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Aging, Mental Health, Parenting, Research

Girls at high risk for developing depression show signs of stress and premature aging

Girls at high risk for developing depression show signs of stress and premature aging

14465-telomeres_newsAs we age and our cells divide, caps at the ends of our chromosomes called telomeres shorten. When a telomere grows too short, it will die or lose its ability to divide, which causes our skin to wrinkle or sag, as well as damage to our organs. Previous research has shown that depression, chronic stress and inflammation can accelerate this process, causing premature aging and making our bodies more susceptible to infections and disease.

In an effort to better understand the connection between stress, depression and changes in the body, Stanford psychologist Ian Gotlib, PhD, and colleagues studied healthy girls with a family history of depression and compared them to a group of their peers without that medical background. During the experiment, researchers measured participants’ stress response through a series of tests and analyzed their DNA samples for telomere length. According to a Stanford Report story:

Before this study, “No one had examined telomere length in young children who are at risk for developing depression,” Gotlib said.

Healthy but high-risk 12-year-old girls had significantly shorter telomeres, a sign of premature aging.

“It’s the equivalent in adults of six years of biological aging,” Gotlib said, but “it’s not at all clear that that makes them 18, because no one has done this measurement in children.”

The researchers are continuing to monitor the girls from the original study. “It’s looking like telomere length is predicting who’s going to become depressed and who’s not,” Gotlib said.

Based on these findings, researchers recommended that girls at high-risk for depression learn stress reduction techniques.

Previously: How meditation can influence gene activity, Shrinking chromosome caps spell aging cells, sniffles, sneezes… and cognitive decline?, Study finds phobias may speed biological aging and Study suggests anticipation of stress may accelerate cellular aging
Photo by Paulius Brazauskas/Shutterstock

Autism, Parenting, Pediatrics, Research, Stanford News

Parents can learn autism therapy in groups to improve kids' verbal skills, Stanford study shows

Parents can learn autism therapy in groups to improve kids' verbal skills, Stanford study shows

HoldingHandsAutism is more than twice as common than it was 15 years ago. But the number of clinicians who treat the developmental disorder is growing more slowly than the number of new cases, prompting caregivers to look for novel ways to share their expertise as widely as possible.

One possible approach: Teach groups of parents an autism therapy they can deliver at home. A new study from Stanford and Lucile Packard Children’s Hospital Stanford, published today in the Journal of Child Psychology and Psychiatry, found that small groups of parents could learn to deliver a scientifically validated autism treatment to their own children in a short series of classes.

The therapy, called pivotal response training, which has been validated in several prior studies, was targeted to kids’ language skills. The therapy gives parents a structured method for nurturing children’s verbal skills during everyday interactions.

The approach of having parents give treatment is meant to complement, not replace, one-on-one therapy with autism professionals. But it can still be valuable to children and their families, as our press release explains:

“There are two benefits: The child can make progress, and the parents leave the treatment program better equipped to facilitate the child’s development over the course of their daily routines,” said study co-author Grace Gengoux, PhD, clinical assistant professor of psychiatry and behavioral sciences and a psychologist specializing in autism treatment at the hospital. “The ways that parents instinctually interact with children to guide language development may not work for a child with autism, which can frustrate parents. Other studies have shown that learning this treatment reduces parents’ stress and improves their happiness. Parents benefit from knowing how to help their children learn.”

… To use the treatment for building language skills, parents identify something the child wants and systematically reward the child for trying to talk about it. For instance, if the child reaches for a ball, the parent says, “Do you want the ball? Say ‘ball.’”

“The child might say ‘ba,’ and you reward him by giving him the ball,” [lead author Antonio] Hardan, MD, said. “Parents can create opportunities for this treatment to work at the dinner table, in the park, in the car, while they’re out for a walk.”

The researchers are now following up with studies that will give them more information about which children and families are most likely to benefit from this therapeutic approach.

Previously: Using Google Glass to help individuals with autism better understand social cues, Using theater’s sensory experience to help children with autism and “No, I’m not ready yet”: A sister’s translation for her brother with autism
Photo by Wilson X

Immunology, In the News, Parenting, Pediatrics

Ivy and Bean help encourage kids to get vaccinated

Ivy and Bean help encourage kids to get vaccinated

Ivy and Bean2Last week, I took my two little boys to get their shots, including the MMR vaccine that protects against measles, mumps and rubella. Although, as a mom, it’s easy for me to understand the value of vaccines, I’m not sure my preschooler was completely convinced that getting poked in the arm was a great idea.

