Friday, May 31, 2013

Homeless and abused children benefit from animal-assisted therapy

Researchers at MIRI have completed a pilot study that used guinea pigs and rabbits as therapists to teach children who have experienced domestic violence situations empathy and coping skills. 

Credit: Erna Vader 

There were almost 32,000 substantiated cases of severe abuse, neglect and violence in Australia last year with some children dying as a result.

According to the Australian Institute of Criminology, the age group most likely to be murdered is 0-12 months.

One particular group amongst the homeless cohort is women with children fleeing violent domestic relationships and living in transitional housing.

Essentially these mothers and children are in hiding. It is known that children who experience traumatic events early in life, particularly abuse and violence, often develop social, emotional, health and behavioural problems as adolescents and adults.

Researchers at the Monash Injury Research Institute (MIRI) have recently completed a pilot study that used animals, such as guinea pigs and rabbits, as therapists to teach children who have experienced domestic violence situations empathy and coping skills.

WAYSS, a registered not-for-profit community based agency in Southern Metropolitan Melbourne region provides family violence and homelessness support services and transitional housing for women and children.

While anecdotal evidence indicated the children who attended the groups showed dramatic improvements in their lives, WAYSS approached the Child Abuse Prevention Research Centre (CAPRA), a specialist unit in MIRI to conduct a two year pilot program to determine whether the program was in fact of benefit.

Neerosh Mudaly
The study was run by Dr Neerosh Mudaly, a Senior Research Fellow. Children are assessed and prepared for entry into the program by a WAYSS Children's Case Worker and they are transported to the program by WAYSS.

The group program is managed by EE&T. The guinea pigs and rabbits, used in the program are carefully chosen and their temperament and health are managed by EE&T.

The group caters for up to 10 children, who attend weekly sessions of 1-1.5 hours.

The children engage in a series of activities which include animal handling (grooming, comforting), animal care (feeding and observing) and art and photography that complement the activities.

According to Dr Mudaly, children who come to the program often do not trust adults. They do not respond to traditional counselling as they are often filled with persistent fear. They may be sad, withdrawn or acting out in aggressive ways.

"These behaviours can make it difficult for the children to settle at school – often resulting in the child either being bullied or becoming a bully," Dr Mudaly said.

"In the group, the children recognise that they are in charge of a vulnerable being such as a guinea pig. They learn empathy and control – and often take these lessons back into their own families where perhaps they bullied their more vulnerable younger siblings."

Dr Mudaly said repeated experiences of gentle, calming contact with small animals in a safe environment appears – from the pilot study – to have had a dramatic effect in helping children heal from abuse and violence.

"It may also help break the cycle of violence and abuse that these children may carry into adolescence and adulthood," Dr Mudaly said.

Eleven children participated in the pilot evaluation, and the results validated a more rigorous evaluation.

According to Dr Mudaly – if funding is found – the next phase of the study would involve in-depth interviews with children, their supportive parent, caseworkers and teachers.

Psychometric measures of trauma and empathy will be administered at entry and again at completion to provide concrete evidence of changes in the children.

"This research has the potential to contribute to international knowledge on effective therapy for traumatised children and the prevention of violence," Dr Mudaly said.

Case study: 
Dr Mudaly talks of one five-year-old girl who witnessed terrible violence towards her mother when the child was injured during one of these episodes.

"When she came into the program she was mute, did not speak for months and would not leave her mother's side," Dr Mudaly said.

The first words she spoke were to a guinea pig in the animal therapy program: "what's your name?" A year later Dr Mudaly saw the child again.

"She was flicking her long hair, talking about how she might work with animals when she grew up. She had so much to say and would not stop talking," Dr Mudaly said.

Good kidney health begins before birth

Researchers have found that conditions in the womb can affect kidney development and have serious health implications for the child not only immediately after birth, but decades later. 

In a paper published today in The Lancet an international team, including Monash University's Professor John Bertram and the University of Queensland's Professor Wendy Hoy, reviewed existing, peer-reviewed research on kidney health and developmental programming - the effects of the in utero environment on adult health.

Wendy Hoy
The accumulated evidence linked low birth weight and prematurity - risk factors for high blood pressure and chronic kidney disease later in life - with low numbers of the kidney's filtration units or nephrons.

In Australia, around 30 per cent of the adult population has high blood pressure and one in nine has at least one clinical symptom of chronic kidney disease.

The incidence of both diseases is significantly higher in Indigenous populations. Professor Bertram, Head of the Department of Anatomy and Developmental Biology, has been researching nephrons for two decades.

