Archive | March, 2012

ADHD coaching to improve a child’s education outcome

31 Mar

Many children have a diagnosis of ADHD. Web MD has an excellent article about  Attention Deficit Hyperactivity Disorder: What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is also known as hyperactivity or attention deficit disorder (ADD). ADHD is a common condition that affects children and adolescents, while ADD is more common in adults.

The National Institute of Mental Health (NIMH) estimates that 3% to 5% of children have ADHD. Some experts, though, say ADHD may occurs in 8% to 10% of school age children. Experts also question whether kids really outgrow ADHD. What that means is that this disorder may be more common in adults than previously thought.

Children with ADHD generally have problems paying attention or concentrating. They can’t seem to follow directions and are easily bored or frustrated with tasks. They also tend to move constantly and are impulsive, not stopping to think before they act. These behaviors are generally common in children. But they occur more often than usual and are more severe in a child with ADHD.

The behaviors that are common with ADHD interfere with a child’s ability to function at school and at home.

Adults with ADHD may have difficulty with time management, organizational skills, goal setting, and employment. They may also have problems with relationships, self-esteem, and addictions.

Increasingly, some families find that an education coach improves their child’s chance of success at school.

Jean Enersen’s King5 News story,  ADHD coaches help students tackle academic goals tells the about the success one family has had with an ADHD coach:

Middle school is all about keeping track of schedules, and getting assignments in on time. It can be complicated.

“I have eight teachers,” said 7th grade student Marcus Wesley.

When his mother asked, “Have you started writing your story?” Marcus could only tell her, “No, but I have all my outline and stuff.” The story was pivotal to his grade.

Keeping a handle on all his upcoming assignments is hard for Marcus. He was recently diagnosed with ADHD.

“I’m a little more hyper than other kids. So they give me the medicine to calm me down,” he explained.

But medicine is only part of the answer said his mother. Alone, it won’t assure his success in school.

“I personally think every student deserves a coach,” said ADHD coach Naomi Zemont.

Since last September, Zemont has been Marcus Wesley’s ADHD coach.

“Last time around, you really wanted to make up this work in humanities,” she reminded Marcus.

Zemont helps the 7th grader develop a plan to achieve his goals. He sets the goals himself, and decides the actions it will take to complete them. In doing so, Marcus is learning to break tasks into parts he can manage. http://www.king5.com/health/childrens-healthlink/ADHD-coaches-help-students-tackle-academic-goals–144024376.html

Before deciding what is the most appropriate therapy, the diagnosis of ADHD must be made by a competent health care provider.

The American Academy of Child and Adolescent Psychiatry discusses the primary symptoms of ADHD in the article, What Is ADHD

The primary symptoms of ADHD are hyperactivity, impulsivity, and inattention.

Hyperactive children always seem to be in motion. A child who is hyperactive may move around touching or playing with whatever is around, or talk continually. During story time or school lessons, the child might squirm around, fidget, or get up and move around the room. Some children wiggle their feet or tap their fingers. A teenager or adult who is hyperactive may feel restless and need to stay busy all the time.

Impulsive children often blurt out comments without thinking first. They may often display their emotions without restraint. They may also fail to consider the consequences of their actions. Such children may find it hard to wait in line or take turns. Impulsive teenagers and adults tend to make choices that have a small immediate payoff rather than working toward larger delayed rewards.

Inattentive children may quickly get bored with an activity if it’s not something they really enjoy. Organizing and completing a task or learning something new is difficult for them. As students, they often forget to write down a school assignment or bring a book home. Completing homework can be huge challenge. At any age, an inattentive person may often be easily distracted, make careless mistakes, forget things, have trouble following instructions, or skip from one activity to another without finishing anything.

Some children with ADHD are mainly inattentive. They seldom act hyperactive or impulsive. An inattentive child with ADHD may sit quietly in class and appear to be working but is not really focusing on the assignment. Teachers and parents may easily overlook the problem.

Children with ADHD need support to help them pay attention, control their behavior, slow down, and feel better about themselves.

What Is Not ADHD?

Many children and adults are easily distracted at times or have trouble finishing tasks. To be ADHD, however, the behaviors must appear before age 7 and continue for at least six months. The symptoms must also create a real handicap in at least two areas of the child’s life—in the classroom, on the playground, at home, in the community, or in social settings.

If a child seems too active on the playground but not elsewhere, the problem might not be ADHD. It might also not be ADHD if the behaviors occur in the classroom but nowhere else. A child who shows some symptoms would not be diagnosed with ADHD if his or her schoolwork or friendships are not impaired by the behaviors.

Even if a child’s behavior seems like ADHD, it might not actually be ADHD. Many other conditions and situations can trigger behavior that resembles ADHD. For example, a child might show ADHD symptoms when experiencing

  • A death or divorce in the family, a parent’s job loss, or other sudden change.
  • Undetected seizures.
  • An ear infection that causes temporary hearing problems.
  • Problems with schoolwork caused by a learning disability.
  • Anxiety or depression. 

ADHD News has a synopsis of the ADHD diagnosis in the article by Mark Domoto, M.Ed. In the section, Diagnosing ADHD

The Edge Foundation provides information about ADHD research:

Our ADHD Coaching Research

Edge Foundation’s 2 year ADHD coaching study research demonstrates that ADHD students significantly benefit from receiving coaching using the JST  ADHD coaching model used by Edge Foundation.

ADHD Coaching Research Study Results

  • Students who received Edge ADHD coaching, based on the JST Coaching model for ADHD youth, showed substantial gains in their overall approach to learning.
  • The study showed that students who received Edge ADHD coaching services showed significant improvement in their ability to organize, direct and manage cognitive activities, emotional responses and overt behaviors.
  • They were able to formulate goals more realistically and consistently work toward achieving them, manage their time more effectively, and stick with tasks even when they found them challenging.

The research report became available on-line beginning November 11, 2010.  (See:  Edge Foundation ADHD Coaching Study Executive Summary and Edge Foundation ADHD Coaching Study Full Report .)

Why the Research Matters

Attention-deficit/hyperactivity disorder (ADHD) has long been associated with poor grades, poor reading and math test scores, and being held back. But despite billions of dollars spent on special education programs, the number of ADHD students dropping out of high school and college is alarming. Now a new study shows that ADHD students don’t have to be “at risk” students.

ADHD Students are “At Risk” Students

A few sobering facts to consider about the impact of ADHD on students’ success:

  • High school students with ADHD are 4 times more likely to drop out of school than the general population.
  • 42% of ADHD students are likely to be held back (compared to 13% general population).
  • 60% of ADHD students are likely to be suspended (compared to only 19% of the general population).
  • And 35% of ADHD students won’t graduate at all and those who stay in school will suffer from lack of confidence, higher risk of substance abuse and menial grades (on average a C- or D+).
  • Only 22% of students with ADHD enter college.
  • Only 5% will graduate.