That’s why I am thrilled to see “Ivy and Bean vs. The Measles,” a set of posters and other educational materials that Sophie Blackall, the illustrator of the popular series of children’s books, has produced in collaboration with the Measles and Rubella Initiative. Blackall’s illustrations show Bean, one of the book’s two heroines, devising a series of unconventional strategies for avoiding the measles: wear a biohazard suit for the rest of your life, get adopted by a polar bear, or (my personal favorite) cover yourself in a 6-inch protective layer of lard.

“Or,” says Ivy, “get vaccinated!”

My son would probably be most interested in Bean’s suggestion to “Move to the moon!” He loves all things outer space-related, and I love the idea of finding something at our doctor’s office that would spark his interest and help me explain to him why he needs that brief poke in the arm.

Bravo, Ivy and Bean!

Via Shots
Previously: Side effects of childhood vaccines are extremely rare, new study finds, Measles is disappearing from the Western hemisphere and Tips for parents on back-to-school vaccinations
Artwork by Sophie Blackall

Behavioral Science, Parenting, Pediatrics, Research, Stanford News

Families can help their teens recover from anorexia, new study shows

Families can help their teens recover from anorexia, new study shows

anorexia-appleUpdated 10-2-14: In a just-published 1:2:1 podcast, Lock discusses this work in depth.

***

9-24-14: A large new study comparing two treatments for anorexia nervosa offers a hopeful message to parents of teens affected by the eating disorder: Families can work with therapists to help their children recover.

The study, which appears today in JAMA Psychiatry and was led by Stanford’s Stewart Agras, MD, was the first large randomized clinical trial to compare two forms of family-based treatment for anorexia. The study included 167 anorexia patients, aged 12 to 18, at six medical centers in the United States and Canada.

In both treatments tested, a trained therapist met regularly with the patient and at least one other member of his or her family. One type of therapy focused on teaching parents how to get their child eating again at home, a method that Agras and Stanford eating disorder expert James Lock, MD, PhD, have researched extensively in the past. The other approach was broader, with the therapist and the family exploring problems in family dynamics and how to solve them. Patients and families in both treatment groups received 16 one-hour therapy sessions over a nine-month period, and patients’ recovery was assessed at the end of the therapy and again one year later.

Both therapies were equally effective in the long run, but the approach that focused on feeding was faster, and patients in that group were hospitalized fewer days during their treatment, which also made this method less expensive. The findings add to a growing list of scientific studies that are changing how physicians think about the families of patients with eating disorders, as our press release explains:

“For a long time, people blamed families for causing anorexia and thought they should be left out of treatment,” said Lock. “But this study suggests that, however you involve them, families can be useful, and that more focused family treatment works faster and more cost-effectively for most patients.” Lock directs the Comprehensive Eating Disorders Program at Lucile Packard Children’s Hospital Stanford.

The need for good treatments for anorexia in teens is bolstered by prior research demonstrating that the disease becomes more difficult to treat in adulthood, as Agras noted:

“The longer anorexia goes on, the more difficult it is to treat,” he said. “A great many people live chronically restricted lives because of this disease — they plan their days around undereating and overexercise — and quite a few die. The idea is to treat the disorder in adolescence to prevent more adults from becoming anorexic.”

Lock is the c0-author of the book Help Your Teenager Beat an Eating Disorder, which is designed to help parents conduct the feeding-based treatment examined in this study. Lock and Agras have both contributed to textbooks and manuals on eating disorder treatment for health care professionals.

Previously: Stanford study investigates how to prevent moms from passing on eating disorders, A growing consensus for revamping anorexia nervosa treatment and Possible predictors of longer-term recovery from eating disorders
Photo by Santiago Alvarez

Chronic Disease, Medical Education, Medicine X, Mental Health, Parenting, Stanford News

Medicine X explores the relationship between mental and physical health: "I don’t usually talk about this"

Medicine X explores the relationship between mental and physical health: "I don’t usually talk about this"

standing o at MedX - smallThis year, Medicine X examined the relationship between physical and emotional well-being with three breakout panels. Psychologists and ePatients came together in two of the sessions to discuss depression in chronic illness and coping through online communities, as well as the topic of mental health and the whole person.

