amo-perspectives-on-the-well-being-of-neurodivergent-human-capita">have put it</a>, is “management practices frequently overlook the relationship between the above-average human capital of neurodivergent employees, their subjective well-being in the workplace and performance outcomes”. </p>
<p>In other words, with understanding colleagues and a flexible work culture, neurodiverse individuals can reach their potential and be recognised as highly valuable employees.</p>
<p>One case study demonstrating this is professional services giant Ernst and Young, which globally employs close to 300,000 people. </p>
<p>In 2016 it established its first “<a href="https://www.ey.com/en_us/diversity-inclusiveness/how-neurodiversity-is-driving-innovation-from-unexpected-places">Neurodiversity Center of Excellence</a>” as part of a pilot program to offer jobs to neurodiverse candidates. </p>
<p>The company says it “considered business metrics only” in evaluating the program. It concluded the neurodiverse employees were comparable to neurotypical staff in work quality, efficiency and productivity. The bonus was “the neurodiverse employees excelled at innovation”.</p>
<p>Australia’s Department of Defence has employed high-performing autistic individuals in its <a href="https://www.defence.gov.au/annualreports/16-17/Features/CyberCapabilityTalentAutism.asp">cyber security</a> work. Their strengths for this work include “a remarkable eye for detail; accuracy and consistency; a logical and analytical approach to detecting irregularities; pattern-matching skills; and a high tolerance for repetitive mental tasks”.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/neurodiversity-at-work-benefits-everyone-why-companies-are-hiring-autistic-people-146788">Neurodiversity at work benefits everyone – why companies are hiring autistic people</a>
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<p>These lessons are being taken on board by others. In July, Google’s cloud computing division announced its <a href="https://cloud.google.com/blog/topics/inside-google-cloud/google-cloud-launches-a-career-program-for-people-with-autism">Autism Career Program</a>, which includes training up to 500 managers “to work effectively and empathetically with autistic candidates”.</p>
<p>We all vary naturally. By understanding and encouraging neurodiverse individuals to be fully engaged in society, we will all reap the rewards.</p><img src="https://counter.theconversation.com/content/164859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Russo is a Non-Executive Director with Autism Spectrum Australia (Aspect), Australia’s largest autism-specific service provider. A not-for-profit organisation, Aspect works in partnership with people of all ages on the autism spectrum, and their families to deliver evidence-informed solutions that includes, among other things, employment services. The views expressed in this article are her own and those of her co-authors, and do not necessarily represent the view of Aspect.</span></em></p><p class="fine-print"><em><span>Dana L. Ott and Miriam Moeller 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>Despite progress in promoting workplace diversity, prejudices keep the employment prospects for neurodiverse individuals shockingly low.Miriam Moeller, Senior Lecturer, International Business, The University of QueenslandDana L. Ott, Lecturer, International Management, University of OtagoEmily Russo, Industry Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1614112021-05-27T03:08:57Z2021-05-27T03:08:57ZMy child has been diagnosed with ADHD. How do I make a decision about medication and what are the side effects?<figure><img src="https://images.theconversation.com/files/402511/original/file-20210525-23-iz1n6n.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6253%2C4647&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If your child has been diagnosed with attention deficit hyperactivity disorder (ADHD), you might be wondering: what now? And how do I know if medication is warranted?</p>
<p>The answer will depend on circumstances and will change over time. It’s quite OK to leave medication as a last resort — but it can be a very useful last resort. </p>
<p>Here are some questions I typically work through with a parent and child negotiating this issue.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adhd-affects-girls-too-and-it-can-present-differently-to-the-way-it-does-in-boys-heres-what-to-look-out-for-158635">ADHD affects girls too, and it can present differently to the way it does in boys. Here's what to look out for</a>
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<h2>Five key questions for parents and children with ADHD</h2>
<p><strong>1. Is this child underachieving academically in relation to their ability?</strong></p>
<p>Was the child bright as a preschooler but struggled at school for reasons unclear (not, for example, due to vision or hearing problems)? Did they cope OK early in school but didn’t achieve at the level expected when schoolwork got harder?</p>
<p><strong>2. Is this child’s behaviour creating unreasonable levels of stress or disruption at school?</strong></p>
<p>For a child with ADHD to complete a task, it must be sufficiently interesting, short or easy. If a child can’t concentrate in class, they get bored. They might talk in class, create distractions or disrupt class. Obviously, careful judgement is needed to differentiate typical child behaviour from problematic behaviour.</p>
<p><strong>3. Is this child’s behaviour creating unreasonable levels of stress or disruption at home?</strong></p>
<p>At home, is the child able to draw, construct with LEGO, do puzzles or play blocks for longish periods of time? Or do they find the sustained effort needed unachievable? Do they then annoy a sibling to make life more interesting, or constantly ask adults to play with them? </p>
<p>If a child is working on homework for half an hour, how much time is spent concentrating? Are they focused for only ten minutes and the remainder is spent guiding them back on track?</p>
<p>Is the parent tearing their hair out with countless reminders and finding every time they check, the child is distracted again?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402513/original/file-20210525-16-1qlg02t.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">Doctors, parents, teachers and the child must work together and regularly ask whether the current approach is actually providing benefit.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p><strong>4. Is there a significant effect on peer relationships?</strong></p>
<p>Children with ADHD don’t always have the patience to wait their turn or concentrate on what peers say. They may come across as bossy; they find it easier to focus on what’s happening in their own mind but more challenging to listen and process what others say. Their peers may eventually find someone else to play with. </p>
<p><strong>5. Is there an impact on self esteem?</strong></p>
<p>Is this a smart child who doesn’t think they’re smart because they struggle to concentrate long enough to get work done? Do they speak negatively about themselves? It’s important to take self esteem seriously.</p>
<p>There are also diagnostic criteria that need to be checked.</p>
<h2>Support strategies at home and in class</h2>
<p>What other supports could help? Is the child sitting at the front of class? Is the teacher giving written instructions? Do they sit next to a good role model? </p>
<p>Has the parent done parenting classes? Have they tried home strategies rewarding good behaviour, or giving appropriate consequences for problematic behaviour? </p>
<p>Having a chart for the morning routine can be helpful. Many such strategies work nicely on children without ADHD. But children with ADHD often find the effort needed to earn a sticker isn’t worth it and may try to negotiate ever greater rewards. </p>
<p>If you’ve got to the end of that road and the child is still having problems, you might consider medication.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402516/original/file-20210525-20-1wql9kc.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">The first thing to know is these stimulants wear off reasonably quickly — after about four hours.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/adhd-claims-were-diagnosing-immature-behaviour-make-it-worse-for-those-affected-72180">ADHD: claims we're diagnosing immature behaviour make it worse for those affected</a>
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<h2>What does medication do?</h2>
<p>With ADHD, it’s like your brain is running on a half-charged battery. Your concentration keeps flicking off or winding down. Medication makes it more like your brain is running with a fully charged battery.</p>
<p>The active ingredient in medication is usually a stimulant such as dexamphetamine or methylphenidate. You might know it by the brand name Ritalin.</p>
<p>These stimulants wear off quickly — after about four hours. That may help the child get through the school morning; they may need another dose at lunch and perhaps a third dose if they have after-school activities. There are also capsules that release medication more slowly.</p>
<p>The medication is always wearing off and you are back to square one. On the one hand, that’s a nuisance. On the other, it means you can try medication, then stop and you’ll still have the same child you had at the beginning.</p>
<p>You start low and increase gradually until you find a dose that lasts about four hours. The teacher can help with feedback. The dosage may need to be adjusted as the child grows. These decisions are all made with the support of the clinician. </p>
<p>Generally, you get improvement up to a point where no further benefit is seen. If the dosage is too high, a child may seem aggressive, depressed or “zombie-like”. Nobody wants a dosage that is not leading to a better outcome. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/402517/original/file-20210525-23-1otsmou.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">If you decide to use medication, the dosage may need to be adjusted as the child grows.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<h2>What about side effects?</h2>
<p>The most significant side effect is appetite suppression, so we monitor weight and height closely. Generally, weight stabilises in the long run.</p>
<p>Rebound hyperactivity as the medication wears off and difficulty sleeping can occur. Sometimes this can be managed by changing the dosage or by not medicating too late in the day.</p>
<p>The decision to give medication is made on a daily basis. If you aren’t happy, you can omit it and see how things go.</p>
<p>This medication improves anyone’s concentration, not just children with ADHD, so it’s also sometimes a drug of abuse (among university students, for example). When used for treating ADHD, the <a href="https://pubmed.ncbi.nlm.nih.gov/17453605/">risk of addiction is minimal</a>.</p>
<p>But if you have concentration problems, you have more scope for improvement. A child who is concentrating most of the time cannot experience much improvement.</p>
<h2>Reviewing progress</h2>
<p>I always ask the child: does the medication work? How do you know? I might find out from a teenager that their concentration has improved from 20% to 80% or 90% of classtime. A younger child who prefers to feel in control of their behaviour may actually remind the parent when the next dose is due. </p>
<p>Often I hear from parents the child is now keen to get homework done, has more friends and feels happier and more confident. </p>
<p>All parents want their child to feel they’re functioning and fulfilling their potential. Most will achieve this without medication. That’s plan A. Plan B is that they are fulfilling their potential and living a great life, helped by medication.</p>
<p>Doesn’t every child, every person, with ADHD deserve a plan B?</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adhd-prescriptions-are-going-up-but-that-doesnt-mean-were-over-medicating-108474">ADHD prescriptions are going up, but that doesn't mean we're over-medicating</a>
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<img src="https://counter.theconversation.com/content/161411/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Poulton receives funding from Brain Mind Centre University of Sydney; Australian Women and Children's Research Foundation. She is affiliated with Australian ADHD Professionals Association; World Federation of ADHD.</span></em></p>It’s quite OK to leave medication as a last resort — but it can be a very useful last resort.Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1588682021-04-15T22:12:01Z2021-04-15T22:12:01ZRoad to nowhere: New Zealanders struggle to get the help they need, 2 years on from a funding boost for mental health services<figure><img src="https://images.theconversation.com/files/395168/original/file-20210415-16-1whk8eg.jpg?ixlib=rb-1.1.0&rect=116%2C170%2C5045%2C3358&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock/Bruce Stanfield</span></span></figcaption></figure><p>As part of New Zealand’s <a href="https://www.beehive.govt.nz/feature/wellbeing-budget-2019">well-being budget in 2019</a>, the government announced an unprecedented <a href="https://www.beehive.govt.nz/release/taking-mental-health-seriously">NZ$1.9 billion increase</a> in funding for the mental health sector. </p>
<p>But almost two years on, there are no tangible signs of improvement and statistics show the number of New Zealanders seeking, but not receiving, mental health support is on the rise.</p>
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<p>The funding boost came on the back of <a href="https://mentalhealth.inquiry.govt.nz/inquiry-report/he-ara-oranga/">He Ara Oranga</a>, a 2018 report of a year-long inquiry into mental health and addiction services in New Zealand, which called for an expansion of access and increased choice of services. </p>
<p>For the sector, it brought hope and expectation that mental health would finally be funded properly and services expanded to all who needed them, not just the most <a href="https://nsfl.health.govt.nz/service-specifications/current-service-specifications/mental-health-and-addiction-service">severe 3% of the population</a>. That hope has turned to despair.</p>
<h2>Long waiting lists</h2>
<p>The COVID-19 lockdowns brought a silent increase in the number of young people <a href="https://www.stuff.co.nz/national/health/120760661/eating-disorders-a-nightmare-in-coronavirus-lockdown">developing eating disorders</a>, such as anorexia nervosa and bulimia nervosa, which are among the most serious and <a href="https://link.springer.com/article/10.1186/s40337-017-0145-3">potentially lethal</a> mental health problems a person can develop.</p>
<p>We need accurate assessments and skilled treatments to help sufferers overcome eating problems. Yet access is almost impossible, with <a href="https://www.rnz.co.nz/news/in-depth/438868/dying-for-help-eating-disorder-treatment-waiting-lists-months-long">waitlists of four months or more</a> to see a psychologist.</p>
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Read more:
<a href="https://theconversation.com/youth-anxiety-and-depression-are-at-record-levels-mental-health-hubs-could-be-the-answer-154722">Youth anxiety and depression are at record levels. Mental health hubs could be the answer</a>
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<p>Access to regionally funded mental health services for children and adolescents seems equally impossible. Unofficial figures released recently by the National Party show the <a href="https://www.stuff.co.nz/national/politics/300271651/wait-times-for-youth-mental-health-services-balloon-out-under-labour-despite-huge-investment">wait time can be up to 72 days</a>. </p>
<p>These services are set up to support only young people with the most severe and complex mental health needs. Imagine being a parent of a teen who is depressed and self-harming, yet being unable to access the expert support needed for over two months.</p>
<h2>Lack of services</h2>