"The kidney is particularly sensitive to life before birth because we stop making nephrons at 36 weeks gestation. So, for a baby born at term, the process of nephron formation is finished and it cannot be restarted," Professor Bertram said.

John Bertram
Humans are born with an average of one million nephrons and lose up to 6000 each year. However, Professor Bertram's research has shown there is a huge variance in nephron number - from just over 200,000 to around two million.

Further, nephron number is positively related to birth weight - a low birth weight equates to low nephron number and larger babies have a higher nephron number.

Given that low birth weight occurs in 15 per cent of live births worldwide, the study has implications for maternal health and clinical screening processes.

"In terms of maternal health during pregnancy, things like a high fat diet, alcohol consumption, various antibiotics and stress hormones have been shown to have a negative impact on foetal kidney development, although more research needs to be done," Professor Bertram said.

"Further, given the strong associations between birth weight, nephron number and disease later in life, and the fact that a baby's weight is routinely recorded in many countries, we suggest that birth weight should be a parameter that clinicians use to determine how often a patient is screened for kidney function or given a blood pressure test.

"Although a newborn may appear perfect, if their birth weight is low, there may be consequences 40 years down the line. We could be proactive about detecting these diseases in the early stages."

Thursday, May 30, 2013

Do diet changes help ADHD children?

Dylan Jerrell was having a tough time in kindergarten. The energetic, outgoing Bigfoot fan was easily frustrated, and he responded to challenges with disruptive meltdowns.

He wouldn't hit anyone, but he'd break down and cry or yell at his teachers. For a week in mid-September, he was in the principal's office every single day.

His mom, Jacqueline Fellows, considered home schooling. His pediatrician offered medication for attention deficit hyperactivity disorder (ADHD). But then Fellows, a health writer in McKinney, Texas, put Dylan on the Feingold diet, which eliminates artificial colours and flavours and some preservatives.

"I started the Feingold diet on a Saturday, the weekend after he'd been in the principal's office every day, and he's only been back to the principal's office once, and that was when (someone) fed him a hot dog," Fellows says.

"It was amazing. It's not a silver bullet, but it's the most powerful tool that I have for him." Parents of children with attention deficit hyperactivity disorder (ADHD) have been reporting marked behavioural improvements due to diets eliminating artificial food colouring and other additives for decades now, but those reports have gained traction in the past decade, with recent studies suggesting that scientists may have been too quick to dismiss dietary triggers for ADHD in the 1980s and '90s.

In 2007, a landmark British study published in The Lancet medical journal found that artificial food colours and preservatives increase hyperactivity in children, leading the European Union to require warning labels on foods containing any of six specific food colors.

This set off renewed debate in the U.S., but the Food and Drug Administration (FDA) declined to take regulatory action.

Now, scientists are getting intriguing results from sophisticated analysis techniques that allow them to pool findings from multiple studies.

A meta-analysis of 34 studies that appeared in the Journal of the American Academy of Child and Adolescent Psychiatry in 2012 found that artificial food colours had a small but significant effect on ADHD symptoms.

Joel Nigg
The overall effect was equivalent to about one-fifteenth to one-thirtieth the effect of medication, according to study co-author Joel Nigg, a professor of psychiatry at Oregon Health & Science University in Portland.

And when patients followed broader elimination diets - excluding not just artificial colours and preservatives, but other suspected triggers such as eggs - the effect was larger: about one-third to one-sixth the effect of medication, Nigg says.

The authors of the 2012 study estimated that as many as 8 percent of kids with ADHD may have symptoms related to artificial food colours and 30 percent of kids with ADHD may have symptoms that improve when they follow more comprehensive diets that eliminate suspected allergens as well.

"The take-away is, it's not a waste of time," Nigg says of dietary restrictions for kids with ADHD. "It has a chance of working - a less than 50-50 chance, but it's a chance. It's going to take some effort, so (if you want to try it) get a good nutritionist to advise you and talk to your child and give it a couple of months of effort."

L. Eugene Arnold
L. Eugene Arnold, a professor emeritus of psychiatry at Ohio State University, points out that the British study found that artificial food dyes and preservatives increase hyperactivity in the general population of children, not just kids with ADHD.

"It makes sense for all kids to reduce the amount of dye they take in," says Arnold, who says that per capita consumption of artificial food dyes has quadrupled in the last 50 years.