Why ADHD Students are at Risk

Students with ADHD are vulnerable because ADHD impacts the portion of the brain that regulates what  is known as  executive functioning. ADHD students have executive function deficits in attention, planning and organization, prioritization, impulse control, memory, time management, and higher-order conceptual thinking.

Turns out a student’s executive function levels are well known by researches to be a hallmark of academic success.

ADHD Coaching Boosts Executive Functioning

Edge Foundation’s study offers hope for students with ADHD because it definitively links ADHD coaching to improved executive functioning.  And improved executive functioning means more success in school.

ADHD students who participated in Edge ADHD coaching sessions, based on the JST model for ADHD youth coaching, demonstrated statistically significant, higher executive functioning than ADHD students who did not receive ADHD coaching. According to the study, “The magnitude of the effect size for self regulation was more than double the typical educational intervention, and executive functioning was quadruple. Findings with effect sizes that large are rare.”

ADHD coaching has long been used by the corporate world to improve performance of CEOs and executives, but little study has been done until now on the impact this particular kind of intervention may have on populations with learning disabilities, like those living with ADHD. While medication has been shown to improve academic productivity (better note-taking, scores on quizzes and worksheets, and homework completion), medication alone is not associated with skills like better learning, reading or the ability to apply knowledge, all of which are critical in a successful post secondary education.

How Edge ADHD Coaching Works

Edge Foundation’s ADHD coaches work with students in seven major areas: scheduling, goal setting, confidence building, organizing, focusing, prioritizing and persisting at tasks. ADHD Coaches help students assess their environments, identify needs, set goals, and offer suggestions and guidance. They monitor student progress and goals through regular phone or email check-ins. The protocol of regularly checking in with clients provides for more structure and accountability. When coaching ADHD teens and college students, check-ins are usually made every day.

If you have questions about the study or would like to find out more about how an Edge ADHD coach can help you succeed in school, give us a call (1-888-718-8886) or send us an email.  We’d love to hear from you.

Reference Links:

Edge Foundation ADHD Coaching Study Executive Summary

Edge Foundation ADHD Coaching Study Full Report

ADHD and College Success: A free guide

UC Davis Study:  Dropout risks: ADHD, conduct disorder, smoking

ADHD and Executive Functioning

Executive Function, ADHD and  Academic Outcomes

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http://edgefoundation.org/information/research/

ADHD coaching is one tool which might help more children who have been diagnosed with ADHD to succeed.

Dr. Wilda says this about that ©

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The growing class divide: Parents taking out loans for kindergarten and elementary school education

29 Mar

If one believes that all children, regardless of that child’s status have a right to a good basic education and that society must fund and implement policies, which support this principle. Then, one must discuss the issue of equity in education.  Plessy v. Ferguson established the principle of “separate but equal” in race issues. Brown v. Board of Education which overturned the principle of “separate but equal.” would not have been necessary, but for Plessy. See also, the history of Brown v. Board of Education Because of the segregation, which resulted after Plessy, most folks focus their analysis of Brown almost solely on race. The issue of equity was just as important. The equity issue was explained in terms of unequal resources and unequal access to education.

People tend to cluster in neighborhoods based upon class as much as race. Good teachers tend to gravitate toward neighborhoods where they are paid well and students come from families who mirror their personal backgrounds and values. Good teachers make a difference in a child’s life. One of the difficulties in busing to achieve equity in education is that neighborhoods tend to be segregated by class as well as race. People often make sacrifices to move into neighborhoods they perceive mirror their values. That is why there must be good schools in all segments of the city and there must be good schools in all parts of this state. A good education should not depend upon one’s class or status.

The crisis in college affordability is evident to students and families trying to figure out how they will be able to afford their preferred option. Loren Berlin has written the Huffington Post article, Student Loans For Kindergarten, High School On The Rise:

As if the student loan debt burden wasn’t troubling enough, some parents are saying, “Bring on the debt!”… even though their kids haven’t even learned to read.

That’s right: cash-strapped parents who want to send their young ones to private schools are taking out loans to pay for grade school, according to SmartMoney. And demand is growing.

Your Tuition Solution, one of the largest providers of loans for K-12 education, reported that the amount of money parents requested is up 10 percent from last year, and that the company is on track to finance $20 million in loans for the 2012-2013 school year, SmartMoney reports. Demand is increasing fast enough that First Marblehead, another pre-college lender, has returned to the market after exiting it in 2008, according to SmartMoney.

As more parents turn to loans to finance private education, school tuition is increasing, furthering the demand for the loans. Over the past 10 years, the median price of first grade at private schools has increased 35 percent nationally, as compared to a 24 percent price hike at Ivy League colleges, according to the New York Times.

Ten years ago, the median tuition for 12th grade at a private school was $14,583. Today, that number has skyrocketed to $24,240, according to the National Association of Independent Schools. Stunningly, in New York City, some of the city’s most elite private high schools are poised to break the $40,000 tuition line this year, surpassing Harvard’s $36,305 price tag, reports the New York Times.

The tuitions are “outrageous,” said Dana Haddad, a private admissions consultant, in an interview with the New York Times. “People don’t want to put a price tag on their children’s future, so they are willing to pay more than many of them can afford.”

It’s a dangerous gamble, as Americans are already struggling under mounting student loan debt. Last week, officials at the Consumer Financial Protection Agency announced that total student debt outstanding is now more than $1 trillion. Student debt is rising not only because of a commiserate increase in tuition, but also because in recent years more Americans have turned to college to flee the lousy labor market, reports the Wall Street Journal.

http://www.huffingtonpost.com/2012/03/29/student-loans-kindergarten-high-school_n_1387706.html?ref=email_share

Affluent parents recognize the importance of education.

So, who is taking out loans for a kindergartner’s private education. According to Jen Doll’s Atlantic Wire article, Kindergarten Loans Are a Sad Reality of Our Time:

Contrary to what you might think, much of the demand is actually coming from families who make more than $150,000 annually. Which means these parents, along with selecting well-above-the-average-means-level schools for their kids, could find themselves repaying loans for the foreseeable future, possibly along with college loans as well. Already, writes Andriotis, “about one in six parents of college graduates have loans, and they’re projected to owe nearly $34,000 on average this year.” More loans before the kids even reach PSAT-taking age means, simply, more and more debt, something it appears Americans are becoming ever more comfortable with—even as the rich complain about how poor they are. Loans are less taboo, and schools are more willing to present loan programs as “an affordability option,” which means these types of loans are likely just going to become more popular.