<p>Unsurprisingly, those whose needs don’t meet the strict criteria of a District Health Board (DHB) mental health service are even worse off. Although attention deficit hyperactivity disorder (<a href="https://werryworkforce.org/attention-deficit-hyperactivity-disorder-adhd">ADHD</a>) is one of the most common disorders, <a href="https://www.rnz.co.nz/national/programmes/ninetonoon/audio/2018789460/adults-with-adhd-missing-out-on-care-clinician">services for adults with ADHD</a> are almost non-existent. </p>
<p>The same applies to mental health support for people who experience psychological trauma — such as those who <a href="https://www.rnz.co.nz/news/national/439924/christchurch-terror-attack-witness-urges-more-mental-health-support">witnessed the Christchurch mosque shootings</a>. While the Accident Compensation Corporation (<a href="https://www.acc.co.nz/">ACC</a>) system provides excellent support for people with physical injuries, it leaves those suffering solely psychological trauma out in the cold. </p>
<p>The number of people seeking psychological support is <a href="https://www.stuff.co.nz/national/health/122695066/new-zealands-psychological-crisis-putting-lives-at-risk">increasing</a>, likely due in part to the groundbreaking and tireless efforts of mental health campaigners such as former rugby player <a href="https://jkfoundation.org.nz/">Sir John Kirwan</a>, former comedian <a href="https://www.iamhope.org.nz/OurPeople/Mike-King">Mike King</a> and the 2021 Young New Zealander of the Year <a href="https://www.tvnz.co.nz/one-news/new-zealand/mental-health-advocate-jazz-thornton-named-young-new-zealander-year">Jazz Thornton</a>. </p>
<p>This increased public demand can be seen in a positive light, as it indicates people are more willing to acknowledge and seek help for their mental health. But it has quickly <a href="https://www.stuff.co.nz/national/health/122267517/shortage-of-psychologists-increasing-wait-times-at-taranaki-hospitals">outstripped supply</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1381815657159790592"}"></div></p>
<p>Mental health services outside those funded by DHBs are either running long waitlists or <a href="https://www.scoop.co.nz/stories/GE2103/S00103/lockdown-impact-on-wellbeing-lingers-one-year-on.htm">no longer accept new referrals</a>. A 2018 <a href="https://healthcentral.nz/new-zealand-needs-extra-1000-psychologists-estimates-taskforce/">survey</a> by the <a href="https://www.nzccp.co.nz/">NZ College of Clinical Psychologists</a> showed New Zealand was short of almost 1000 psychologists at the time. </p>
<h2>Government inaction</h2>
<p>The government has acknowledged the workforce shortage and that increasing the mental health workforce is a long game. Health minister Andrew Little said the <a href="https://www.stuff.co.nz/national/politics/300271651/wait-times-for-sutherlandyouth-mental-health-services-balloon-out-under-labour-despite-huge-investment">workforce shortfall is being addressed</a> through programmes such as postgraduate training in cognitive behavioural therapy and child and adolescent mental health. </p>
<p>But government investments thus far are doing little more than shuffling deckchairs on the Titanic. Most of these programmes are simply upskilling or moving workers already employed in the mental health system, not increasing the total number of staff.</p>
<p>It takes several years to train psychologists, mental health nurses, psychiatrists and social workers to provide evidence-based, culturally appropriate assessment and treatment. An obvious answer would be to increase funding for mental health training programmes to allow them to expand the number of people who enter these professions.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/is-it-adult-adhd-covid-19-has-people-feeling-restless-lacking-focus-and-seeking-diagnosis-155651">Is it adult ADHD? COVID-19 has people feeling restless, lacking focus and seeking diagnosis</a>
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</em>
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<p>Is the government daunted by the scale of change required to bring about meaningful improvements in our mental health system? In response to calls to expand ACC funding to include psychological injury, minister Little said the government had <a href="https://www.rnz.co.nz/news/national/438216/law-won-t-be-changed-for-mosque-shooting-witnesses-to-get-acc-andrew-little-says">no intentions to make the necessary law change</a>. Surely, such systemic change is exactly what is needed if we are to implement the recommendations of the inquiry report.</p>
<p>The government should at least tell the public if and how it plans to implement the recommendations the <a href="https://mentalhealth.inquiry.govt.nz/inquiry-report/he-ara-oranga/">He Ara Oranga</a> report made. Laying out a roadmap for change would provide vision, show leadership and perhaps allow us to hope again. At the moment it feels like we’re in the dark on a road to nowhere.</p><img src="https://counter.theconversation.com/content/158868/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dougal Sutherland works for Victoria University of Wellington and is an Associate at Umbrella Wellbeing</span></em></p>Two years ago an inquiry called for major reform of New Zealand’s mental health services, but since then, things got worse rather than better.Dougal Sutherland, Clinical Psychologist, Te Herenga Waka — Victoria University of WellingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1293142020-01-07T12:01:27Z2020-01-07T12:01:27ZChildhood deprivation affects brain size and behaviour<figure><img src="https://images.theconversation.com/files/308655/original/file-20200106-123364-1dip4pj.jpg?ixlib=rb-1.1.0&rect=24%2C0%2C5439%2C3293&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hopeless-life-close-depressed-poor-little-336377765">Yakobchuk Viacheslav/Shutterstock</a></span></figcaption></figure><p>The human brain goes through dramatic <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987539/">developmental changes</a> in the first years of life. During this period it is particularly <a href="https://www.nature.com/articles/nrn2639">sensitive</a> to environmental influences. This sensitivity helps babies learn and develop, but it also leaves them vulnerable to negative experiences, such as maltreatment, which can have a lasting physical and psychological impact. </p>
<p>In our <a href="https://www.pnas.org/content/early/2020/01/01/1911264116">latest research</a>, published in PNAS, we show that extreme adversity early in life is linked to changes in brain structure in adulthood. Early childhood adversity experienced in institutions was related to a smaller brain as well as regional changes in brain structures. Some of these changes were linked to neurodevelopmental problems, such as <a href="https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/">attention deficit hyperactivity disorder (ADHD)</a>, which can arise following adversity. </p>
<p>Our study examined a group of adoptees who were exposed to severe early deprivation when living in institutions in Romania under the <a href="https://www.britannica.com/biography/Nicolae-Ceausescu">Ceaușescu regime</a>. The conditions in these institutions were appalling. Often children did not have enough food and they had no toys to play with. They were confined to cots and had no permanent caretakers with whom to form a bond. Many children <a href="https://www.theguardian.com/world/2019/dec/15/romania-orphanage-child-abusers-may-face-justice-30-years-on">died</a> in these institutions. </p>
<p>After the fall of Nicolae Ceaușescu, footage of the conditions in these institutions gained worldwide publicity. This was followed by a large international adoption campaign. For the children, adoption meant a sudden change in their circumstances for the better. They were now living in nurturing and loving families. </p>
<p>The English and Romanian Adoptees (ERA) Study follows the development of some of these children who were adopted by families in the UK. The study included a comparison group of UK adoptees who did not experience any institutional deprivation.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1469-7610.00343?sid=nlm%3Apubmed">Previous research on the ERA study</a> has shown that the Romanian adoptees were severely affected when they first arrived in their adoptive homes. For most of them, this was followed by rapid recovery. </p>
<p>By <a href="https://psycnet.apa.org/record/2003-10667-007">age six</a>, many of the children, especially those who had spent only a limited time in the institutions, had fully recovered their physical and cognitive development. Yet many of the adoptees who had been exposed to institutions for an extended time developed cognitive problems and mental health disorders, such as increased symptom rates of ADHD and <a href="https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/autistic-spectrum-disorder-asd">autism spectrum disorder (ASD)</a> and lower IQ. These problems often <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30045-4/fulltext">persisted</a> through to adulthood.</p>
<h2>Brain images</h2>
<p>We were interested to find out whether fundamental changes in brain development could explain this increase in mental health disorders. To do so we investigated the impact of early institutional deprivation on adult brain structure by taking brain scans of our participants in a magnetic resonance imaging (MRI) scanner. </p>
<p>We found that institutional deprivation was associated with a smaller brain in young adulthood. There was a direct relationship with the duration of deprivation – the longer the adoptees had spent in the institutions, the smaller their brains tended to be. A smaller brain volume was also linked to lower intelligence and more symptoms of ADHD.</p>
<p>Some regions in the frontal and temporal parts of the brain seemed to be particularly sensitive to deprivation. Changes in a region in the temporal part of the brain, the inferior temporal cortex, were associated with fewer symptoms of ADHD. This indicates that this change in brain structure might be compensatory, rather than impairing, as it was associated with better outcomes.</p>
<p>This research has shown that early institutional deprivation is associated with changes in brain structure that are still visible in adulthood more than 20 years after the adoptees left the institutions. These findings provide compelling evidence for the notion that extreme adversity early in life can lead to long-lasting changes in brain development despite later environmental enrichment.</p>
<p>Changes in brain structure did not always suggest impairment – in some cases they suggested compensation. Future research is needed to identify how we can best prevent and treat psychiatric conditions that arise from adversity. For example, it would be interesting to see whether the compensatory processes found in this study could be targeted in cognitive training to reduce ADHD symptoms in people
who experienced early deprivation.</p><img src="https://counter.theconversation.com/content/129314/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nuria Mackes receives funding from the Medical Research Council (MR/K022474/1). Her research is supported by the National Institute for Health Research Clinical Research Network (NIHR CRN).</span></em></p>The lasting impact of neglect.Nuria Mackes, Postdoctoral Research Associate, Neuroimaging, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1224732019-08-28T20:03:17Z2019-08-28T20:03:17ZThere’s no evidence caesarean sections cause autism or ADHD<figure><img src="https://images.theconversation.com/files/289753/original/file-20190828-184222-12ywzar.jpg?ixlib=rb-1.1.0&rect=35%2C53%2C3958%2C2940&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caesarean delivery alone does not contribute to the odds of a child developing autism or ADHD.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/5zp0jym2w9M">Aditya Romansa</a></span></figcaption></figure><p>A <a href="https://doi.org/10.1001/jamanetworkopen.2019.10236">new study</a> that combines data from over 20 million births has found that a caesarean section delivery is associated with autism spectrum disorder (autism) and attention-deficit hyperactivity disorder (ADHD). </p>
<p>However, the study does not indicate that caesarean section deliveries cause autism or ADHD. The truth is much more difficult to decipher, and provides an excellent case study for the old adage that correlation doesn’t equal causation. </p>
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Read more:
<a href="https://theconversation.com/clearing-up-confusion-between-correlation-and-causation-30761">Clearing up confusion between correlation and causation</a>
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<h2>Remind me, what are these disorders?</h2>
<p>Autism and ADHD are what we call neurodevelopmental disorders. This means they have clear differences in behavioural development, which we presume are due to brain differences. </p>
<p>In the case of autism, behavioural differences occur in the part of the brain primarily responsible for social and communication development. For ADHD, these differences affect the ability to control and direct attention. </p>
<p>The exact reasons why the brain develops differently are not entirely clear. Studies in twins, which are able to help us understand the role of genetic and environmental influences on a given trait, have shown that both autism and ADHD involve a large genetic component. </p>
<p>However, these studies have also indicated that environmental influences, such as <a href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">bacterial or viral infections</a> during pregnancy, may play a role in the development of these conditions, most likely through interactions with genetic make-up.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-autism-what-we-know-dont-know-and-suspect-53977">What causes autism? What we know, don’t know and suspect</a>
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<h2>What did this study find?</h2>
<p>The association between certain caesarean sections and autism has been <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/482014">known for close to two decades</a>. Any possible link with ADHD has received comparatively less research, but there have still be numerous studies in this area. </p>
<p>Today’s study, <a href="https://doi.org/10.1001/jamanetworkopen.2019.10236">published in the journal JAMA Network Open</a>, combines all of the studies conducted previously into a single analysis. This “meta-analysis” then allows the researchers to come up with a single estimate of how strong the association between caesarean sections, autism and ADHD may be. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289770/original/file-20190828-184202-1bdtllq.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 researchers were looking for a pattern that warrants further investigation.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/xTedodxYTuQ">freestocks.org</a></span>
</figcaption>
</figure>
<p>In this case, the meta-analysis included over 20 million people. It found children born via caesarean section had an increase in odds of being diagnosed with autism or ADHD in early childhood. </p>
<p>The associations were scientifically robust, but very small. Children delivered via caesarean section were 1.33 times more likely to be diagnosed with autism and 1.17 times more likely to be diagnosed with ADHD.</p>
<p>When the prevalence of these conditions is already relatively low (around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919599/">1%</a> for autism, and <a href="https://pediatrics.aappublications.org/content/135/4/e994.short">7%</a> for ADHD), this increase in odds is not substantial. In the instance of autism, this is a shift in odds from a 1% prevalence to 1.33%. This shift is not consequential and certainly does not call for any change in our clinical practice.</p>
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<em>
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Read more:
<a href="https://theconversation.com/what-you-need-to-know-to-understand-risk-estimates-67643">What you need to know to understand risk estimates</a>
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<p>This association was similar for children born by either elective or emergency caesarean section. </p>
<h2>But what does it mean?</h2>
<p>The temptation with findings like this is to draw a causal link between one factor (caesarean section) and the other (autism or ADHD). Unlike so many other areas of science, the conclusions are easily understood and the implications appear obvious. </p>
<p>But the simplicity is deceptive, and says more about our desire for simple answers than it does about the truth of the science. </p>
<p>The studies included in this meta-analysis used a branch of science called epidemiology, which is concerned with how often conditions and diseases occur in different groups of people and why, and how to prevent or manage them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/epidemiology-and-the-media-15972">Epidemiology and the media </a>
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<p>Epidemiological studies survey a large population and find a pattern of results that indicate a certain factor may be coinciding with a certain disease more often than we would expect by chance. </p>
<p>In this case, there is the observation that people with autism or ADHD are more likely to be born by caesarean section than we would otherwise typically expect. </p>
<p>But this kind of epidemiological study is unable determine if one factor (caesarean section) causes another (ADHD or autism). </p>
<p>There are two key reasons why. </p>
<p>First, we can’t rule out that a third factor may be influencing this association. We know, for example, that caesarean sections are more common for pregnant women who are <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002937803019240">obese</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2010.00409.x">older</a>, and who have a <a href="https://www.tandfonline.com/doi/abs/10.3109/14767058.2013.847080">history of immune conditions</a> such as asthma. </p>
<p>All of these factors have also been linked with an increased chance of having a child with autism, and it is entirely possible – and some would argue, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12351">probable</a> – that it is more likely these factors underlie the relationship between caesarean section and neurodevelopmental disorders. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/289762/original/file-20190828-184196-e2ia6f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The link might be due to other factors such as the mother’s age or weight.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/I0ItPtIsVEE">Christian Bowen</a></span>
</figcaption>
</figure>
<p>The second reason is that these kind of epidemiological studies are unable to provide what scientists call “a mechanism” – that is, a biological explanation as to why this association may exist. </p>
<p>A mechanism study in this area may be to explore biological differences in newborns either born via vaginal or caesarean delivery, and understand how these differences may lead to atypical behavioural development.</p>
<p>Without a strong body of evidence from these kinds of studies, there is simply no scientific basis for concluding a causal link between caesarean section and neurodevelopmental disorders. </p>
<h2>So what should we take away from this study?</h2>
<p>The study provides a strong basis for concluding there is a statistical association between caesarean section delivery on one hand, and autism and ADHD on the other. But that’s about it. </p>
<p>Why this link exists remains unknown, but it is almost certain that a caesarean delivery alone does not contribute to the odds of a child developing autism or ADHD. </p>
<p>Instead, it is likely that other pregnancy factors play a role in this relationship, as well as genetic factors that may interact with the environmental influences during pregnancy to contribute to brain development. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adhd-prescriptions-are-going-up-but-that-doesnt-mean-were-over-medicating-108474">ADHD prescriptions are going up, but that doesn't mean we're over-medicating</a>
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<img src="https://counter.theconversation.com/content/122473/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Whitehouse receives funding from the National Health and Medical Research Council, the Australian Research Council and the Autism CRC.</span></em></p>A new study has found a link between being born by caesarean section and having a greater chance of being diagnosed with autism or ADHD. But there’s no evidence caesarean sections cause them.Andrew Whitehouse, Bennett Chair of Autism, Telethon Kids Institute, Univeristy of Western Australia, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1167182019-05-14T10:46:17Z2019-05-14T10:46:17ZIs the brain parasite ‘Toxoplasma’ manipulating your behavior, or is your immune system to blame?<figure><img src="https://images.theconversation.com/files/273657/original/file-20190509-183106-7hivhq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The parasite _Toxoplasma gondii_ only reproduces sexually in cats.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/toxoplasma-gondii-disease-toxoplasmosis-cyst-3d-451646536?src=6OOaAcfnnosUsp1NPTTkXw-1-53">fotovapl/Shutterstock.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>We’re not the same when we get sick. Whether it is sneezing when we get a cold, or ferociously biting people when we get rabies, germs change our behavior.</p>
<p>That’s because germs need to transmit from one host to another. Consequently, host behavior is usually altered in ways that help the pathogen spread. Rabies, for example, causes infected animals to aggressively bite others because the virus transmits through saliva. But some microbes are more subtle.</p>
<p><em>Toxoplasma gondii</em> parasites, which sexually reproduce only in cats but can infect any animal, hijack the brain and affect the host’s behavior. In a turn of events that would make Charles Darwin smile, rats and mice infected with <em>Toxoplasma</em> behave in ways that make them easy prey for cats – exactly where <em>Toxoplasma</em> wants to go. </p>
<p>The ability of <em>Toxoplasma</em> to disrupt such basic instincts in rodents is alarming when you consider that <a href="https://doi.org/10.1079/AHR2005100">one-third of humans also carry this parasite’s cysts in their brain</a>. Latent toxoplasmosis in humans has been associated with serious neurological disorders, including <a href="https://doi.org/10.1016/j.neubiorev.2018.11.012">schizophrenia, intermittent explosive (rage) disorder and suicide</a>, but has never been shown to be a direct cause.</p>
<p>Could the parasite be manipulating people as well? Is there a way we can get rid of this parasite and, if so, would behavior return to normal?</p>
<p>I am a microbiologist who has been studying <em>Toxoplasma</em> for over 20 years. Not only have I found the parasite’s effects on its host to be endlessly fascinating, I have been trying to identify its vulnerabilities so physicians can better treat this currently incurable lifelong infection.</p>
<p>In a collaboration with biochemist <a href="https://medicine.iu.edu/faculty/15110/wek-ronald/">Ronald Wek</a> and neuroscientist <a href="https://science.iupui.edu/people/boehm-stephen">Stephen L. Boehm II</a>, we have made the surprising discovery that the parasites may not be directly manipulating its rodent host. Rather, the host’s immune response to the <a href="https://mbio.asm.org/content/10/2/e00381-19.long">chronic infection may be to blame</a>.</p>
<h2>Your brain on <em>Toxoplasma</em></h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273629/original/file-20190509-183089-1su4kwj.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">Toxoplasma cyst, green, in a section of brain tissue. The nuclei are stained blue.</span>
<span class="attribution"><span class="source">Jennifer Martynowicz</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p><em>Toxoplasma</em> is a single-celled parasite that really gets around - it has managed to infiltrate the brains of billions of creatures around the world, from birds to beluga whales. Of all the species <em>Toxoplasma</em> can infect, though, only cats support its sexual stage. After sex in the cat gut, <em>Toxoplasma</em> is packaged into sturdy pods called oocysts that are released into the environment via feces, and can then be ingested or inhaled by other animals.</p>
<p>Infection with <em>Toxoplasma</em> does not usually produce symptoms in humans unless their immune systems are compromised, but the parasites remain in the body for life as latent tissue cysts. These tissue cysts are commonly found in the brain, heart and skeletal muscle. The formation of tissue cysts occurs in all infected animals, including many that end up on our dinner plate. Consumption of these tissue cysts in raw or undercooked meat also transmits the infection.</p>
<p>Another way these tissue cysts serve as a vehicle for parasite transmission is through the alteration of host behavior. Rats and mice with latent toxoplasmosis become hyperactive and lose their instinctual fear of cats, essentially making them a free lunch for felines.</p>
<p>Jennifer Martynowicz, an M.D.-Ph.D. student in my lab, was intrigued by the ability of latent toxoplasmosis to alter the behavior of mice. It has long been a mystery as to how exactly this little microbe, which seems inert when encased in its tissue cyst wall, manages to pull off such a feat. It is known that <a href="https://doi.org/10.1128/CMR.00005-17"><em>Toxoplasma</em> releases an arsenal of parasite proteins into host cells</a> that can alter gene activity, but how this translates into altering behavior remains unknown.</p>
<p><a href="https://doi.org/10.1128/AAC.01683-15">Previous work in our lab</a> found that guanabenz, an FDA-approved drug used to treat hypertension, significantly reduces the number of brain cysts in an infected strain of mice we call BALB/c. Using this drug, Martynowicz was able to address a fundamental question: If we reduce the number of parasite cysts in the brain, can we restore normal behavior? </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/273887/original/file-20190510-183089-4g914a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273887/original/file-20190510-183089-4g914a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=321&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273887/original/file-20190510-183089-4g914a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=321&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273887/original/file-20190510-183089-4g914a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=321&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273887/original/file-20190510-183089-4g914a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=404&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273887/original/file-20190510-183089-4g914a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=404&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273887/original/file-20190510-183089-4g914a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=404&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mice infected with <em>Toxoplasma gondii</em> are unafraid of cats.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-mouse-coming-out-hole-97810163?src=6US3A-M5To7wDrHL4s1LCQ-1-4">Fer Gregory/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2><em>Toxoplasma</em> changes behavior – drug reverses it</h2>
<p>Martynowicz administered guanabenz for three weeks to the mice that were hyperactive due to latent toxoplasmosis. When Martynowicz examined the brains of the treated mice and mice that received no guanabenz, she discovered that cyst counts were lowered about 75% in treated mice, reinforcing the results from prior studies. </p>
<p>In the first demonstration of its kind, Martynowicz then examined whether the reduction in cysts affected activity levels in the mice. To our delight, the hyperactivity usually seen in mice with latent toxoplasmosis had disappeared. The animals treated with guanabenz behaved like normal, uninfected mice.</p>
<p>So it looked like our lab’s hypothesis was correct: Brain cysts correlated with behavior changes.</p>
<p>To be certain that the hyperactivity was caused by the cysts, Martynowicz decided to examine the effect of guanabenz in a different mouse strain called C57BL/6, which are more susceptible to <em>Toxoplasma</em>. In this mouse strain, guanabenz did not lower cyst counts. But it reversed the hyperactive behavior. These unexpected findings showed that the hyperactivity in infected mice does not correlate with the number of parasite brain cysts after all.</p>
<p>To address this puzzling discrepancy, Martynowicz examined the level of inflammation in the brains of these mice. <a href="https://doi.org/10.1186/1742-2094-5-48">Other investigators</a> have observed that latent parasite cysts in the brain recruit immune cells, producing a low level of sustained inflammation. </p>
<h2>Is brain inflammation changing behavior?</h2>
<p>Guanabenz is known to have <a href="https://doi.org/10.3390/ijms17050674">anti-inflammatory effects</a>. Decreasing brain inflammation is exactly what it appears to be doing in the brains of both infected mouse strains. These results suggest that the hyperactivity in infected mice is more likely driven by their immune response rather than a parasite-driven manipulation. If so, the key to controlling some behavioral changes in infected animals may be modulating their immune response.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/273653/original/file-20190509-183089-pyvquv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These two cartoons show the impact of guanabenz in two different strains of mice. The results suggest that brain inflammation may be to blame for behavioral changes.</span>
<span class="attribution"><span class="source">Jennifer Martynowicz</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>We do not yet know how neuroinflammation may lead to hyperactivity. But it is interesting to note that <a href="https://doi.org/10.3389/fpsyt.2017.00228">some emerging studies</a> have also found a link between inflammation and attention-deficit hyperactivity disorder (ADHD), <a href="https://www.cdc.gov/ncbddd/adhd/data.html">which affects more than 6 million children in the U.S.</a></p>
<p>If our findings in mice, published in the journal <a href="https://mbio.asm.org/content/10/2/e00381-19.long">mBio</a>, extend to people, it could have important ramifications for how we currently treat brain infections. Our results suggest that brain infections may cause neurological consequences only in a subset of people, based on their immune response. Further studies are needed to determine if anti-inflammatory drugs like guanabenz may be effective at managing these conditions.</p><img src="https://counter.theconversation.com/content/116718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan works for Indiana University School of Medicine and his research is supported by grants from the National Institutes of Health.</span></em></p>The parasite Toxoplasma gondii infects hosts, causes cysts in the brain and changes the behavior of the host. But is the microbe changing the hosts behavior or is the immune system to blame?Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1063792018-12-06T12:35:00Z2018-12-06T12:35:00ZSouth Africa’s children aren’t getting the mental health care they need<figure><img src="https://images.theconversation.com/files/247708/original/file-20181128-32185-kmorri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mental health clinics exist in South Africa's public health sector, but children with ADHD often never reach them.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Attention-deficit/hyperactivity disorder (ADHD) has received increased scientific, clinical and public <a href="https://sajp.org.za/index.php/sajp/article/view/1072/936">attention</a> over the past few decades. It’s the most common psychiatric disorder in children – affecting <a href="https://chadd.org/about-adhd/treatment-data/">2% to 16%</a> of the school going population.</p>