The conversations centered on five themes: how the uncertainty, fear and overall stress of living with a chronic illness, or being a caregiver, can lead to depression and anxiety; why patients’ desire to be empowered can prevent them from seeking help; why eliminating the stigma associated with mental health conditions is so important; the need to better integrate the training of future doctors and mental-health professionals; and ways patients can identify that they may need mental health services and how to find them.

Ann Becker-Schutte, PhD, a Kansas City-based psychologist who participated in both panels, told the audience, “Living with any of these illnesses, whether it’s rare or well-known, requires a lot of work. There is a burden of gilt, fear and shame that are all rolled into one. It’s not unusual for anyone facing these conditions to get tired and just say ‘I’m done’.”

Sarah Kucharski, a Medicine X ePatient advisor diagnosed with depression, anxiety and fibromuscular dysplasia, gave the audience insight into how depression can take over – explaining that she was shocked to learn during a therapy session that a recent string of major life events (getting married, having bypass surgery and buying a house) had elevated her score on the Holmes and Rahe Stress Scale to roughly 500. “I had no ideas that such things had a rating or that they could be cumulative,” she said. “As a result, I try to be more cognizant and slow down.”

Other ePatients spoke candidly and courageously about some for their darkest moments, with many saying it was challenging to discuss their experiences with depression and anxiety outside their inner circles. “I don’t usually talk about this,” said Hugo Campos, an ePatient with an implantable cardiac defibrillator in his chest. “This will be particularly difficult to admit in public.”

Campos opened up about the severe depression he encountered during the month following a procedure to implant into his chest a cardiac defibrillator, which shocks the heart to control life-threatening arrhythmias and prevent sudden cardiac arrest. Since the device was implanted preventatively, he felt that by having the surgery he had somehow failed himself and continued to be unsure if the device was necessary. There was also anxiety and fear about the device spontaneously shocking him. He turned to his online community to learn how to cope with these feelings. “I felt I would be better of speaking with my peers online, rather than a professional who did not have an implantable device and didn’t know what I was going through,” he explained.

Scott Strange, who was diagnosed with Type 1 diabetes in 1970 and also struggles with chronic depression, also turned to the Internet for support. “My journey to acceptance started when I found my online community. Until I found them, I never really faced it.”

Strange talked about growing up with the knowledge that not properly monitoring his glucose and insulin levels could be fatal. He also addressed the shame and exhaustion that results from “busting your rear end and trying to do everything your doctor says” and not seeing an improvement in your health.

While some turned to their patient communities online, others turned to someone outside of their social networks. When the demands of being a caregiver began to overwhelm Erin Moore, the mother of a four-year-old son with cystic fibrosis (CF) and three other children, she opted not to discuss it with someone well-versed with her situation. “Initially I sought help outside of the CF community because I was aware of how many people rely on me for my strength and I didn’t want to admit a weakness.”

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Parenting, Pediatrics, Public Health, Research

Examining the effects of family time, screen time and parenting styles on child behavior

boardgameAs kids head back to school, many parents may be wondering what they can do to boost their children’s academic achievement. Findings recently published in the Journal of Family Psychology suggest that limiting screen time, increasing family time, and choosing parenting styles that rely on positive reinforcement are among the things that can help children perform better in school.

For The Learning Habit Study, the largest study of its kind, more than 21,000 parents across the country completed a 108-question survey about their children and family life. Among the findings: three family activities – eating regular dinners, attending religious services, and playing board games – were “significantly related to reduced screen time among children, higher GPA, and fewer emotional problems; ” parenting styles involving disciplining children when they misbehave or underperform were associated with a negative impact on children’s academic success, sleep and focus; and students’ sleep quality and grades start to decline after just 45 minutes of screen time.

From a recent WebMD story:

The good news for parents is they can easily make positive changes at home, says Robert Pressman, PhD. He’s the director of research at the New England Center for Pediatric Psychology and the study’s lead author.

Have regular family dinners, for example. They tend to happen at expected times and include conversation and information sharing. Parents can also shift their own habits and parenting styles in response to the study’s findings.

“These are all things that parents can do to make a difference,” Pressman says. “I think it’s going to change everything in terms of how we are going to interact with patients,” he adds. “We have hard data now that we didn’t have before. As a clinician, I know that I will have a greater impact.”