But that’s pretty scary, particularly when you consider that the costs of private schools and colleges keep going higher and higher. Per Andriotis: “The average cost of private school is nearly $22,000 a year, up 4% from a year ago and up 26% from 2006-07, according to the NAIS.” Though total private school enrollment is on the decline (perhaps because of the recession?), if loans are available to make up that difference, and if even wealthy people are requiring such loans, there’s hardly a bar to keep the costs from continuing to escalate. The people who benefit from this the most are not, necessarily, the kids, but the banks or schools getting as much as a 20 percent interest rate on a loan that might go as high as $40,000—something you might look at as preying on parents who think it’s their duty to send their child to a particular (and particularly pricey) school. Well, kids have always been expensive.

http://news.yahoo.com/kindergarten-loans-sad-reality-time-191851594.html;_ylc=X3oDMTNsMnRoZ3NpBF9TAzk3NDc2MTc1BGFjdANtYWlsX2NiBGN0A2EEaW50bAN1cwRsYW5nA2VuLVVTBHBrZwNhZGQzMzg2OS0xYTFiLTMwMDYtYjY0OS01ZGMyZDk3ZDI2ZTAEc2VjA21pdF9zaGFyZQRzbGsDbWFpbAR0ZXN0Aw–;_ylv=3

See, Student Loans on Rise — for Kindergarten http://www.smartmoney.com/borrow/student-loans/student-loans-on-rise–for-kindergarten-1332957614617/

Moi knows that the lawyers in Brown were told that lawsuits were futile and that the legislatures would address the issue of segregation eventually when the public was ready. Meanwhile, several generations of African Americans waited for people to come around and say the Constitution applied to us as well. Generations of African Americans suffered in inferior schools. This state cannot sacrifice the lives of children by not addressing the issue of equity in school funding in a timely manner.

The next huge case, like Brown, will be about equity in education funding. It may not come this year or the next year. It, like Brown, may come several years after a Plessy. It will come. Equity in education funding is the civil rights issue of this century

Related:

3rd world America: Money changes everything

https://drwilda.wordpress.com/2012/02/11/3rd-world-america-money-changes-everything/

School choice: Given a choice, parents vote with their feet

https://drwilda.wordpress.com/2011/12/15/school-choice-given-a-choice-parents-vote-with-their-feet/

The next great civil rights struggle: Disparity in education funding

https://drwilda.wordpress.com/2011/12/02/the-next-great-civil-rights-struggle-disparity-in-education-funding/

Dr. Wilda says this about that ©

Stupid decision from 5th Circuit Court of Appeals regarding school’s custodial responsibilities

28 Mar

Parents in the 5th Circuit should exercise caution when dropping the children off at school. They cannot automatically assume that the school district will be responsible for the child’s safety. Mark Walsh writes in the Education Week article, School Not Liable in Girl’s Sex Assault, Full Appeals Court Rules:

A Mississippi school district is not liable in a federal civil rights suit for failing to protect a 4th grade student from sexual assault by a man who checked the girl out of school without authorization, a full federal appeals court has ruled.

The 16-2 decision by the full U.S. Court of Appeals for the 5th Circuit, in New Orleans, holds that the student did not have a special custodial relationship with her school, and thus the school had no constitutional duty to protect her from harm inflicted by a private “actor.” The court also rejected two other theories for holding the school liable.

“While we should have every reason to expect that public schools can and will provide for the safety of public school students, no matter their age, our precedents, and the decisions of every other circuit to have considered this issue, dictate that schools are simply not constitutionally required to ensure students’ safety from private actors,” said the majority opinion by Carolyn Dineen King on March 23 in Doe v. Covington County School District..

A three-judge panel of the 5th Circuit had ruled 2-1 last August that the school district may be liable in the case. The full appeals court tossed out that ruling in September and said it would look at the case “en banc.”

The two judges who voted for liability in the panel decision were the dissenters from the full court’s contrary opinion….

The district had a compulsory check-out policy, with parents filling out a form listing adults authorized to check out their children. The man was not authorized to check out Jane Doe but would claim to be her father and even once signed the girl out as her mother, court papers say.

The man was convicted of sexual battery in the assaults and is serving a 10-year prison term, according to press reports at the time of the panel decision.

The suit alleged that the district violated the girl’s 14th Amendment substantive due process rights by being deliberately indifferent to her safety.

While a federal district court dismissed the suit, the 5th Circuit panel ruled last August that the school did have a special relationship with the girl, resulting in a duty to protect her from harm.

The panel cited language from the U.S. Supreme Court’s 1989 decision in DeShaney v. Winnebago County Department of Social Services. In that case, the high court held that there was no special relationship between government social workers and a child who was severely beaten by his father after the social workers had investigated reports of abuse and declined to remove the child from his home.

The high court went on in DeShaney to say that the government agency could have had a duty to protect the child from private violence if it had taken an affirmatively active role in the child’s care.

The full 5th Circuit majority, rejecting the panel’s conclusions, said it has been binding precedent in that circuit for decades that a public school does not have a DeShaney special relationship with its students requiring the school to ensure the students’ safety from private actors.

“Without a special relationship, a public school has no constitutional duty to ensure that its students are safe from private violence,” Judge King said in the majority opinion.

The full 5th Circuit court also rejected district liability under so-called state-created danger and municipal liability theories.

http://blogs.edweek.org/edweek/school_law/2012/03/school_not_liable_in_girls_sex.html?intc=bs&cmp=SOC-SHR-GEN

The 5th Circuit had previously ruled in a school custodian case.

The North Carolina School of Law reported about an equally egregious case in the article, School officials did not have duty to protect student from rape by school custodian:

Doe v. Hillsboro Independent School District, 113 F.3d 1412 (5th Cir. 1997)

Facts:

Jane Doe, a thirteen-year-old student, was raped and assaulted by a school custodian while staying after school to do special work on her studies. Through her parents Doe brought suit against individual school officials, among others, alleging that the officials violated their constitutional duty to protect her from harm by third parties. Normally governmental officials do not have a constitutional duty to protect citizens from harm by third parties, but Doe alleged that her case fit into two exceptions to this rule: the custodial-relationship exception and the state-created-danger exception.

Holding:

The Fifth Circuit Court of Appeals rejected Doe’s arguments and ordered judgment in favor of the district.

Custodial-relationship argument. The court first rejected Doe’s argument that she was in a custodial relationship with the school district that gave the school officials a constitutional duty to protect her. The custodial-relationship exception was created for relationships in which action the state has taken has deprived the injured party of the ability to protect himself or herself—for instance, when the state imprisons a person or places him or her in a mental institution. Compulsory school attendance laws, without more, do not create that kind of relationship between a school district and its students, the court concluded, joining every other circuit court that had ever considered the issue.

State-created-danger argument. The court went on to reject Doe’s argument that school officials had a duty to protect her because the school district created the danger that caused her harm by hiring the custodian without checking his criminal background. The court noted that the school district placed Doe in the same general area as a school custodian with no known criminal record, with school teachers present in the same building, and that these actions were insufficient to trigger a duty to protect. There was no showing that the district knew the custodian was dangerous. Doe did not allege, and produced no proof to show, that the custodian even had a criminal record for the district to discover.

summarized by Ingrid M. Johansen

posted Spring 1998

http://csl.sog.unc.edu/node/686

The dissent in Doe v. Covington School District made the argument as to why the school district should be liable.