<p>But in South Africa data on prevalence rates, access to care, and treatment for ADHD is limited. Despite the known efficacy of treatment, access to health care and treatment remains limited for many children in the country. This is a problem as untreated ADHD results in substantial costs and has a negative impact both on educational attainment and quality of life.</p>
<p>We have recently completed <a href="https://sajp.org.za/index.php/sajp/article/view/1293/1253">a study</a> that looked at the mental health barriers South African school children face. Our research focused on the work of a not for profit organisation, set up in 2017 to provide mental health screening services for school children and with a particular focus on ADHD. </p>
<p>Our research found a prevalence rate of 2.5% among the more than 500 children we screened at 13 schools. However, most of the children referred to us were in their foundation phase of schooling – that’s, aged between about 5 and 14. It’s possible that many of the children in the higher grades may also be struggling with ADHD and other mental health disorders but were not referred. </p>
<p>More significantly, our research shows that there are very low levels of awareness among teachers who had very stereotypical views of how ADHD presents itself. There was a lot of stigma attached to the condition. </p>
<p>It was also clear from our research that various government departments which should be working collaboratively – such as education, health and social development – are working in silos, each with separate processes and procedures. This hinders the provision of services for children.</p>
<h2>Falling through the cracks</h2>
<p>Although there are mental health clinics in the public sector, children with ADHD and other mental health disorders often never reach this point of diagnosis and treatment due to poor service delivery. </p>
<p>And on the schooling front, the Department of Basic Education requires that children first be assessed and assisted by <a href="http://www.included.org.za/wp-content/uploads/2018/01/PRINT_IESA_EU-Factsheet-04_Role-Function-of-the-SBST.pdf">school based support teams</a> before they are referred for treatment. </p>
<p>These teams are responsible for, among other things, identifying children’s needs. In collaboration with teachers, they should assess individual pupils and provide support where necessary. However, 61% of the children were directly referred to the not for profit organisation by teachers. That’s because the school support teams were not functional in most of the schools which we visited. </p>
<p>The NGO visited 18 schools and 13 participated in the screening. The schools are located in the Metro North Educational District in Cape Town and are all in underprivileged areas where no school fees are being charged. </p>
<h2>Findings</h2>
<p>Just more than 500 children between the ages of five and 14 years were screened. They were referred to the NGO for screening by teachers due to learning difficulties (86%), behavioural problems (41%) and emotional difficulties such as anxiety or depression (33%). </p>
<p>More than 50% of the children referred to the NGO presented with ADHD, or symptoms that suggested they may have the disorder. In the total group of screened children 4% had been previously diagnosed with ADHD. </p>
<p>We have referred 67% of the children for further evaluations to confirm diagnoses or to exclude other conditions which can “mimic” or accompany ADHD, while 10% of the children were referred back to the support teams without any intervention other than recommending school support and parental guidance. </p>
<p>The prevalence rate of 2.5% is lower than the international prevalence rates of 5% to 16%. This may reflect a number of factors, including a lack of awareness of the disorder, misconceptions about the disorder in the community and stigma. </p>
<p>Other factors that could have affected our findings were that teachers opted not to refer any children – possibly because of their workload. There was also a tendency to refer children who met the “classical” picture the public has of ADHD: a naughty, hyperactive boy. This would have led to silent daydreamers – usually girls – not being identified. </p>
<h2>Gaps in the system</h2>
<p>Mental health clinics do exist in South Africa’s public health sector, but children with ADHD often never reach this point of diagnosis and treatment. Although medication plays and important role in the treatment in some of these children, behavioural interventions as well as educational and emotional support are also crucial. </p>
<p>The results from our study highlight the need to raise awareness and reduce stigma. Collaboration between government departments are crucial to reduce, and remove, mental health barriers to education. Early diagnosis and intervention is essential to prevent long term consequences.</p><img src="https://counter.theconversation.com/content/106379/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prof Renata Schoeman is a co-founder of the Goldilocks and The Bear Foundation, associate professor in Leadership at the University of Stellenbosch Business School, a psychiatrist in private practice, and convenor of the SASOP Special Interest Group for ADHD. She have received sponsorships from Aspen, Shire, Janssen, Lundbeck, Cipla, and Dr Reddy, and speaker fees from Servier, Sanofi/Zentiva, Janssen, Lundbeck, Lilly, Dr Reddy, Adcock, Mylan, and Shire.
</span></em></p>School children with attention-deficit/ hyperactivity disorder (ADHD) have limited access to care in South Africa’s education and health sectors.Renata Schoeman, Associate professor, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/921512018-03-13T10:42:53Z2018-03-13T10:42:53ZWhy is ADHD more common in boys than girls?<figure><img src="https://images.theconversation.com/files/209980/original/file-20180312-30975-lntju3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Classroom distraction.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lesson-class-hyperactive-child-boy-indulges-432985345">Tatyana Dzemileva/Shutterstock</a></span></figcaption></figure><p>About one in 20 children <a href="https://www.nature.com/articles/nrdp201520">are diagnosed</a> with attention deficit hyperactivity disorder (ADHD) at some point during their school life. Interestingly, for every girl diagnosed, there are between three and seven boys who receive an ADHD diagnosis. </p>
<p>Children and adolescents who are affected by ADHD have difficulty with things like sitting still, organisation and concentrating on work. These and other symptoms often make the school environment hard to cope with, and have a negative impact on academic achievement, relationships, and future employment opportunities. Some children do grow out of their ADHD symptoms, but many continue to experience problems as adults. </p>
<p>Though medication has been developed to relieve the symptoms, little is known about <a href="http://adc.bmj.com/content/97/3/260">ADHD’s exact causes</a>. Our biggest clue has come from family studies – particularly those comparing ADHD symptoms in identical and fraternal twins – which have long indicated that ADHD is <a href="http://adc.bmj.com/content/97/3/260">largely genetic</a>. And recently, <a href="https://www.biorxiv.org/content/early/2017/06/03/145581">groundbreaking research</a> has begun to identify the specific genetic risk factors related to ADHD, and to reveal the complexity of the condition. We now know that thousands of different genetic risk factors – including common variants in genes known to affect healthy brain development – collectively contribute to increase the risk of ADHD. But it is still not yet clear why there is a gender difference in prevalence. </p>
<p>There are many theories as to why ADHD is more commonly diagnosed in boys than girls. One possibility is that girls are in some way “protected” from developing ADHD, and so it takes a <a href="http://www.jaacap.com/article/S0890-8567(16)30104-6/abstract">higher burden of risk factors</a> than in boys for girls to develop problems. Another possibility is that ADHD symptoms are <a href="https://link.springer.com/article/10.2165/00023210-200620020-00003">missed in girls</a> or that mental health problems in girls develop into <a href="http://www.psychiatrist.com/pcc/article/Pages/2014/v16n03/13r01596.aspx">problems other than ADHD</a>.</p>
<h2>Girls and boys</h2>
<p>Together with a large international team of researchers, I have been investigating the possible explanations for the childhood gender difference in ADHD in a series of studies. </p>
<p>We looked into the genetic risk factors which occur commonly in lots of people (known as <a href="https://ghr.nlm.nih.gov/primer/genomicresearch/snp">single nucleotide polymorphisms</a>). To do this we used the world’s largest genetic dataset of people with and without ADHD (about 55,000 people). <a href="http://www.biologicalpsychiatryjournal.com/article/S0006-3223(17)32245-X/fulltext?rss=yes">We found that</a> the same genetic variants increase risk of ADHD in girls and boys.</p>
<p>However, in contrast to <a href="https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2013.12081129">previous smaller studies</a>, we found no evidence to suggest that girls have a greater burden of these types of risk factors compared to boys. So, our results suggest that genetic risk factors which occur less commonly – or some other factors – may contribute to the lower rates of ADHD diagnosis in girls.</p>
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<p>We also looked at family data from 2m people in Sweden, where we found some small but important gender differences. <a href="http://www.biologicalpsychiatryjournal.com/article/S0006-3223(17)32245-X/fulltext?rss=yes">These results suggested</a> that girls with ADHD may have a more clinically complex presentation. That is to say they may have a greater risk of having autism and other developmental problems at the same time as ADHD. </p>
<p>We also found that the siblings of girls with ADHD are at a slightly greater risk for ADHD than the siblings of affected boys. This indicates that there might be a somewhat greater burden of risk factors in families with girls who are diagnosed with ADHD. Given that commonly occurring genetic risk factors do not seem to be elevated in girls, other familial factors will be important for future investigation, to help us understand what is going on. </p>
<h2>Mental health</h2>
<p>In <a href="http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12874/full">a separate study</a> we examined the possibility that genetic risk factors for ADHD might be linked to different mental health problems in boys and girls. We studied data from about 1,000 Swedish and British children with anxiety or depression, and found that in the group of children who had received real-life clinician’s diagnoses (based on national registry data) of anxiety and depression, girls had a higher burden of the genetic variants known to increase risk for ADHD compared to boys. But the difference was not present when all children were screened for anxiety and depression as part of the research studies. </p>
<p>These results indicate that genetic risk factors related to ADHD may be more likely to be clinically diagnosed as anxiety or depression in girls than in boys. If confirmed in other studies, this could give important clues as to why ADHD is less commonly diagnosed in girls than in boys. </p>
<p>More work is needed to confirm and further explore these results. Genetic effects are complex, and how they affect individuals can be rather small. There also needs to be more research examining different types of risk factors, such as less commonly occurring genetic mutations found in genes that are important for brain development. </p>
<p>What our results do suggest is that girls who are presenting with any anxiety, depression or ADHD symptoms, as well as their family members, might benefit from careful screening for these clinical problems. In any case, gender-specific early and accurate diagnosis of mental health problems is necessary to make sure that all children have the support they need.</p><img src="https://counter.theconversation.com/content/92151/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanna Martin receives funding from The Wellcome Trust.</span></em></p>For every girl diagnosed with ADHD, up to seven boys are diagnosed. Researchers looked at risk factors, the role of genetics, and mental health for clues.Joanna Martin, Research Associate, Division of Psychological Medicine and Clinical Neurosciences, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/863772017-11-16T22:09:53Z2017-11-16T22:09:53ZFourteen signs your daughter may have ADHD<figure><img src="https://images.theconversation.com/files/194857/original/file-20171115-19789-fgxfrd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Does your daughter forget or misplace things all the time? Is she the classroom helper? Assessment scales for ADHD have tended to use data from boys so the signs of ADHD in girls may not be what you expect. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>When asked to describe a typical child with attention deficit hyperactivity disorder (ADHD), most people would describe a young boy who climbs on things, is impatient and does not do what he is told. Few people would describe a bubbly young girl with lots of friends, who works hard to get good grades. </p>
<p>It may be, however, that the girl does experience ADHD symptoms that interfere with her daily life — and that these symptoms are overlooked by the adults around her. </p>
<p>Undiagnosed ADHD has long-term consequences including <a href="http://dx.doi.org/10.1111/cch.12380">an increased likelihood of engaging in risky behaviours</a> — such as unprotected sex and substance use — as well as <a href="http://www.addvance.com/help/women/daughter.html">academic underachievement and low self-esteem</a>. Perhaps most alarmingly, girls who struggle with ADHD for a long period of time <a href="http://dx.doi.org/10.1111/cch.12380">can suffer from mental health problems</a>. </p>
<p>As a psychologist in clinical practice, I used to see many older girls and adult women with ADHD who had already been prescribed medication to treat anxiety and depression. Early diagnosis then is vital. </p>
<h2>Assessment scales use data from boys</h2>
<p>Individuals with ADHD exhibit three main clusters of symptoms: hyperactivity, impulsivity and inattention. Although three times as many boys are diagnosed with ADHD in childhood than girls, the <a href="http://dx.doi.org/10.1177/1087054711416909">diagnostic rates in adults are more equally divided between males and females</a>. This suggests girls go unnoticed when they are younger. </p>
<p>As a disorder traditionally seen as affecting males, and with males referred more often for a diagnosis, research to assess ADHD has been based on samples largely consisting of boys. It has been argued that the rating scales developed to assess ADHD have been <a href="http://dx.doi.org/10.1177/1087054711416909">based on the behaviours observed in the mainly male research samples</a>. </p>
<p>ADHD can look different in girls than boys. A boy who is hyperactive might have trouble sitting in his seat in the classroom — so he sits with one knee on the seat and one foot on the floor. It is likely, given his constant shifting and unequal balance on the seat, that the back legs of the chair will eventually lift up and the chair pitch forward causing the boy to fall to the floor.</p>
<p>In contrast, a hyperactive girl may be out of her seat but have taken on the role of classroom helper, wandering around to different desks. A teacher completing a rating scale might rate the boy higher on hyperactive questions than the girl because the second example is not seen as disruptive. Thus, girls do not score as high as boys on these scales and are underrepresented because they do not meet criteria for a diagnosis.</p>