Previously: With school bells ringing, parents should ensure their children are doing enough sleeping, Study: Too much TV, computer could hurt kids’ mental health, Does TV watching, or prolonged sitting, contribute to child obesity rates? and Paper explores effects of electronic media on kids’ health
Photo by woodleywonderworks

Parenting, Pediatrics, Sleep

With school bells ringing, parents should ensure their children are doing enough sleeping

With school bells ringing, parents should ensure their children are doing enough sleeping

With so many schools starting today – or having recently started – it’s a good time for a reminder of the importance of sleep among children. In a recent blog post and the video above, Seattle Mama Doc (a.k.a. Wendy Sue Swanson, MD), offers guidance on how much sleep a child needs and offers five ways that parents can support good sleep:

    • Keep to an 8pm bedtime for young children. Move bedtime back slowly (move it by 30 minutes every 3-5 days) to prime your child for success and avoid battles!
    • 10pm bedtime for children age 12 & up is age-appropriate. More info here.
    • Habits: No screens 1-2 hours prior to bed, no caffeine after school, no food right before bed.
    • Exercise or move 30-60 minutes a day to help kids sleep easier
    • No sleeping with cell phones (create a docking station in the kitchen)
    • Don’t use OTC medications (cough & cold, for example) to knock your kids out and get them to sleep. Using medications that have a side effect of drowsiness can cause sleepiness to extend into daytime which can negatively affect school and sports performance.

Previously: Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”Stanford expert: Students shouldn’t sacrifice sleep, TV in a child’s bedroom? “No way,” says expert and Districts pushing back bells for the sake of teens’ sleep

Parenting, Pediatrics, Public Health

Study shows cavities have become the most common childhood disease

Study shows cavities have become the most common childhood disease

Kids mouthA Washington Post blog entry published earlier this week reports that cavities are the most common childhood chronic disease in the United States. Fifty-nine percent of kids between the ages of twelve and nineteen have at least one cavity, according to a recent Pediatrics paper, and the American Academy of Pediatrics in turn issued new recommendations advising parents to start brushing children’s teeth with fluoride as soon as the teeth appear. The study refers to cavities in young children as a “silent epidemic” that disproportionately affects poor, young and minority populations.

From the article:

“We’re still seeing a lot of cavities in very young children,” said Rebecca Slayton, a pediatric dentist and member of the executive committee of the academy’s section on oral health.  “Various national surveys show that we are making progress in some age groups, but in the younger age groups we are not.”

Some of the problem stems from poor and immigrant children lacking dental care, but even among parents with the resources to get their children to dentists, there is a lack of awareness that baby teeth need the same care as permanent ones. And infants, of course, can’t complain about tooth pain.

Whether it’s a lack awareness or lack of resources that is preventing parents from addressing tooth health, the article makes clear that regular dental hygiene for children is an important part of their overall health.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Side effects of childhood vaccines are extremely rare, new study finds, “Mountain Dew mouth” rots teeth, costs taxpayers 
Photo By: Emran Kassin

Autism, Parenting

Growing up with an autistic sibling: "My sister has a little cup"

Growing up with an autistic sibling: "My sister has a little cup"

It was the photo that first draw my attention: the big sister and little sister, with their bed-head hair and pink-and-purple pajamas, hugging each other happily. It was like a scene straight out of my house, and I’m a sucker for stories about sisters – so I began reading. The Huffington Post piece was, indeed about two close, loving little siblings – but, more specifically, about the writer-mom’s concerns over how her youngest daughter’s autism has affected her daughter Phaedra.

Neither of my girls has autism, but Janel Mills is such a gifted writer (and her older daughter, with her maternal, sensitive ways, reminded me so much of mine) that it wasn’t difficult to feel what it would be like in this mother’s shoes. And this portion of the story, with Mills’ beautiful, simple description of what was going on in her younger daughter’s mind, brought me to tears:

One day, as we were driving to my mom’s house, Bella started having a full-blast, take-it-to-eleven, screeching meltdown because she dropped a toy somewhere in the car and neither she nor I could reach it. Phaedra hates the car meltdowns most of all because she can’t go anywhere to escape them. Listening to Bella melt down hurts her physically (the screams are LOUD) and emotionally (she’s a sensitive soul). When we finally pulled into my mom’s driveway and I got Bella her toy, Phaedra asked me with a shaky voice why Bella reacted the way she did. I must have heard this or read this somewhere, because there’s no way I was this clever on the spot, but this is what I told her:

“Everyone has a cup in their head. We pour all of our feelings, like happy, sad, mad, scared, anything, into that cup. Most people have regular-size cups. When you pour out your feelings into your cup, you have more than enough room for them. Bella has a cup, too, but her cup is little. When she pours her feelings out, her little cup can’t hold all of them, and it overflows. Does that make sense, honey?”