Here is a key portion of the Doe v. Covington School District dissent from Circuit Judge Weiner who was joined by Circuit Judge Dennis, the two dissenters:

Case: 09-60406 Document: 00511798661 Page: 41 Date Filed: 03/23/2012

No. 09-60406

WIENER, Circuit Judge, joined by DENNIS, Circuit Judge, dissenting. Like the law of nature, the law of man recognizes no more basic or extensive “special relationship” than that between parents and their “very young” children. Central to that relationship is the parents’ exclusive right to the custody of their children and the concomitant duty to protect them. It must

follow that when a state mandates that parents delegate the custody of their child to a state agency, subdivision, or municipality, such total delegation creates a special relationship between the delegatee and the child in its custody–at least when such child is “very young”–and imposes on such custodial state delegatee a duty to protect that child from violations of her constitutional rights. I am convinced that the parents’ custodial delegatee here– the Covington County Elementary School (“the School”)–cannot be permitted to evade its duty to protect its very young pupils while they are in its exclusive custody.

As is apparent from the Does’ Iqbal/Twombley-compliant complaint and 1 the majority opinion, this case involves repeated decisions and acts by the School’s officials to temporarily sub-delegate its exclusive custody of a nine-yearold fourth-grade girl, in the middle of six different school days, over a span of four months, to an unidentified adult, who was not authorized under the School’s express policy to check her out, and whose identity it did not even attempt to

verify. On each of those six occasions, that adult, Tommy Keyes, proceeded to brutally rape the little girl, Jane Doe, and then return her to the custody of the School–still during the course of the school day. This was no isolated or anecdotal incident, and the School’s officials allegedly contributed to its recurrence by failing, each time, to verify Keyes’s identity and his lack of authorization.

Despite our standard of review of dismissal of actions at their initial (Rule 12(b)(6)) stage, the majority raises the stakes of this appeal by not limiting its analysis to the Does’ complaint, but instead asserting categorically that public schools have no DeShaney special relationship with, and thus no constitutional 2 duty to protect, any schoolchildren–not even the very young–from non-state actors...

Citation:

IN THE UNITED STATES COURT OF APPEALS FOR THE FIFTH CIRCUIT No. 09-60406

JANE DOE, A Minor, By and Through Her Next Friends, Daniel Magee and Geneva Magee; DANIEL MAGEE, Individually and on Behalf of Jane Doe; GENEVA MAGEE, Individually and on Behalf of Jane Doe, A Minor,

Plaintiffs–Appellants

v.

COVINGTON COUNTY SCHOOL DISTRICT, by and through its Board of Education and its President, Andrew Keys and its Superintendent of Education, I.S. Sanford, Jr.; COVINGTON COUNTY SUPERINTENDENT OF EDUCATION, I.S. SANFORD, Officially and in His Individual Capacity; COVINGTON COUNTY BOARD OF EDUCATION, By and Through its

President, Andrew Keys; ANDREW KEYS, Officially and in His Individual Capacity; TOMMY KEYES; OTHER UNKNOWN JOHN DOE AND JANE DOE EDUCATION DEFENDANTS A-Z, In Their Official and Individual Capacities,

Defendants–Appellees

Appeal from the United States District Court for the Southern District of Mississippi

Before JONES, Chief Judge, and KING, JOLLY, DAVIS, SMITH, WIENER,

GARZA, BENAVIDES, STEWART, DENNIS, CLEMENT, PRADO, OWEN,

ELROD, SOUTHWICK, HAYNES, GRAVES, and HIGGINSON, Circuit Judges.

KING, Circuit Judge, joined by EDITH H. JONES, Chief Judge, E. GRADY

JOLLY, W. EUGENE DAVIS, JERRY E. SMITH, EMILIO M. GARZA,

United States Court of Appeals

Fifth Circuit

F I L E D

March 23, 2012

Lyle W. Cayce

Clerk

Case: 09-60406 Document: 00511798661 Page: 1 Date Filed: 03/23/2012

No. 09-60406

http://www.ca5.uscourts.gov/opinions/pub/09/09-60406-CV2.wpd.pdf

The judges writing for the majority deserve the scorn of the nation.

“The law, in its majestic equality, forbids the rich and the poor alike to sleep under bridges, to beg in the streets, and to steal bread.” (Le Lys Rouge)

Anatole France

Dr. Wilda says this about that ©

Autism and children of color

27 Mar

Lauran Neergaard reported in the Huffington Post article, Autism Not Diagnosed As Early In Minority Children: Study:

Her preliminary research suggests even when diagnosed in toddlerhood, minority youngsters have more severe developmental delays than their white counterparts. She says cultural differences in how parents view developmental milestones, and how they interact with doctors, may play a role.

Consider: Tots tend to point before they talk, but pointing is rude in some cultures and may not be missed by a new parent, Landa says. Or maybe mom’s worried that her son isn’t talking yet but the family matriarch, her grandmother, says don’t worry – Cousin Harry spoke late, too, and he’s fine. Or maybe the pediatrician dismissed the parents’ concern, and they were taught not to question doctors.

It’s possible to detect autism as early as 14 months of age, and the American Academy of Pediatrics recommends that youngsters be screened for it starting at 18 months. While there’s no cure, behavioral and other therapies are thought to work best when started very young.

Yet on average, U.S. children aren’t diagnosed until they’re about 4 1/2 years old, according to government statistics.

And troubling studies show that white kids may be diagnosed with autism as much as a year and a half earlier than black and other minority children, says University of Pennsylvania autism expert David Mandell, who led much of that work. Socioeconomics can play a role, if minority families have less access to health care or less education.

But Mandell says the full story is more complex. One of his own studies, for example, found that black children with autism were more likely than whites to get the wrong diagnosis during their first visit with a specialist.

http://www.huffingtonpost.com/2012/02/28/autism-not-diagnosed-as-early-in-minority-children_n_1306272.html

See, New Study Shows Minority Toddlers with Autism are More Delayed than Affected Caucasian Peers http://www.kennedykrieger.org/overview/news/new-study-shows-minority-toddlers-autism-are-more-delayed-affected-caucasian-peers

Citation:

Journal of Autism and Developmental Disorders

DOI: 10.1007/s10803-012-1445-8

Original Paper

Differences in Autism Symptoms Between Minority and Non-Minority Toddlers

Saime Tek and Rebecca J. Landa

The number of children with autism appears to be growing.

The Centers for Disease Control and Prevention provides statistics on the number of children with autism in the section Data and Statistics:

Prevalence

  • It is estimated that between 1 in 80 and 1 in 240 with an average of 1 in 110 children in the United States have an ASD. [Read article
  • ASDs are reported to occur in all racial, ethnic, and socioeconomic groups, yet are on average 4 to 5 times more likely to occur in boys than in girls.  However, we need more information on some less studied populations and regions around the world. [Read article]
  • Studies in Asia, Europe, and North America have identified individuals with an ASD with an approximate prevalence of 0.6% to over 1%. A recent study in South Korea reported a prevalence of 2.6%. [Data table Adobe PDF file]
  • Approximately 13% of children have a developmental disability, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism.  [Read articleExternal Web Site Icon]

Learn more about prevalence of ASDs »

Learn more about the ADDM Project »

Learn more about the MADDSP Project »

On this Page

http://www.cdc.gov/ncbddd/autism/data.html

In order for children with autism to reach their full potential there must be early diagnosis and treatment.