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<img alt="" src="https://images.theconversation.com/files/194862/original/file-20171115-19789-10ujki4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194862/original/file-20171115-19789-10ujki4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194862/original/file-20171115-19789-10ujki4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194862/original/file-20171115-19789-10ujki4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194862/original/file-20171115-19789-10ujki4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194862/original/file-20171115-19789-10ujki4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194862/original/file-20171115-19789-10ujki4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Does homework take your seemingly studious daughter longer than it should?</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Not only do symptoms of ADHD look different in boys but boys also have a tendency to be more hyperactive and impulsive than girls. Because hyperactive and impulsive behaviours are more disruptive in the classroom, teachers are more likely to notice boys as a problem and refer them for attention challenges. </p>
<p>Lastly, <a href="http://dx.doi.org/10.1002/jclp.20121">symptoms of ADHD in girls are sometimes masked because they work hard to meet adult expectations</a>. Without meaning to, adults have different expectations of girls than boys. In my clinical experience, adults expect girls to be tidy and organized, achieve good grades and to be easygoing. In turn, girls are more likely to want to obey social norms and not cause trouble. They will work extra hard to achieve success by staying up late to finish homework or tidying their rooms when asked. </p>
<p>Sometimes, when adults encounter girls who have difficulty meeting their expectations but the girls are agreeable, <a href="https://books.google.ca/books/about/Understanding_Girls_with_AD_HD.html?id=rpLgAAAAMAAJ&redir_esc=y">they excuse the behaviours by describing the girls as “ditzy,” “dramatic” or “artsy.</a>” </p>
<h2>Signs that your daughter might have ADHD</h2>
<p>There are many symptoms of ADHD shared by both boys and girls. The following are examples of how they can manifest in girls:</p>
<ol>
<li><p>Homework takes longer than it should. She forgets about it or is distracted by surfing the internet or texting her friends and ends up staying up late the night before an assignment is due to finish it.</p></li>
<li><p>She is an inefficient student. While she appears to study for tests, her performance does not seem to match the time spent studying.</p></li>
<li><p>She has weak reading comprehension. She can get facts from a text but does not make links between the ideas she reads. She misses details in instructions on assignments and tests.</p></li>
<li><p>She struggles with friendships because she does not read social cues or follow conversations. Peers start to reject and isolate her or make fun of her.</p></li>
<li><p>She forgets things she needs (e.g. dance shoes or soccer cleats). This is a classic sign but agreeable girls with ADHD will often have friends or adults who compensate for them (for example sharing a pen because she doesn’t have one).</p></li>
<li><p>She misplaces her things regularly (for example her phone, keys or bank card).</p></li>
<li><p>She talks, and talks and talks.</p></li>
<li><p>She does not run and climb about like boys but is the classroom helper and is social and chatty in class. </p></li>
<li><p>She has lots of friends because she is fun to be around but when she tries to organize activities she seems anxious and indecisive. Her friends help her make decisions, find her things and keep her organized.</p></li>
<li><p>She has great ideas and wants to start acting on them right away but does not finish projects or follow through.</p></li>
<li><p>She is chronically late or is not ready when she needs to be.</p></li>
<li><p>She channels hyperactivity by being involved in many extracurricular activities like swimming, school clubs and soccer. </p></li>
<li><p>She does not seem to learn from consequences.</p></li>
<li><p>She has wide swings in mood. One moment she is on top of the world and the next moment she is crushed because of a casual comment that is taken as harsh criticism.</p></li>
</ol>
<p><em>If you think your daughter might have ADHD, you should consult with a psychologist or pediatrician who is familiar with ADHD and can provide an in-depth assessment.</em></p><img src="https://counter.theconversation.com/content/86377/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meadow Schroeder 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>Assessment scales for ADHD have been developed using mostly male research samples. As a result, the behaviours indicating ADHD in girls may not be what you expect.Meadow Schroeder, Assistant Professor of Education, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/796252017-07-26T01:52:36Z2017-07-26T01:52:36ZHelping your student with disabilities prepare for the future<figure><img src="https://images.theconversation.com/files/179682/original/file-20170725-30157-b1t0co.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Planning is important for any teen on their way to college – but for those with disabilities, it's absolutely imperative.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ncvophotos/8547312501/">NCVO London</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Summer is a busy time for high school juniors. They’re getting ready to say goodbye to school as they know it and they’re researching colleges, visiting campuses and trying to figure out what college fits their needs.</p>
<p>Planning is an important part of this process, but for parents and guardians of students with disabilities, this is especially true.</p>
<p>As a professor and <a href="https://doi.org/10.1177/0014402915615884">researcher in special education</a>, I’ve worked with many students with disabilities transitioning to college. The ones who are typically most successful after high school are the ones who were prepared to be strong self-advocates, who could seek out needed services and supports, and who could manage the multiple demands of being independent. </p>
<p>These are all skills that can – and should – be taught at the middle and high school level. Whether it’s understanding your child’s disability and legal rights or figuring out what accommodations and study habits work best, preparation is key.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179683/original/file-20170725-30152-14rqvcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179683/original/file-20170725-30152-14rqvcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179683/original/file-20170725-30152-14rqvcz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179683/original/file-20170725-30152-14rqvcz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179683/original/file-20170725-30152-14rqvcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179683/original/file-20170725-30152-14rqvcz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179683/original/file-20170725-30152-14rqvcz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Campus tours are a part of many high school students’ planning process.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/washington-dc-usa-march-30-2016-400258873">Rob Crandall/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>A wide range of disabilities on college campuses</h2>
<p>According to a 2016 report by the United States Department of Education, approximately <a href="https://nces.ed.gov/fastfacts/display.asp?id=60">11 percent of all undergraduates</a> report having a disability – up from <a href="https://nces.ed.gov/pubs99/1999187.pdf">6 percent</a> almost two decades prior. Since nearly two-thirds of all students who received special education services in high school did not self-disclose their disability to a college, the actual number of students with disabilities on campuses <a href="https://nlts2.sri.com/reports/2011_09_02/nlts2_report_2011_09_02_ch2.pdf">is likely much higher</a>. </p>
<p>Most of these students have what are often called “nonvisible” disabilities, including learning disabilities, attention deficit/hyperactivity disorder and, increasingly, mental health disorders such as <a href="http://www.bu.edu/today/2016/mental-health-college-students/">anxiety or depression</a>.</p>
<p>Students with <a href="https://www.facultyfocus.com/articles/effective-classroom-management/teaching-college-students-with-autism-spectrum-disorders/">autism spectrum disorders</a> are also more often attending college than a decade ago. And on some campuses, programs are emerging for students with <a href="https://www.theatlantic.com/education/archive/2017/05/the-path-to-higher-education-with-an-intellectual-disability/524748/">intellectual disabilities</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179684/original/file-20170725-30152-wr6xwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179684/original/file-20170725-30152-wr6xwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179684/original/file-20170725-30152-wr6xwp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179684/original/file-20170725-30152-wr6xwp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179684/original/file-20170725-30152-wr6xwp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179684/original/file-20170725-30152-wr6xwp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179684/original/file-20170725-30152-wr6xwp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A student and instructor work on skills necessary for college success at the West Virginia Autism Training Center at Marshall University in Huntington, West Virginia.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/AP-A-WV-USA-College-Autism/86853eb874d541cd9e2a6009525ef3e3/9/0">AP Photo/Jeff Gentner</a></span>
</figcaption>
</figure>
<h2>A change in legal status</h2>
<p>Many of these students receive special education services during some (or all) of their kindergarten through 12th grade school years. </p>
<p>For many, these services are provided under the Individuals with Disabilities Education Act of 2004 (<a href="http://www.wrightslaw.com/idea/law.htm">IDEA</a>). The IDEA requires a free and appropriate education, in the least restrictive environment, that meets the individual needs of students. A team of professionals work with the student’s family or guardians to develop an Individualized Education Program (IEP). The IEP outlines the student’s strengths and needs, sets annual goals and determines what modifications might be required to help the student meet those goals.</p>
<p>Other students with disabilities don’t need IDEA. They qualify for services under <a href="https://www2.ed.gov/policy/rights/reg/ocr/edlite-34cfr104.html#D">Subpart D</a> of <a href="http://www.wrightslaw.com/info/sec504.index.htm">Section 504</a> of the Rehabilitation Act of 1973, which is a civil rights law (not a special education law) that prohibits discrimination on the basis of disability.</p>
<p>However, in both of these cases, services end at graduation. Special education services and individualized support and instruction required by the IDEA are not available in college.</p>
<p>At the college level, students with disabilities may be covered under a different part of the Rehabilitation Act. (Subpart D of Section 504 covers K-12, while <a href="https://www2.ed.gov/policy/rights/reg/ocr/edlite-34cfr104.html#E">Subpart E</a> covers post-secondary.) Subpart E protects college students with disabilities against discrimination and requires that they be provided equal access to all aspects of the academic program and facilities – provided that the student gains admission into college and maintains eligibility to remain enrolled, without consideration of their disability.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179686/original/file-20170725-30103-1vqq68c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179686/original/file-20170725-30103-1vqq68c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179686/original/file-20170725-30103-1vqq68c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179686/original/file-20170725-30103-1vqq68c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179686/original/file-20170725-30103-1vqq68c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179686/original/file-20170725-30103-1vqq68c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179686/original/file-20170725-30103-1vqq68c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">President George W. Bush signs the Individuals with Disabilities Education Improvement Act in 2004.</span>
<span class="attribution"><a class="source" href="https://georgewbush-whitehouse.archives.gov/news/releases/2004/12/images/20041203-6_la6g1658jpg-515h.html">White House photo by Tina Hager</a></span>
</figcaption>
</figure>
<p>If admitted, and if the student would like to receive accommodations, they must seek out disability services and provide the college with required information about the nature of the disability and how it impacts access to the physical environment or to learning. Often called “<a href="https://www2.ed.gov/about/offices/list/ocr/letters/parent-20070316.html">documentation</a>,” the specific requirements vary based upon disability type and, often, the college that the student attends.</p>
<p>It’s important to note that it’s the <a href="https://eric.ed.gov/?id=EJ1107472">student’s choice</a> to seek out and to use services at the college level. But it’s also important to know that students must self-identify as having a disability or else they’re not eligible for services – the college does not need to seek students out.</p>
<h2>How families can prepare</h2>
<p>There are several things that families can do to get ready for life after high school. The list below is by no means exhaustive. Each student with a disability has unique needs and questions that should be addressed.</p>
<p>In general, however, students and their families should:</p>
<p>• Learn more about the disability and the student’s unique characteristics. When leaving high school, the student should understand his or her own strengths, preferences and weaknesses – to be able to self-advocate, to use and adjust learning strategies that work for him or her, and to independently make life choices.</p>
<p>• Become active in the IEP or Section 504 process and be active members of the team that develops and monitors the individualized plan. Students are often left out of this process, but <a href="https://doi.org/10.1177/1053451208314910">should be included</a> as early as is appropriate and to the greatest extent possible, based on the student’s skills. </p>
<p>• Learn about accommodation needs. Students and families can work with individual teachers to request and set these up. High school is a great time for a student to learn how to monitor what’s useful and what’s not. Learning which accommodations are really needed will be an important skill in college or work life. </p>
<p>• Transition away from any modifications to instruction, tests or grading, and focus on the use of learning strategies. Changes to teaching methods and tests are generally not provided after high school. </p>
<p>• Work on time management skills. The college day is much less structured than the high school day. This creates many exciting opportunities for students, but also challenges. Students need to be prepared to productively and independently handle this free time.</p>