Apparently it did, because she uses this story to explain to others how Bella is different. She shares it with teachers, friends, basically anyone who will stand still and listen to her talk about her family.

“My sister Bella has a little cup.”

Previously: “No, I’m not ready yet”: A sister’s translation for her brother with autism and A mother’s story on what she learned from her autistic son

Applied Biotechnology, Parenting, Pediatrics, Research, Sleep, Stanford News, Technology

Biodesign fellows take on night terrors in children

Biodesign fellows take on night terrors in children

baby on bed

Standing in the Clark Center’s grand courtyard, gazing upward at scientists ascending an outdoor staircase and traversing the exterior corridors on the top two floors, one senses that big ideas take shape here. But how?

Prototyping, say Andy Rink, MD, and Varun Boriah, MS, who spent the last year as Biodesign fellows. Part of Stanford’s Bio-X community, the Biodesign Program trains researchers, clinicians and engineers to be medical-technology innovators during its year-long fellowship. Fellows learn the Biodesign Process, which could be likened to design thinking for health care. On teams of two or four, the fellows identify a substantial health-care need and generate ideas to solve it using medical-device innovation.

Though most Biodesign projects take root after fellows complete a “clinical immersion” shadowing health-care workers in a hospital to observe problems, Rink found his inspiration when visiting family and waking up to a 3-year-old relative’s screams from recurring night terrors. The problem was not so much that it affected the child – pediatricians may advise that children will likely outgrow the condition – but that it affected the parents, Rink saw.  The parent’s lost sleep and anxiety over their child’s well being had huge effects on their quality of life. (In some cases, these are so severe that Xanax and Valium may be prescribed to the children as a last-ditch effort.) What if a treatment could be found that involved no medication and no parental intervention, offering everyone a solid night’s sleep?

The physician and engineer are working with School of Medicine sleep researchers Christian Guilleminault, MD, professor of psychiatry and behavioral sciences, and Shannon Sullivan, MD, clinical assistant professor of psychiatry and behavioral sciences, on a clinical method to treat night terrors in children. In a first-floor room of the Clark Center, they’re protoyping an under-mattress device that senses how deeply a child is sleeping and is able to prevent the nightly episodes from occurring, creating a healthier sleep cycle for the children.  This relieves the parent’s anxiety, and helps the entire family sleep better.

Faculty and students from more than 40 departments across Stanford’s campus, including the schools of medicine, business, law, engineering and humanities and sciences, play a role in Biodesign, as do experts from outside the university. Fellows work closely with the Institute of Design at Stanford, attending – and then teaching – the school’s d.bootcamp. They also have access to the d.school’s facilities and consult regularly with their faculty. Some of the d.school’s methods – focusing on big problems, encouraging radical collaboration, prototyping early and user-testing before focusing on functionality – guide the trajectory of Biodesign projects.

Physicians who are Biodesign fellows often work outside their specialty, and engineers bring a mix of academic and industry experience to the design table. While faculty mentors may simply provide advice to fellows, Guilleminault and Sullivan have become invested in the course of the research as lead investigators on the study. For their involvement, they were both honored with the Biodesign Specialty Team Mentorship Award.

Fellow Boriah noted that medical-device innovation is moving from products like catheters to systems such as health IT, mobile health and software. A former CEO and co-founder of a wearable patient blood-diagnostics device, he said the Biodesign program has provided valuable “access to clinical reality.” Rink, a surgical resident at Northwestern University, said that as a fellow, he’s been “exposed to a side you don’t see in a hospital.”

The researchers are currently recruiting participants ages 2-12 for their study. Rink and Boriah are also working with the Stanford-supported StartX to see their project into the next stage of development.

Previously: Sleep, baby, sleep: Infants’ sleep difficulties could signal future problemsStudying pediatric sleep disorders an “integral part” of the future of sleep medicine and At Med School 101, teens learn that it’s “so cool to be a doctor” 
Photo by MissMayoi

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