The National Institute of Neurological Disorders and Stroke has an autism fact sheet

What is autism?

Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior.  Autistic disorder, sometimes called autism or classical ASD, is the most severe form of ASD, while other conditions along the spectrum include a milder form known as Asperger syndrome, and childhood disintegrative disorder and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS).  Although ASD varies significantly in character and severity, it occurs in all ethnic and socioeconomic groups and affects every age group.  Experts estimate that six children out of every 1,000 will have an ASD.  Males are four times more likely to have an ASD than females.

What are some common signs of autism?

The hallmark feature of ASD is impaired social interaction.  As early as infancy, a baby with ASD may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time.  A child with ASD may appear to develop normally and then withdraw and become indifferent to social engagement.

Children with an ASD may fail to respond to their names and often avoid eye contact with other people.  They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behavior.  They lack empathy.

Many children with an ASD engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging.  They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.”  Children with an ASD don’t know how to play interactively with other children.  Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Children with characteristics of an ASD may have co-occurring conditions, including Fragile X syndrome (which causes mental retardation), tuberous sclerosis, epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder.  About 20 to 30 percent of children with an ASD develop epilepsy by the time they reach adulthood. .

How is autism diagnosed?

ASD varies widely in severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps.  Very early indicators that require evaluation by an expert include:

  • no babbling or pointing by age 1
  • no single words by 16 months or two-word phrases by age 2
  • no response to name
  • loss of language or social skills
  • poor eye contact
  • excessive lining up of toys or objects
  • no smiling or social responsiveness.

Later indicators include:

  • impaired ability to make friends with peers
  • impaired ability to initiate or sustain a conversation with others
  • absence or impairment of imaginative and social play
  • stereotyped, repetitive, or unusual use of language
  • restricted patterns of interest that are abnormal in intensity or focus
  • preoccupation with certain objects or subjects
  • inflexible adherence to specific routines or rituals.

Health care providers will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior.  Some screening instruments rely solely on parent observations, while others rely on a combination of parent and doctor observations.  If screening instruments indicate the possibility of an ASD, a more comprehensive evaluation is usually indicated….

What causes autism?

Scientists aren’t certain about what causes ASD, but it’s likely that both genetics and environment play a role.  Researchers have identified a number of genes associated with the disorder.  Studies of people with ASD have found irregularities in several regions of the brain.  Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain.  These abnormalities suggest that ASD could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function.  While these findings are intriguing, they are preliminary and require further study.  The theory that parental practices are responsible for ASD has long been disproved….

Parents must pay attention to whether their children are developing within the parameters of what is appropriate for the child’s age.

Resources:

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov

Association for Science in Autism Treatment
P.O. Box 188
Crosswicks, NJ   08515-0188
info@asatonline.org
http://www.asatonline.org

Autism National Committee (AUTCOM)
P.O. Box 429
Forest Knolls, CA   94933
http://www.autcom.org

Autism Network International (ANI)
P.O. Box 35448
Syracuse, NY   13235-5448
jisincla@syr.edu
http://www.ani.ac

Autism Research Institute (ARI)
4182 Adams Avenue
San Diego, CA   92116
director@autism.com
http://www.autismresearchinstitute.com
Tel: 866-366-3361
Fax: 619-563-6840

Autism Science Foundation
419 Lafayette Street
2nd floor
New York, NY   10003
contactus@autismsciencefoundation.org
http://www.autismsciencefoundation.org/
Tel: 646-723-3978
Fax: 212-228-3557

Autism Society of America
4340 East-West Highway
Suite 350
Bethesda, MD   20814
http://www.autism-society.org
Tel: 301-657-0881 800-3AUTISM (328-8476)
Fax: 301-657-0869

Autism Speaks, Inc.
2 Park Avenue
11th Floor
New York, NY   10016
contactus@autismspeaks.org
http://www.autismspeaks.org
Tel: 212-252-8584 California: 310-230-3568
Fax: 212-252-8676

Birth Defect Research for Children, Inc.
976 Lake Baldwin Lane
Suite 104
Orlando, FL   32814
betty@birthdefects.org
http://www.birthdefects.org
Tel: 407-895-0802

MAAP Services for Autism, Asperger Syndrome, and PDD
P.O. Box 524
Crown Point, IN   46308
info@aspergersyndrome.org
http://www.aspergersyndrome.org/
Tel: 219-662-1311
Fax: 219-662-1315

National Dissemination Center for Children with Disabilities
U.S. Dept. of Education, Office of Special Education Programs
1825 Connecticut Avenue NW, Suite 700
Washington, DC   20009
nichcy@aed.org
http://www.nichcy.org
Tel: 800-695-0285 202-884-8200
Fax: 202-884-8441

National Institute of Child Health and Human Development (NICHD)
National Institutes of Health, DHHS
31 Center Drive, Rm. 2A32 MSC 2425
Bethesda, MD   20892-2425
http://www.nichd.nih.gov
Tel: 301-496-5133
Fax: 301-496-7101

National Institute on Deafness and Other Communication Disorders Information Clearinghouse
1 Communication Avenue
Bethesda, MD   20892-3456
nidcdinfo@nidcd.nih.gov
http://www.nidcd.nih.gov
Tel: 800-241-1044 800-241-1055 (TTD/TTY)

National Institute of Environmental Health Sciences (NIEHS)
National Institutes of Health, DHHS
111 T.W. Alexander Drive
Research Triangle Park, NC   27709
webcenter@niehs.nih.gov
http://www.niehs.nih.gov
Tel: 919-541-3345

National Institute of Mental Health (NIMH)
National Institutes of Health, DHHS
6001 Executive Blvd. Rm. 8184, MSC 9663
Bethesda, MD   20892-9663
nimhinfo@nih.gov
http://www.nimh.nih.gov
Tel: 301-443-4513/866-415-8051 301-443-8431 (TTY)
Fax: 301-443-4279

“Autism Fact Sheet,” NINDS. Publication date September 2009.

NIH Publication No. 09-1877

Back to Autism Information Page

Dr. Wilda says this about that ©

Seattle Children’s Institute study: Supportive middle school teachers affect a kid’s alcohol use

26 Mar

Substance abuse is a serious problem for many young people. The Centers for Disease Control provide statistics about underage drinking in the Fact Sheet: Underage Drinking:

Underage Drinking

Alcohol use by persons under age 21 years is a major public health problem.1 Alcohol is the most commonly used and abused drug among youth in the United States, more than tobacco and illicit drugs. Although drinking by persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the United States.2 More than 90% of this alcohol is consumed in the form of binge drinks.2 On average, underage drinkers consume more drinks per drinking occasion than adult drinkers.3 In 2008, there were approximately 190,000 emergency rooms visits by persons under age 21 for injuries and other conditions linked to alcohol.4

Drinking Levels among Youth

The 2009 Youth Risk Behavior Survey5 found that among high school students, during the past 30 days

  • 42% drank some amount of alcohol.
  • 24% binge drank.
  • 10% drove after drinking alcohol.
  • 28% rode with a driver who had been drinking alcohol.