<p>• Research the disability supports offered at different colleges. Section 504 only requires colleges to ensure access and prohibit discrimination, but many colleges provide more extensive services and supports. This may affect what colleges you want to visit or apply to.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179687/original/file-20170725-30108-56bpyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179687/original/file-20170725-30108-56bpyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179687/original/file-20170725-30108-56bpyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179687/original/file-20170725-30108-56bpyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179687/original/file-20170725-30108-56bpyh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=580&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179687/original/file-20170725-30108-56bpyh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=580&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179687/original/file-20170725-30108-56bpyh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=580&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 help their children practice good study habits and time management that will greatly improve disabled students’ chances when they’re on their own.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-overlooks-her-teenaged-son-uses-656248012">Creatista/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>An exciting option</h2>
<p>Once you know what life after high school will bring, there’s even more you can do to prepare: Learn about the documentation requirements for the college you’ve chosen, get in touch with disability services and talk about needed accommodations and supports, and if appropriate for a student, think about transportation needs and access to medication or doctors.</p>
<p>But the most important thing is to simply start looking forward to the challenge ahead of you. College presents an exciting and viable option for students with disabilities. With preparation in high school (and knowing <a href="http://theconversation.com/how-to-succeed-in-college-with-a-disability-79226">what to do when you actually arrive</a> on campus) students with disabilities can succeed in college – or in whatever life after high school they choose.</p><img src="https://counter.theconversation.com/content/79625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Madaus receives funding from the Connecticut State Department of Education; the United States Department of Education. </span></em></p>Numerous measures are in place to help young disabled children thrive, but the transition beyond school can be a difficult one. Here are some tips for families to help their children prepare for life beyond.Joseph Madaus, Professor of Education, Associate Dean for Academic Affairs, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/767262017-06-22T11:33:17Z2017-06-22T11:33:17ZAre autistic people at greater risk of being radicalised?<p>Terror recruits often seem to come from vulnerable backgrounds. But <a href="http://www.emeraldinsight.com/doi/abs/10.1108/JIDOB-11-2016-0022">new research</a> suggests that those with traits of Autism Spectrum Disorder (ASD) could be more at risk of being radicalised. It follows a number of high-profile cases where autism appears to have played a role in the offender’s behaviour. So if people with ASD could be at higher risk, how can we protect them from falling under the spell of terror organisations such as the so-called Islamic State? </p>
<p>Terrorism involves committing violent acts for political, religious or ideological reasons. It can either be committed as part of an organised group or alone but it is traditionally characterised and understood as a <a href="http://www.terrorismanalysts.com/pt/index.php/pot/article/view/231">group phenomenon</a>. But a new type of terrorist threat has emerged in recent years – the “<a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2177295">lone wolf</a>”. Over the last decade, the rise of lone wolf terrorists has necessitated the need for an understanding of the pathway from radical ideology to radical violence. A greater understanding of this issue would inform the development of more effective <a href="http://www.defence.gov.au/ADC/Publications/IndoPac/Buggy_IPSP_Final.pdf">identification strategies</a>. </p>
<p>Given that the examination of any connection between ASD and terrorism is in its infancy, a simple categorical model describing different levels of commitment to a terrorist cause may be one step forward. Arie Kruglanski and colleagues <a href="http://onlinelibrary.wiley.com/doi/10.1111/pops.12163/full">describe</a> a “degree of radicalisation” scheme where different levels of commitment to different terrorist-related activities was identified. According to their scheme, the most prevalent group of individuals are those who are “passive supporters” (those who are sympathetic to the cause). Next, are individuals who are more active in the organisation (they may have an administrative function or recruit others). The next category involves individuals who actively support violence and are ready to fight for the cause. Lastly, they identify suicide bombers who are willing to give their lives. Lone wolf terrorism would fit this last category. </p>
<p>I have been <a href="http://www.emeraldinsight.com/doi/abs/10.1108/JIDOB-11-2016-0022">examining the link</a> between ASD and terrorism in collaboration with <a href="https://www.researchgate.net/profile/Lino_Faccini">Lino Faccini</a>, a New York State psychologist. Together we presented specific examples of people with ASD who had engaged in each level of commitment to different terrorist-related activities. We did this to illustrate how some of the symptoms of ASD can “help” make a pathway towards being inspired to act on behalf of a terrorist cause, join a terrorist organisation, engage in directed attacks – or indeed carry out lone wolf terrorism.</p>
<h2>‘Active supporters’ and lone wolves</h2>
<p>In 2015, <a href="http://www.esquire.com/news-politics/a47390/alabama-isis-peyton-pruitt/">Peyton Pruitt</a> – a youngster diagnosed with Autism, mild intellectual disability and Attention Deficit Disorder – was arrested in Alabama for sending bomb making instructions to a person he believed was part of IS. This case may be about a naive and vulnerable person, who spent an exceptional amount of time scouring the internet without supervision. But in doing so he became fascinated or fixated with terrorism. Subsequently he found some affiliation with others whom he could relate to, via the safety of the internet. As a result, he was then exploited and/or became sympathetic to and inspired by IS. </p>
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<p>Another case we discussed was that of <a href="https://www.theguardian.com/uk/2008/may/25/uksecurity.terrorism">Nicky Reilly</a>, an 18-year-old man, diagnosed with Asperger’s Syndrome. Reilly did not have many friends and lived in a poor area of Plymouth, England. Reilly clearly had difficulties relating to other people and had a fixation with terrorism and martyrdom. He sought and found affiliation (and also what he believed was the right life). He became a practising Muslim in 2002. After his girlfriend left him, he befriended a group of Muslim men. Reilly became obsessed with martyrdom and with the Twin Tower attacks. He had posters of the attacks on his wall and as wallpaper on his computer. He would watch videos of the 9/11 attacks and watch video clips of beheadings. Reilly believed that he would be entitled to a better life if he died a Muslim. </p>
<p>Eventually, he changed his name to Mohammed Rasheed. Reilly also turned on his family calling them “infidels”. He devised a plan to make three crude bombs, and strap them to his chest as a suicide bomber, then run out in a crowded restaurant killing as many people as possible. Reilly went into the bathroom of a restaurant with bottles containing sodium hydroxide, paraffin and nails. But when he activated the bomb, he had difficulty opening the bathroom stall door and it exploded. He was seriously injured. Tragically, <a href="http://www.bbc.co.uk/news/uk-england-devon-37721020">Reilly took his own life</a> while in prison some eight years later in 2016. </p>
<h2>Risk factors</h2>
<p>It is important to caution here that there is no substantial link between ASD and terrorism. However, there may be specific risk factors which <a href="http://europepmc.org/abstract/med/27236173">could increase the risk of offending</a> among people with ASD. Autistic special interests such as fantasy, obsessiveness (extreme compulsiveness), the need for routine/predictability and social/communication difficulties can all increase the vulnerability of an person with ASD to going down the <a href="http://programme.exordo.com/autismeurope2016/delegates/keynote/12/">pathway to terrorism</a>.</p>
<p>Searching for a “need to matter” or social connection and support for someone who is alienated or without friends may also present as risk factors. People with an ASD may be more vulnerable to being drawn into increasingly more involved commitment. They also have a tendency to hyper-focus in on their fascinations and interests at the expense of other attachments and life interests. These are potentially the conditions which extremists are increasingly exploiting in people they <a href="http://hub.salford.ac.uk/salfordpsych/2016/03/15/certain-mental-disorders-put-people-risk-radicalised/">target for recruitment</a> and training.</p>
<p>Our findings clearly highlight the need for clinicians carrying out forensic evaluations of people who have engaged in terror-related actions to investigate whether ASD may be related to their behaviour. Such evaluations are vital – not just in delivering justice – but also to ensure rehabilitation and offender management are informed by an understanding of the ASD diagnosis in each case.</p><img src="https://counter.theconversation.com/content/76726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Allely receives funding from the Gillberg Neuropsychiatry Centre. She is affiliated with the Gillberg Neuropsychiatry Centre at Gothenburg University, Sweden. Clare is also an Honorary Research Fellow in the College of Medical, Veterinary and Life Sciences affiliated to the institute of Health and Wellbeing at the University of Glasgow.</span></em></p>People suffering from autism could be far more vulnerable to falling under the spell of terror organisations on the look-out for new recruits.Clare Allely, Lecturer in Psychology, University of SalfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/774562017-05-18T00:54:59Z2017-05-18T00:54:59ZFidget toys aren’t just hype<figure><img src="https://images.theconversation.com/files/169815/original/file-20170517-2399-pt8l8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Balancing and doing tricks requires visual attention.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-teenager-spinning-fidget-spinner-device-641169160">ThamKC via shutterstock.com</a></span></figcaption></figure><p><em>An updated version of this article was published on May 7, 2021. <a href="https://theconversation.com/popping-toys-the-latest-fidget-craze-might-reduce-stress-for-adults-and-children-alike-158746">Read it here</a>.</em></p>
<p>The fidget spinner craze has been <a href="http://www.cbsnews.com/news/fidget-spinner-craze-is-sweeping-the-u-s-but-some-schools-say-theyre-discractions/">sweeping elementary and middle schools</a>. As of May 17 <a href="https://www.amazon.com/Best-Sellers-Toys-Games/zgbs/toys-and-games#1">every one of the top 10 best-selling toys on Amazon</a> was a form of the hand-held toy people can spin and do tricks with. Kids and parents are even making them for themselves using <a href="https://www.thingiverse.com/glitchpudding/collections/fidget/page:1">3D printers</a> and other <a href="http://kidsactivitiesblog.com/107885/make-fidget-spinner">more homespun crafting techniques</a>.</p>
<p>But some teachers are <a href="http://time.com/money/4765188/fidget-spinners-ban-schools-classrooms-teachers/?xid=homepage">banning them from classrooms</a>. And <a href="http://time.com/money/4774133/fidget-spinners-adhd-anxiety-stress/">experts challenge the idea</a> that spinners are good for conditions like ADHD and anxiety. Meanwhile, the <a href="https://www.kickstarter.com/projects/antsylabs/fidget-cube-a-vinyl-desk-toy">Kickstarter online fundraising campaign</a> for the Fidget Cube – another popular fidget toy in 2017 – raised an astounding US$6.4 million, and can be seen on the desks of hipsters and techies across the globe. </p>
<p>My research group has taken <a href="https://doi.org/10.1145/2971485.2971557">a deep look at how people use fidget items</a> over the last several years. What we found tells us that these items are not <a href="https://theconversation.com/whats-behind-the-fidget-spinner-fad-77140">a fad that will soon disappear</a>. Despite sometimes being an <a href="http://www.npr.org/2017/05/14/527988954/whirring-purring-fidget-spinners-provide-entertainment-not-adhd-help">annoying distraction for others</a>, fidget items can have some practical uses for adults; our inquiry into their usefulness for children is underway.</p>
<h2>Understanding fidgeting</h2>
<p>Fidgeting didn’t start with the spinner craze. If you’ve ever clicked a ballpoint pen again and again, you’ve used a fidget item. As part of our work, we’ve asked people what items they like to fidget with and how and when they use them. (We’re <a href="http://fidgetwidgets.tumblr.com">compiling their answers online</a> and welcome <a href="http://fidgetwidgets.tumblr.com/submit">additional contributions</a>.)</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169817/original/file-20170517-24350-hq4ai4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People fidget with everyday items such as paper clips.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/metal-paperclip-isolated-on-white-background-198562463">MaIII Themd via shutterstock.com</a></span>
</figcaption>
</figure>
<p>One thing people often report is that fidgeting with an object in the hand helps them to stay focused when doing a long task or sitting still and attentive in a long meeting. Many examples people have told us about are ready-to-hand objects like paper clips, USB thumb drives, headphone earbuds and sticky tape. But people also buy specialized items like a fidget spinner or a Fidget Cube for this purpose.</p>
<p>Another common thread involves people using some fidget objects – like a favorite smooth stone – to calm themselves down, helping them achieve a more relaxed, contemplative, even mindful state. </p>
<h2>Fine-tuning for focus</h2>
<p>Psychology research about sensation seeking tells us that people often seek to adjust their experiences and their environments so that they provide <a href="https://www.routledge.com/Sensation-Seeking-Psychology-Revivals-Beyond-the-Optimal-Level-of-Arousal/Zuckerman/p/book/9781315755496">just the right level of stimulation</a>. Different people function well under different circumstances. Some people like total quiet to help them focus, while others are happiest working in a busy, noisy environment. </p>
<p>The optimal level of stimulation (or lack thereof) not only varies <a href="https://www.steelcase.com/insights/articles/quiet-ones/">among people</a> but even can change for one person throughout the day <a href="https://www.brainscape.com/blog/2015/07/noise-can-help-you-study/">depending upon what he or she is trying to do</a>. So people fine-tune their environments to get things just right: for example, <a href="https://www.15five.com/blog/getting-sht-done-in-an-open-office/">putting on headphones in a noisy office environment</a> to substitute less distracting noise.</p>
<p>A person who can’t get up and walk around to wake up a bit, or go have a nice cup of tea to calm down, may find it helpful to use a fidget item to get in the right frame of mind to stay focused and calm while staying put.</p>
<h2>What researchers say</h2>
<p>Our results align with <a href="https://www.brainbalancecenters.com/blog/2014/11/fidgeting-strategies-for-kids-with-neurodevelopmental-disorders/">anecdotal accounts</a> about fidget toys helping children with attention or anxiety issues to stay focused and calm in the classroom. In fact, fidget toys have been <a href="https://www.therapyshoppe.com/category/8-fidget-toys">available for kids</a> for quite some time. </p>
<p>There hasn’t yet been a definitive study of the impact of these toys in the research world. In one <a href="https://eric.ed.gov/?id=EJ853381">preliminary study</a> looking at stress ball use, sixth graders who used these fidget toys during instruction independently reported that their “attitude, attention, writing abilities, and peer interaction improved.” </p>
<p>The closest significant research is UC Davis behavioral science professor Julie Schweitzer’s study of <a href="https://doi.org/10.1080/09297049.2015.1044511">letting children with ADHD fidget</a> – wriggling, bouncing or otherwise moving gently in place – while they worked on a lab-based concentration task called the “<a href="http://dx.doi.org/10.3758/BF03192844">flanker paradigm</a>.” She found that more overall movement (measured using an accelerometer on the ankle) in children with ADHD did help them perform this cognitively demanding task.</p>
<p>Of course, it’s a big step from that finding to a claim that fidgeting with small objects in the hand can work, too. However, therapists tend to focus more on results than theoretical findings. They use what gets results and throw out what doesn’t, so practical experience suggests these toys may help kids.</p>
<h2>Avoiding distraction</h2>
<p>And yet, <a href="http://www.businessinsider.com/fidget-spinners-banned-from-top-high-schools-2017-5">schools are banning the spinners</a> and <a href="http://www.businessinsider.com/fidget-spinners-are-being-banned-from-classrooms-2017-5">teachers are taking them away</a>. The reason is that not all fidget items are created equal.</p>
<p>The items that therapists recommend are primarily tactile – a user holds it in a hand and can manipulate it without looking. But fidget spinners require hand-eye coordination. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/YHq9t05vKHA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The basics of using a fidget spinner.</span></figcaption>
</figure>
<p><a href="https://www.youtube.com/watch?v=YHq9t05vKHA">To use a fidget spinner</a>, a person holds the center of the spinner with thumb and finger, and then uses the other hand (or other fingers on the same hand) to get the spinner rotating. Once it’s spinning, there are tricks to be explored, like balancing the rotating spinner on a thumb. </p>
<p>Balancing a moving object really requires keeping an eye on it, and doing tricks is a lot of what makes the spinners fun. It’s also what draws the eyes of the user away from the teacher, and likely also the eyes of nearby students. This is the bane of a teacher trying to keep a classroom focused.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169819/original/file-20170517-9937-1aijvbh.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">Less spinning, more focus?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fidget-cube-stress-reliever-fingers-toy-634069979">idan gamliel via shutterstock.com</a></span>
</figcaption>
</figure>
<p>By contrast, <a href="http://www.chicagotribune.com/business/ct-crazy-aarons-thinking-putty-0415-biz-20160414-story.html">putty</a>, stress balls and other therapeutic fidget items don’t have this visual attention problem. They can serve the same purpose as the spinners, but are more classroom-ready and less distracting. In the same way, the Kickstarted Fidget Cube, too, is probably also more classroom-friendly.</p>
<p>Fidget items do seem to serve a valuable purpose. There’s still science to be done, but they’re not just a fad. They embody an enduring phenomenon that nearly everyone uses at some point – just watch your own behavior when doing desk work or sitting in meetings. My research team continues to study fidgeting behavior and design, working to create next-generation smart fidget objects that support managing attention and keeping calm.</p><img src="https://counter.theconversation.com/content/77456/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Isbister receives funding from Committee for Children, a nonprofit focused on teaching children social-emotional skills. </span></em></p>Fidget items can have practical uses that help people calm down and stay focused. The problem with spinners may be that they require visual attention, which can distract users and others nearby.Katherine Isbister, Professor of Computational Media, University of California, Santa CruzLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/752552017-04-10T13:10:27Z2017-04-10T13:10:27ZWhy ADHD can be a valuable bonus for entrepreneurs<figure><img src="https://images.theconversation.com/files/164255/original/image-20170406-6394-1nqd36e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Changing definitions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fake-dictionary-definition-word-adhd-attention-172349609">Shutterstock</a></span></figcaption></figure><p>Entrepreneurship is about moving forwards. It involves branching out, a search for the new, starting a journey in which the destination is unknown. In a sense then, it is not an entirely rational process, in which actions are driven by considerations of consequences. Instead, entrepreneurship requires a certain impulsiveness and an ability to act without fear of consequence. Precisely the symptoms seen in people diagnosed with ADHD. </p>
<p>ADHD – Attention Deficit Hyperactivity Disorder – is a common neuro-development psychological disorder characterised by problems with focus, impulsivity and high activity level. It is normally associated with a range of negative consequences such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398051/">crime</a>, <a href="http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780195398700.001.0001/oxfordhb-9780195398700-e-21">social exclusion</a>, and <a href="http://www.sciencedirect.com/science/article/pii/S0022440502001000">academic under-performance</a>. </p>
<p>But in an entrepreneurial context, we have found, it is a condition which brings clear advantages. Our <a href="http://www.sciencedirect.com/science/article/pii/S2352673416300178">recent study</a> into the experiences of entrepreneurs with ADHD offers a glimpse into a different kind of thinking and acting. Prominent entrepreneurs such as Ikea founder, <a href="https://www.researchgate.net/blog/post/adhd-makes-for-better-entrepreneurs">Ingvar Kamprad</a>, Virgin boss, <a href="https://www.entrepreneur.com/article/252231">Richard Branson</a>, and airline mogul, <a href="http://www.additudemag.com/adhd/article/8681-4.html">David Neeleman</a>, have often been in the press in relation to having ADHD, and some <a href="https://www.forbes.com/sites/dalearcher/2014/05/14/adhd-the-entrepreneurs-superpower/#4ff2417459e9">view the condition</a> as instrumental to their success. </p>
<p>Neeleman <a href="http://www.additudemag.com/adhd/article/754.html">said in an interview</a>: </p>
<blockquote>
<p>If someone told me you could be normal or you could continue to have your ADD [Attention Deficit Disorder], I would take ADD. </p>
</blockquote>
<p>He added:</p>
<blockquote>
<p>With the disorganisation, procrastination and inability to focus, and all the other bad things that come with ADD, there also come creativity and the ability to take risks. </p>
</blockquote>
<p>It is therefore the context rather than the condition itself that determine its value. Entrepreneurship and academia could not be more different: one opens up new possibilities and the other rationalises them. Our study set out to explore the possible advantages that aspects of ADHD bring to entrepreneurship.</p>
<p>One key plus point was that impulsivity leads to bold business choices, undeterred by unknown consequences, such as buying a business on the spot. Acting without thinking places intuition and gut feelings at centre stage. </p>
<p>Impatience triggers proactive behaviours and a constant churn of new ideas. One entrepreneur we interviewed from the education industry had introduced 250 new products in just a few years. The need for novelty enables risk taking and improvisation in unexpected situations. Such circumstances could be highly stressful for others, but as the respondents indicated in our in-depth interviews into the interplay between their personal conditions and entrepreneurial journeys, they felt at ease and stimulated.</p>
<h2>Focusing on the good points</h2>
<p>Hyperfocus, an intensive concentration and complete absorption in tasks, also gave rise to passion, persistence, and time commitment. While people with ADHD can get easily bored with tasks they do not find interesting, their high levels of absorption in areas that do capture their attention can create a higher work capacity. It can also hone skills and expertise that can give them competitive advantage. In addition, running their own business enables them to set their own hours and match the pace of work with their own energy levels.</p>
<p>Not all attempts at entrepreneurship work out, of course. But failures and setbacks go hand-in-hand with entrepreneurship and are an indelible part of the experimentation it demands. It is by trying many things and experiencing dead ends that those in the business world get to discover what works and what ideas gain traction. The prospect of failure induces fear of the unknown, of taking the first step. ADHD in those we spoke to shortcut through this paralysis. The actions and activities it propels need no external justification. They are internally anchored, with their own sense of appropriateness.</p>
<p><a href="http://www.annualreviews.org/doi/10.1146/annurev-orgpsych-031413-091326">Entrepreneurship research</a> has a strong bias towards positive personal characteristics and positive outcomes. Meanwhile, research on ADHD has tended to <a href="http://docplayer.net/33274785-The-relationship-of-attention-deficit-hyperactivity-disorder-to-crime-and-delinquency-a-meta-analysis.html">focus on its negative consequences</a>. Whether the outcomes of entrepreneurial efforts will be positive or negative cannot be ascertained in advance. But accepting both possibilities is difficult when the rationality of our actions is subject to the judgement of others. ADHD appears to provide useful tools for reducing this fundamental tension. Perhaps in entrepreneurial situations it shouldn’t be called a disorder at all.</p><img src="https://counter.theconversation.com/content/75255/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dimo Dimov 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>Elements of the condition are well suited to getting on with business.Dimo Dimov, Professor of Innovation and Entrepreneurship, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/734752017-03-28T09:38:07Z2017-03-28T09:38:07ZAnalysing the way children sleep could help us to understand autism<figure><img src="https://images.theconversation.com/files/162885/original/image-20170328-30776-12apovu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>On average, humans spend roughly a <a href="https://www.nhlbi.nih.gov/about/org/ncsdr/">third of their lives asleep</a>. This might sound like quite a long time, but sleep has been shown to be vital for “normal” human functioning. Without enough sleep, things go downhill for most people pretty quickly.</p>
<p>As well as being vital for getting through the day, sleep is well known to play an important part in the process of memory making – sleep helps us take newly formed “fragile memories” and make them “robust”. Through sleep, our brains hit the “save” button, allowing us to transfer memories to a long-term storage system.</p>
<p>Research from the <a href="https://www.ncbi.nlm.nih.gov/pubmed/19933145">Sleep Language and Memory</a> (SLAM) lab at the University of York has focused on the relationship between sleep and language learning. This research has shown that sleep plays a role in strengthening our memories for newly learned words – for both adults and children. </p>
<p>We found that people who get more deep sleep <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989532/">show bigger improvements</a> in their memory for new words after sleep. And that going to sleep after learning new words also allows those words to be embedded into the brain’s mental dictionary – meaning these words begin to behave like words we already know. </p>
<p>As part of this research, children learned new words before and after a period of <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-7687.2012.01172.x/abstract">wakefulness or sleep</a>. Greater improvements in vocabulary learning were seen after a period of sleep, compared with the equivalent time spent awake. So in essence, children who learned new words then went to sleep were able to better recall the words, compared to the children who learned the new words and just stayed awake.</p>
<p>And with this in mind, the SLAM lab is now working out the optimal delay between learning something new and going to sleep. This includes the use of bedtime stories for vocabulary learning in children. </p>
<h2>Sleep and developmental disorders</h2>
<p>But outside of learning new words, this research could also help to better understand developmental disorders. This is because children with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and dyslexia often have <a href="http://onlinelibrary.wiley.com/doi/10.1111/apa.13506/full">sleep problems</a> and as part of our research, we are looking at how these sleep problems impact on children’s learning. </p>
<p>Sleep difficulties are thought to <a href="https://link.springer.com/article/10.1007%2Fs10578-006-0028-3?LI=true">affect up to 86%</a> of the ASD population, and given that we know about sleep and the learning of vocabulary, it’s clear these sleepless nights could be having a damaging impact on these children’s lives. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/162746/original/image-20170327-3303-1eeq379.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/162746/original/image-20170327-3303-1eeq379.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162746/original/image-20170327-3303-1eeq379.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162746/original/image-20170327-3303-1eeq379.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162746/original/image-20170327-3303-1eeq379.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162746/original/image-20170327-3303-1eeq379.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162746/original/image-20170327-3303-1eeq379.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">Many children have sleep issues. But for those on the autism spectrum, sleeping well may be particularly difficult.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="http://www.tandfonline.com/doi/abs/10.3109/13682820903461493">Levels of vocabulary</a> in children with ASD vary dramatically. While some children have typical or above average vocabularies, many children with ASD show delays in early language acquisition – and often have smaller vocabularies than expected for their age. Researchers cannot currently explain this diversity, but it is suspected that sleep difficulties play a key part. </p>
<p>And <a href="http://onlinelibrary.wiley.com/doi/10.1111/desc.12169/abstract">our own research</a> has also shown that children with ASD show almost the reverse pattern in terms of word learning and sleeping – so sleep doesn’t seem to have the same memory making impact for these children in terms of vocabulary.</p>
<h2>Impact on education</h2>
<p>Our research is now beginning to untangle whether sleep difficulties might impact on learning difficulties in children with autism. And we are doing this by recording brain activity while children sleep in their own beds. </p>
<p>As yet, there has been no investigation into how poor sleep patterns may impact on the language learning difficulties that characterise ASD. So this is exactly what our research aims to address. </p>