Other national surveys indicate

  • In 2008 the National Survey on Drug Use and HealthExternal Web Site Icon reported that 28% of youth aged 12 to 20 years drink alcohol and 19% reported binge drinking.6
  • In 2009, the Monitoring the Future SurveyExternal Web Site Icon reported that 37% of 8th graders and 72% of 12th graders had tried alcohol, and 15% of 8th graders and 44% of 12th graders drank during the past month.7

Consequences of Underage Drinking

Youth who drink alcohol1, 3, 8 are more likely to experience

  • School problems, such as higher absence and poor or failing grades.
  • Social problems, such as fighting and lack of participation in youth activities.
  • Legal problems, such as arrest for driving or physically hurting someone while drunk.
  • Physical problems, such as hangovers or illnesses.
  • Unwanted, unplanned, and unprotected sexual activity.
  • Disruption of normal growth and sexual development.
  • Physical and sexual assault.
  • Higher risk for suicide and homicide.
  • Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
  • Memory problems.
  • Abuse of other drugs.
  • Changes in brain development that may have life-long effects.
  • Death from alcohol poisoning.

In general, the risk of youth experiencing these problems is greater for those who binge drink than for those who do not binge drink.8

Youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or abuse later in life than those who begin drinking at or after age 21 years.9, 10 http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm

See, Alcohol Use Among Adolescents and Young Adults http://pubs.niaaa.nih.gov/publications/arh27-1/79-86.htm

Seattle Children’s Institute has just published the the study, “Emotional Health Predictors of Substance Use Initiation During Middle School,” was published in advance online in Psychology of Addictive Behaviors. Here is the press release from Seattle Children’s Institute:

Middle School Teacher Support Lowers Risk for Early Alcohol Use

March 21, 2012

Youth with parental separation anxiety also at decreased risk

Anxiety, depression, stress and social support can predict early alcohol and illicit drug use in youth, according to a study from Carolyn McCarty, PhD, of Seattle Children’s Research Institute, and researchers from the University of Washington and Seattle University.  Middle school students from the sixth to the eighth grade who felt more emotional support from teachers reported a delay in alcohol and other illicit substance initiation. Those who reported higher levels of separation anxiety from their parents were also at decreased risk for early alcohol use. The study, “Emotional Health Predictors of Substance Use Initiation During Middle School,” was published in advance online in Psychology of Addictive Behaviors.

Relatively few studies have examined support for youth from nonfamily members of the adolescent’s social support network, including teachers. “Our results were surprising,” said Dr. McCarty, who is also a University of Washington research associate professor.  “We have known that middle school teachers are important in the lives of young people, but this is the first data-driven study which shows that teacher support is associated with lower levels of early alcohol use.”  Middle school students defined teacher support as feeling close to a teacher or being able to talk with a teacher about problems they are experiencing.

Youth that are close to or even cling to parents can have separation anxiety and may be less susceptible to negative influences from peers, including experimentation with risky behaviors like alcohol use.  “Teens in general seek new sensations or experiences and they take more risks when they are with peers,” said Dr. McCarty.  “Youth with separation anxiety symptoms may be protected by virtue of their intense connection to their parents, making them less likely to be in settings where substance use initiation is possible,” she said.

The study also found that youth who initiated alcohol and other illicit drug use prior to sixth grade had significantly higher levels of depressive symptoms.  This suggests that depression may be a consequence of very early use or a risk factor for initiation of use prior to the middle school years.  Depression was defined by asking youth about their mood and feelings, and asking them if statements such as “I felt awful or unhappy” and “I felt grumpy or upset with my parents” were true, false or sometimes true during a two-week timeframe. 

Based on the study and our findings, substance use prevention needs to be addressed on a multidimensional level,” said Dr. McCarty.  “We need to be aware of and monitor early adolescent stress levels, and parents, teachers and adults need to tune into kids’ mental health.  We know that youth who initiate substance abuse before age 14 are at a high risk of long-term substance abuse problems and myriad health complications.” 

Dr. McCarty Offers Tips for Parents to Help Reduce Early Alcohol Use 

  • Know where your child is, and check in with your child on a regular basis 
  • Get to know your child’s friends, and who your child spends time with 
  • Teach stress management skills 
  • Help your child feel connected with adults at school  

Dr. McCarty and the research team analyzed data from the Developmental Pathways Project, a longitudinal study of 521 youth sampled from the Seattle Public Schools.  Researchers analyzed the effects of depression, anxiety, stress and support on initiation of substance use, which was measured at five different time points between sixth and eighth grade.

Seattle Children’s Research Institute, in collaboration with the University of Washington and Seattle University, will continue to study this topic, next looking at the timing between youth substance use and depression, as well as how intervention programs for depression impact substance use.

Dr. McCarty’s co-authors were:  Elizabeth McCauley, PhD, Seattle Children’s Research Institute, University of Washington; Elise Murowchick, PhD, Seattle University; Isaac Rhew, PhD, University of Washington; and Ann Vander Stoep, PhD, University of Washington.

Supporting Materials: 

http://www.seattlechildrens.org/Press-Releases/2012/Middle-School-Teacher-Support-Lowers-Risk-for-Early-Alcohol-Use/

Assuming you are not one of those ill-advised parents who supply their child with alcohol or drugs like marijuana in an attempt to be hip or cool, suspicions that your child may have a substance abuse problem are a concern. Confirmation that your child has a substance abuse problem can be heartbreaking. Even children whose parents have seemingly done everything right can become involved with drugs. The best defense is knowledge about your child, your child’s friends, and your child’s activities. You need to be aware of what is influencing your child.

Our goal should be:

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

Related:

New study about substance abuse and kids https://drwilda.wordpress.com/2011/11/09/new-study-about-substance-abuse-and-kids/

Dr. Wilda says this about that ©

So, we’re all wearing hoodies now? It really is about stereotypes

25 Mar

The death cult of hip-hop has been on a lot of people’s radar for the past few years. Because of artistic freedom and the romanticizing  of some hip-hop and rap stars, those sounding the alarm about this death cult have been labeled as prudes, nervous ninnies, and anti-free speech. A 2005 Nightline story by Jake Tapper and Marie Nelson looked at the links between corporate America and hip-hop

“The blueprint now is an image that promotes all of the worst aspects of violent and anti-social behavior,” said Source editor Mays. “It takes those real issues of violent life that occur in our inner cities, it takes them out of context.”

Attorney Londell McMillan, who represents Lil’ Kim and many other hip-hop performers, says the record labels and radio stations push the artists toward a more violent image. “They all seek to do things that are extraordinary,” he said, “unfortunately it’s been extraordinarily in the pain of a people. They are often encouraged to take a certain kind of approach to the art form.”

Added NYPD Commissioner Kelly, “Whereas some of the other violence was sort of attendant to the business itself, now I think they’re trying to exploit it and make money off of it.”

But C-Murder says if he projected a more benign image his career would be over. “I wouldn’t sell a record because my fans would know that’s not me,” he said. “They don’t expect me to just sit in that booth and write about stuff that the news or the media want to hear about.”

Record executive Dash adds there is a double standard between predominantly black and predominantly white music. “I remember Woodstock Part II was a mess,” Dash said, referring to the 1999 rock ‘n’ roll concert festival that exploded in a mass of riots and rapes. But, Dash said, “nothing more about it than that” transpired. “There wasn’t any new laws, there wasn’t any investigations. It just was.” 

Lest you think I am anti-capitalism, the real kind, not the corporate welfare of Goldman Sachs and JP Morgan Chase, you are wrong. Most inner city neighborhoods and poor regions like Appalachia and Mississippi desperately need investment and capital to encourage entrepreneurs.  As the motto of Homeboy Industries states, the best defense against violence is a job.

Moi has been railing against the hip hop culture for years because it is destructive, produces violence, but just as important it stereotypes Blacks whether they participate in hip hop culture or not. Geraldo Rivera got excoriated for suggesting that Trayvon Martin was shot because of his hoodie. Jack Mirkinson reports in the Huffington Post article, Trayvon Martin Hoodie Comments: ‘Half Of It Is The Way The Young Men Look’ (VIDEO):

The Fox News host caused a firestorm on Friday morning when he said that Martin was shot to death in part because he was wearing a hoodie. “I’ll bet you money, if he didn’t have that hoodie on, that nutty neighborhood watch guy wouldn’t have responded in that violent and aggressive way,” he said.

Instant outrage, and a fair amount of ridicule, followed. Rivera admitted that his own son told him he was ashamed of him. But he stood staunchly behind his comments when speaking to O’Reilly. The two began talking about New York’s controversial “stop and frisk” laws, which disproportionately affect people of color. Rivera said he supported the laws, and then brought up hoodies again.

“I’m telling you, half of it is the way the young men look,” he said. “…If a cop looks at three kids on the corner, and they’ve got those hoodies up — and this is where I got in trouble with the Trayvon Martin case — if they’ve got those hoodies up, and they’re hanging out on the corner, the cops look at them and say, ‘Hmm, hoodies. Who else wears hoodies? Everybody that ever stuck up a convenience store, D.B. Cooper, the guy that hijacked a plane, Ted Kaczynski, the Unabomber…'” http://www.huffingtonpost.com/2012/03/24/geraldo-rivera-trayvon-martin-hoodie-comments_n_1377014.html?ref=email_share

Moi wonders how many of those who were so up in arms about Rivera’s comments have practical experience living in an urban environment? Moi is a bus chick and takes the bus all over Seattle. From observation, moi can tell you that when a group of young men wearing hoodies boards the bus a considerable number of folks exit at the next stop. Or, what about the observation that in large corporate office buildings people don’t want to be the lone person to enter an elevator alone with with a well-dressed Black man. It is about perception of culture and stereotypes.

Project Implicit measures an individual’s feelings about stereotypes.

Here you will have the opportunity to assess your conscious and unconscious preferences for over 90 different topics ranging from pets to political issues, ethnic groups to sports teams, and entertainers to styles of music. At the same time, you will be assisting psychological research on thoughts and feelings.

Sessions require 10-15 minutes to complete. Each time you begin a session you will be randomly assigned to a topic. Try one or do them all! At the end of the session, you will get some information about the study and a summary of your results. We hope that you will find the experience interesting and informative.

If you haven’t already registered, fill out a brief form and then begin! This site is free and there are no advertisements.

https://implicit.harvard.edu/implicit/research/

IAT Home

It is well known that people don’t always ‘speak their minds’, and it is suspected that people don’t always ‘know their minds’. Understanding such divergences is important to scientific psychology.

This web site presents a method that demonstrates the conscious-unconscious divergences much more convincingly than has been possible with previous methods. This new method is called the Implicit Association Test, or IAT for short.

In addition, this site contains various related information. The value of this information may be greatest if you try at least one test first…

Go to the Demonstration Tests.

Or, go directly to the featured task: Featured Task.

https://implicit.harvard.edu/implicit/demo/

Stereotypes can be deadly as the Trayvon Martin case demonstrates.

John Mc Whorter wrote a prescient 2003 article in City Journal entitled, How Hip-hop Holds Blacks Back

But rap took a dark turn in the early 1980s, as this “bubble gum” music gave way to a “gangsta” style that picked up where blaxploitation left off. Now top rappers began to write edgy lyrics celebrating street warfare or drugs and promiscuity. Grandmaster Flash’s ominous 1982 hit, “The Message,” with its chorus, “It’s like a jungle sometimes, it makes me wonder how I keep from going under,” marked the change in sensibility. It depicted ghetto life as profoundly desolate:

You grow in the ghetto, living second rate
And your eyes will sing a song of deep hate.
The places you play and where you stay
Looks like one great big alley way.
You’ll admire all the numberbook takers,
Thugs, pimps and pushers, and the big money makers.

Music critics fell over themselves to praise “The Message,” treating it as the poetry of the streets—as the elite media has characterized hip-hop ever since. The song’s grim fatalism struck a chord; twice, I’ve heard blacks in audiences for talks on race cite the chorus to underscore a point about black victimhood. So did the warning it carried: “Don’t push me, ’cause I’m close to the edge,” menacingly raps Melle Mel. The ultimate message of “The Message”—that ghetto life is so hopeless that an explosion of violence is both justified and imminent—would become a hip-hop mantra in the years ahead.

The angry, oppositional stance that “The Message” reintroduced into black popular culture transformed rap from a fad into a multi-billion-dollar industry that sold more than 80 million records in the U.S. in 2002—nearly 13 percent of all recordings sold. To rap producers like Russell Simmons, earlier black pop was just sissy music. He despised the “soft, unaggressive music (and non-threatening images)” of artists like Michael Jackson or Luther Vandross. “So the first chance I got,” he says, “I did exactly the opposite.”

Now, for many children of color, the worry of being held back has been overtaken by dying young. Mc Whorter and the late C. Delores Tucker, among others, were warning about the dangers of hip-hop back in the day. Their predictions have come true.

Hip-hop music and hip-hop culture is just as virulent a disease as AIDS or cancer. The lifestyle is claiming bodies all over the country. There is money to be made in this culture of death and “presentable” purveyors like Sean Combs, Jay Z, and Russell Simmons funnel resources to public relations bonanzas like encouraging teen voting to burnish their image. I’m not sure if any of the trio has been appointed an UN ambassador yet. They, like the family portrayed in the God Father want to move into the mainstream and hide the source of their wealth. The mainstream corporations who profit from hip-hop and are all too happy to let Combs, Jay Z, and Simmons front the money making machine as they are smiling all the way to the bank.

So, I guess we all wear hoodies now. Meanwhile, the body count continues.