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<img alt="" src="https://images.theconversation.com/files/162887/original/image-20170328-30794-15zazvp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/162887/original/image-20170328-30794-15zazvp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162887/original/image-20170328-30794-15zazvp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162887/original/image-20170328-30794-15zazvp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162887/original/image-20170328-30794-15zazvp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162887/original/image-20170328-30794-15zazvp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162887/original/image-20170328-30794-15zazvp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Can sleep disturbances impact a child’s ability to learn?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>The SLAM lab, along with University College London, was recently awarded funding from the Economic and Social Research Council for the SleepSmart project, which will look at how sleep supports language learning in both children who are developing “typically” as well as children who have autism spectrum disorder (ASD). </p>
<p>This type of research is vitally important and could potentially make a difference to many children’s lives. And this all comes at a time when researchers are beginning to understand the importance of sleep – particularly for learning and memory. </p>
<p>Yet historically far more emphasis has been placed on what we do while awake than what we do when we’re sleeping. Which is why it’s time to start giving sleep – especially for children – the respect that it deserves.</p><img src="https://counter.theconversation.com/content/73475/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Henderson 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>Can disturbed sleep patterns have an impact on a child’s ability to acquire language and vocabulary?Lisa Henderson, Lecturer in Psychology, specialising in the development and disorders of language, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/691292017-01-09T19:34:33Z2017-01-09T19:34:33ZFive ways kids can benefit from being outside this summer break<figure><img src="https://images.theconversation.com/files/149000/original/image-20161207-25738-1y7430e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Simply being exposed to nature can help children better cope with stress.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>The summer break is well underway. The weather is warming and kids are getting used to some time away from school. </p>
<p>Parents, meanwhile, are trying to find ways to keep the kids entertained over the break. </p>
<p>Chances are you remember your own childhood summers full of adventures outdoors in some plot of green near your home. Perhaps you had cubby houses or made cakes out of mud or just ran around seeking shade under the nearest tree.</p>
<p>For this generation, not only have changes in families’ lifestyles resulted in children spending much less time outdoors than in previous generations, but many children prefer to spend time indoors playing electronic games, rather than getting out in nature. </p>
<p>In fact, the majority of children <a href="http://www.beactive.wa.gov.au/assets/files/Research/Updated%20CAPANS%202008%20reprot.pdf">spend more</a> than the recommended maximum of two hours per day involved in “screen time”. In a 2009 study, researchers found that over half of the Australian children studied between the ages of ten to 12 spent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661046/">less than 1 hour outside each day</a>.</p>
<p>But there are plenty of physical and mental benefits to outdoor time for children. Here are just a few reasons to get outside this summer.</p>
<h2>1. Physical health</h2>
<p>Research shows that children who play outside are more active and generally have a <a href="http://treeday.planetark.org/documents/doc-813-planting-trees-key-findings-2012-06-27-final.pdf">lower risk of childhood obesity</a> due to higher levels of physical activity generally (how many children do you know that sit perfectly still outside?). </p>
<p>Also, children who take part in school veggie gardening projects <a href="http://gardening.cals.cornell.edu/program-tools/benefits-and-research/key-findings/">develop more healthy eating habits</a>, including making healthier food choices. Children are more curious about a variety of foods when they have watched them grow.</p>
<p>Interestingly, at least <a href="https://www.scientificamerican.com/article/more-time-outside-tied-to-less-nearsightedness-in-children/">one study also shows</a> that the more time a child spends outside, the lower their risk is for shortsightedness. An increase of about 45 minutes of outdoor time per day is enough to make a difference, which doctors suspect has to do with higher levels of light outside.</p>
<h2>2. Immune system</h2>
<p>Exposure to sunlight increases the body’s natural production of Vitamin D3. Children who are outside create more of this vitamin, which is important for bone and muscle development. It is also beneficial for overall health, but balancing your sun exposure is particularly important during the summer months, so <a href="http://www.sunsmart.com.au/vitamin-d/how-much-sun-is-enough">remember to use sun protection as needed</a>. </p>
<p>Despite the old adage that going out in the rain will make you sick, growing up on a farm can <a href="http://www.nature.com/nri/journal/v10/n12/abs/nri2871.html">protect children from allergies and asthma</a>. A day out playing in the rain does not make you ill - the most important thing is to be sure children are adequately dressed.</p>
<h2>3. Cognitive skills</h2>
<p>There are many benefits of natural environments in relation to how children’s brains work. </p>
<p>Research shows that being outdoors can lead to a range of cognitive benefits for children, including <a href="https://www.ncbi.nlm.nih.gov/pubmed/26080420">better memory</a>, <a href="http://jad.sagepub.com/content/12/5/402">improvements in Attention deficit hyperactivity disorder (ADHD) symptoms</a>, <a href="http://sfrc.ufl.edu/urbanforestry/Resources/PDF%20downloads/Wells_2000.pdf">improved concentration</a>, and <a href="https://www.whitehutchinson.com/children/articles/benefits.shtml">better reasoning skills</a>. </p>
<p>It is thought that exposure to nature <a href="http://www.pnas.org/content/112/26/7937.full">plays a positive role in brain development</a> by providing children with opportunities to take risks, discover new things, be creative, develop a sense of wonder and engage in new tasks. </p>
<h2>4. Psychological state</h2>
<p>Children can also benefit psychologically from being outdoors. </p>
<p>Research shows that exposure to natural environments can lead to a <a href="http://www.centreforconfidence.co.uk/docs/Forest_school_2.pdf">reduction in anger</a>, a <a href="https://www.wmich.edu/sites/default/files/attachments/u58/2015/Challenge_Programs.pdf">decreased risk for problem behaviour</a>, greater <a href="https://www.ncbi.nlm.nih.gov/pubmed/15630057">respect for self and others</a>, greater autonomy and a reduction in <a href="http://news.ubc.ca/2016/04/11/kids-more-active-less-depressed-when-playgrounds-include-natural-elements/">depressive symptoms</a>. </p>
<p>Children’s ability to regulate their emotions is also improved through exposure to nature. </p>
<p>Attention Restoration Theory (ART) is one explanation for how exposure to nature helps children psychologically. It is thought that modern life requires extended periods of concentration, which leads to mental fatigue. This can make a person irritable and easily distracted. Exposure to nature, however, can help to repair this mental fatigue and <a href="http://pss.sagepub.com/content/19/12/1207">restore a person’s wellbeing</a>. </p>
<h2>5. Wellbeing</h2>
<p>Children’s general wellbeing can also be helped by exposure to nature. </p>
<p>Studies have found that even the simple presence of nature (trees, grass, plants) near children’s homes can help children <a href="http://eab.sagepub.com/content/35/3/311.abstract">better cope with stress</a>. </p>
<p>It also seems that spending time in nature can have long lasting benefits into adulthood. Research shows that children who spend more time in nature grow up to <a href="http://www.sciencedirect.com/science/article/pii/S0169204611003665">feel more connected to nature</a> and have more <a href="http://www.peecworks.org/PEEC/PEEC_Research/S01798C0C-01A68781">positive attitudes about environmental sustainability</a>. </p>
<p>The stress reduction theory offers one explanation for the impact of nature on children’s wellbeing. </p>
<p>Research shows that being in a non-threatening natural environment reduces the body’s stress reaction. The natural environment triggers the body’s relaxation response, where <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564151/">blood pressure, heart rate and cortisol levels are reduced</a>. </p>
<p>So, this summer get your kids out to a park, go on a long nature walk, or simply have them go play outside in the garden for a few hours. It really is good for them.</p><img src="https://counter.theconversation.com/content/69129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shelby Gull Laird has previously received funding from the Albury Conservation Company, and currently receives funding from the USDA NIFA McIntire–Stennis program. She is a board member of the Texas Association for Environmental Education.</span></em></p><p class="fine-print"><em><span>Laura McFarland 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>Exposure to nature plays a positive role in brain development by providing children with opportunities to take risks, discover new things, and be creative.Shelby Gull Laird, Assistant Professor, Stephen F. Austin State UniversityLaura McFarland, Lecturer in Early Childhood Studies, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/624332016-07-20T20:06:07Z2016-07-20T20:06:07ZSleep problems that persist could affect children’s emotional development<figure><img src="https://images.theconversation.com/files/130843/original/image-20160718-2133-1ih1e50.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Poor sleep can have longer-term effects.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Sleep. Many children make a sport out of resisting it, reaching Olympic levels of prowess in bedtime shenanigans. </p>
<p>And while night waking is a part of human sleep, requiring adult attention on every night wake is not only tiring for parents but may also be indicative of children’s overall ability to self-regulate.</p>
<p>Self-regulation is an important skill gained during the early years, which helps children to maintain and focus attention and also control their own emotions and behaviours. </p>
<p>In the end, though, does it really matter if children aren’t sleeping well?</p>
<h2>Longer-term effects of poor sleep</h2>
<p>We analysed data for 3,000 children participating in a larger <a href="http://www.growingupinaustralia.gov.au/">longitudinal study</a>, with data collected every two years from birth to nine years. Our analysis found that if bedtime behaviours persist beyond infancy, this <a href="https://eprints.qut.edu.au/85043/">could have implications</a> for children’s emotional and attentional development two years later, beginning from the first year, and up to the age of nine.</p>
<p>The research focused on behavioural sleep problems such as bedtime resistance, persistent night waking and trouble falling asleep and resettling independently. These are distinct from medical sleep problems, such as sleep <a href="http://www.racgp.org.au/afp/2015/june/sleep-apnoea-in-the-child/">apnoea</a>, which is difficulty with breathing during sleep, and from the <a href="http://www.smh.com.au/lifestyle/life/experts-reveal-new-sleep-requirements-for-different-age-groups-20150204-1366nx.html">length of time</a> that a child sleeps.</p>
<p>Infants naturally need a lot of support at bedtime and during the night. For most children (70%) such sleep behaviours steadily improved. </p>
<p>At five years old, these children showed no regular ongoing sleep problems. They were independently settling themselves at bedtime and at night waking (unless sick or at other upsetting times). </p>
<p>For the remaining 30% of children, these behavioural sleep problems escalated from birth to five years. These children required more and more adult support around sleep across this time period.</p>
<p>In the classroom at six years of age, teachers of this group of children <a href="https://eprints.qut.edu.au/92613/">rated them</a> as more hyperactive, emotionally unsettled and disorganised, and as having poorer social skills. This is likely due to sleep problems influencing brain development over time in a way not conducive to developing self-regulation skills. </p>
<p>Children with sleep problems may have over-reactive emotional responses to events during the day and be preoccupied with trying to regulate their emotional system. This limits their opportunity to focus and benefit from activities that build attentional regulation.</p>
<p>Of course, not all five-year-old children with sleep problems will struggle to adjust to school, but for those who do, sleep might be an important target for change.</p>
<h2>Detecting ADHD</h2>
<p>The research <a href="https://eprints.qut.edu.au/92611/">detected differences</a> in the extent to which parents reported their child had a moderate or severe sleep problem for children later diagnosed with clinical symptoms of Attentional Deficit Hyperactivity Disorder (ADHD). </p>
<p>From as early as two years old, children who were later diagnosed with ADHD had significantly higher levels of parent-reported sleep problems, including bedtime resistance and night waking, than children without ADHD. </p>
<p>While prevalence in sleep problems for the non-ADHD group decreased substantially from birth to seven years, for the ADHD group rates of sleep problems remained more stable across this time (around 20% of these children continued to have sleep problems up to age seven). </p>
<p>Whether or not toddler sleep problems were an early sign of underlying neurological differences in children with ADHD or contributed to a mutually exacerbating cycle of poorer attentional behaviours over time is yet to be fully understood.</p>
<p>Programs that support parents to manage bedtime with <a href="http://raisingchildren.net.au/articles/calling_out_and_getting_out_of_bed.html/context/617">warm and firm routines and rituals</a> and to use behavioural techniques to gradually withdraw adult support for falling and staying asleep are largely effective. </p>
<p>They not only directly improve sleep behaviours but also improve children’s daytime behaviour and attention in both the general population and <a href="http://www.bmj.com/content/350/bmj.h68">children with ADHD</a>. </p>
<p>There is no strong evidence that such techniques cause long-term emotional harm – and the immediate benefits for child development, family functioning and parental wellbeing are considered to outweigh any small chance of risk. </p>
<p>Techniques differ according to a child’s age and can be adjusted to accommodate parents’ individual comfort levels with leaving their child alone to settle. </p>
<p>Ultimately, parents should have the final decision about the approach they take, as consistency and commitment are key to all approaches.</p>
<p>The ways that children’s sleep is managed varies greatly from house to house and across cultures. If parents are concerned about the way children are adjusting to school, developing social relationships, coping with their own emotions and managing their attention, then sleep behaviours is a conversation to have and consider addressing. </p>
<p>The short-term pain of sleep training in early childhood is likely to reap long-term gain for children and families.</p><img src="https://counter.theconversation.com/content/62433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate E. Williams 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>If behavioural sleep problems persist beyond infancy, there could be implications for children’s emotional and attentional development longer term.Kate E. Williams, Lecturer of Early Childhood, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.