Dr. Wilda says this about that ©

Albert Einstein School of Medicine study: Abnormal breathing during sleep can lead to behavior problems in children

25 Mar

A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination  A physical examination is important to discover any problems which might affect a child’s ability to learn or which might affect the child’s future health.

Albert Einstein School of Medicine announced the study, “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.”

A study of more than 11,000 children followed for over six years has found that young children with sleep-disordered breathing are prone to developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships, according to researchers at Albert Einstein College of Medicine of Yeshiva University. Their study, the largest and most comprehensive of its kind, published online today

“This is the strongest evidence to date that snoring, mouth breathing, and apnea [abnormally long pauses in breathing during sleep] can have serious behavioral and social-emotional consequences for children,” said study leader Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women’s health at Einstein. “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Sleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. Its hallmarks are snoring (which is usually accompanied by mouth breathing) and sleep apnea. SDB reportedly peaks from two to six years of age, but also occurs in younger children. About 1 in 10 children snore regularly and 2 to 4 percent have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids.

“Until now, we really didn’t have strong evidence that SDB actually preceded problematic behavior such as hyperactivity,” said Ronald D. Chervin, M.D., M.S., a co-author of the study and professor of sleep medicine and of neurology at the University of Michigan. “Previous studies suggesting a possible connection between SDB symptoms and subsequent behavioral problems weren’t definitive, since they included only small numbers of patients, short follow-ups of a single SDB symptom, or limited control of variables such as low birth weight that could skew the results. But this study shows clearly that SDB symptoms do precede behavioral problems and strongly suggests that SDB symptoms are causing those problems.”

The new study analyzed the combined effects of snoring, apnea and mouth-breathing patterns on the behavior of children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems….”

— Karen Bonuck, Ph.D.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems,” said Dr. Bonuck.  “The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures.”

Children whose symptoms peaked early—at 6 or 18 months—were 40 percent and 50 percent more likely, respectively, to experience behavioral problems at age 7 compared with normally-breathing children. Children with the most serious behavioral problems were those with SDB symptoms that persisted throughout the evaluation period and became most severe at 30 months.

Researchers believe that SDB could cause behavioral problems by affecting the brain in several ways: decreasing oxygen levels and increasing carbon dioxide levels in the prefrontal cortex; interrupting the restorative processes of sleep; and disrupting the balance of various cellular and chemical. Behavioral problems resulting from these adverse effects on the brain include impairments in executive functioning (i.e., being able to to pay attention, plan ahead, and organize), the ability to suppress behavior, and the ability to self-regulate emotion and arousal.

“Although snoring and apnea are relatively common in children, pediatricians and family physicians do not routinely check for sleep-disordered breathing,” said Dr. Bonuck. “In many cases, the doctor will simply ask parents, ‘How is your child sleeping?’ Instead, physicians need to specifically ask parents whether their children are experiencing one or more of the symptoms—snoring, mouth breathing or apnea—of SDB.”

“As for parents,” said Dr. Bonuck, “if they suspect that their child is showing symptoms of SDB, they should ask their pediatrician or family physician if their child needs to be evaluated by an otolaryngologist (ear, nose and throat physician) or sleep specialist.”

According to the AAO-HNS, surgery is the first-line treatment for severe pediatric SDB in cases where the tonsils and adenoids are enlarged. Another option is weight loss for overweight or obese children.

Dr. Bonuck’s paper is titled “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.” In addition to Dr. Bonuck, other Einstein contributors were Katherine Freeman, Dr.P.H., and Linzhi Xu, Ph.D.

The study was supported by grants from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.                                                 http://www.einstein.yu.edu/news/releases/771/kids-abnormal-breathing-during-sleep-linked-to-increased-risk-for-behavioral-difficulties/

Citation:

Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years

Pediatrics

Karen Bonuck, PhDa, Katherine Freeman, DrPHb, Ronald D. Chervin, MD, MSc, and Linzhi Xu, PhDa

  1. 1.    Published online March 5, 2012(doi: 10.1542/peds.2011-1402)
  2. » AbstractFree
  3. Full Text (PDF)
  4. Supplemental Information

The Cincinnati Children’s Hospital describes the Process of the Physical Examination

Process of the Physical Exam

A thorough history often precedes the physical examination and allows the cardiology staff to determine the reason for referral, significant family and medical history, and symptomatic status with respect to the cardiovascular system.

The history also provides the first interaction of our staff with the patient’s family so that some familiarity can be achieved prior to the performance of the physical examination.

The history is likely to vary somewhat based not only on the age of the patient, but also on the reason for referral.

A detailed history also allows us to tailor the physical examination and, if needed, subsequent testing to deal precisely and thoroughly with the patient’s suspected problem.

The first portion of the physical examination is performed by the screening clinic nurse. Height, weight, blood pressure and oxygen saturation determinations are made in the clinic at the time of being checked into the examination room.

Although these tests are painless, on occasion smaller children are anxious at the performance of blood pressure and pulse oximetry.

Rarely, however, are these tests difficult to obtain. The physical examination performed by the physician can be broken down into three separate parts, all of which are important in the accurate assessment of the patient.

  • Observation: The simple act of observing a patient is often very revealing. Patients are observed for their general sense of distress / discomfort, possible associated abnormalities (for example, orthopedic deformities or Down syndrome) and for any more subtle abnormalities that might be a clue to more serious underlying heart disease, for example, cyanosis or chest asymmetry.
  • Palpation (examination by touching): Using the fingers and hands, the physician in the clinic can gain insight into peripheral circulation (arms and legs) as well as overall heart muscle performance. Signs of peripheral fluid buildup (edema) can also be noted.

The chest is often palpated to determine the location of the heart and its overall degree of activity.

Additionally, some murmurs often create a loud enough noise to be felt through the chest, and the location of these “thrills” can pinpoint a structural heart abnormality.

  • Auscultation (examination by listening): The final portion of the physical examination involves the use of the stethoscope to listen to various sounds that a heart makes.

During the auscultation process, valve closure and opening sounds are determined. We attempt to determine how many valve closure sounds there are, how loud they are, and where they are best heard.

Heart murmurs are characterized by timing in the heart cycle, loudness, pitch, and location. The entire chest and often the back are inspected with the stethoscope during this process.

In addition, extra sounds such as rubs, gallops and clicks are listened for. These, if present, can lead to a precise bedside diagnosis of a cardiac abnormality.

Finally, the lungs and abdomen are examined both by auscultation and palpation so as to determine position and size of abdominal organs, abnormal lung findings and possible murmurs in the abdomen or back.

During the course of the physical examination process, the pulse rate (heart rate) and respiratory rate are determined often by several observers.

The Albert Einstein study should be taken seriously because of the implications for future behavior issues of children. See, Babies’ snoring linked to later behavior problems . http://www.king5.com/health/childrens-healthlink/Babies-snoring-linked-to-later-behavior-problems–143398676.html

Our goal as a society should be:

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

Dr. Wilda says this about that ©