But in 2011 an advisory panel for the FDA concluded that although artificial food dyes may trigger hyperactivity in a small percentage of children with behavioural problems such as ADHD, there isn't enough evidence to claim that food dyes cause hyperactivity in the general population.

The panel voted against recommending warning labels on foods with artificial dyes and called for more research.

According to a recent statement released by the FDA, "the agency continues to study the matter in various populations, including children, and will report its findings."

Benjamin Feingold
The FDA did not say when those findings would be reported. Popularised in Benjamin Feingold's best-selling 1974 book, "Why Your Child Is Hyperactive," the Feingold diet eliminates artificial colours and flavours and three preservatives, and it temporarily removes foods containing natural salicylates, such as oranges and apples. The foods with natural salicylates may later be reintroduced.

The diet fell out of favour with scientists after a 1983 meta-analysis concluding that the overall effect was too small to be important, according to a 2012 article in Neurotherapeutics.

Fellows says that before she put her son on the diet, she was your typical suburban mom, treating her son to cherry limeades and never really questioning the chemical additives in foods.

But she had a friend whose son had seen a marked improvement in a behavioural tick - involuntarily sniffing - on the Feingold diet, and, with Dylan's pediatrician saying her son was a candidate for medication, Fellows figured she had nothing to lose.

Seven months later, she says, Dylan can still be a handful - he's 6, after all - but his behaviour is much better.

Before the dietary changes, Fellows volunteered regularly in his school cafeteria and saw Dylan popping up and down, spinning in his seat, yelling and not really eating his lunch.

She dropped by during lunch time a few months after the dietary change, and he was sitting down, eating his lunch and talking quietly to the little girl next to him.

"He didn't go from 'wild man' to calm," Fellows says. "He was just able to really listen and comprehend what you said. He could learn. Before he would get really agitated if he couldn't do it the first time or you asked him to do something he really didn't want to do. When he started doing Feingold, he was a reasonable child to parent. He was an easier child to parent."

Accounts such as Fellows' are plausible, says Nigg, particularly when the effect lasts over a period of months and it's observed by teachers as well as parents.

Nigg's analysis applies to the entire group studied; both kids who responded to dietary restrictions and the ones who didn't.

He says the data don't really lend themselves to analyzing the range of effects on individual kids, but it appears that some kids were getting something close to full recovery from ADHD symptoms from dietary restrictions alone.

"I think it is possible that, for some kids, you would get a dramatic effect," he said. "And probably for a lot of kids, you'll get some effect."

WHAT'S AN ADHD DIET? 
ADHD diets are basically elimination diets; you remove the foods or ingredients most likely to trigger or heighten symptoms, and if you see an improvement, you try adding back foods one by one, nixing the ones that bring back symptoms.

The chief suspects are artificial food colourings and preservatives, but the authors of a recent research analysis in the Journal of the American Academy of Child and Adolescent Psychiatry found diets are more effective when they restrict other foods as well.

The authors estimated that 30 percent of kids with ADHD experienced a reduction in symptoms when they initially eliminated foods such as wheat, rye, barley, eggs, dairy, corn, yeast, soy, citrus, eggs, chocolate and peanuts.

Study co-author Joel Nigg recommends consulting with a nutritionist before embarking on this type of diet.

Down syndrome: Neurons grown from stem cells show signature problems - Oxidative Stress

Down syndrome, the most common genetic form of intellectual disability, results from an extra copy of one chromosome.

Although people with Down syndrome experience intellectual difficulties and other problems, scientists have had trouble identifying why that extra chromosome causes such widespread effects.

Anita Bhattacharyya
In new research published this week, Anita Bhattacharyya, a neuroscientist at the Waisman Center at the University of Wisconsin-Madison, reports on brain cells that were grown from skin cells of individuals with Down syndrome.

The research, published the week of May 27 in the Proceedings of the National Academy of Sciences (PNAS), was a basic exploration of the roots of Down syndrome.

"Even though Down syndrome is very common, it's surprising how little we know about what goes wrong in the brain," says Bhattacharyya. "These new cells provide a way to look at early brain development."

The study began when those skin cells were transformed into induced pluripotent stem cells, which can be grown into any type of specialized cell.

One significant finding was a reduction in connections among the neurons, Bhattacharyya says. "They communicate less, are quieter. This is new, but it fits with what little we know about the Down syndrome brain."

Brain cells communicate through connections called synapses, and the Down neurons had only about 60 percent of the usual number of synapses and synaptic activity.

"This is enough to make a difference," says Bhattacharyya. "Even if they recovered these synapses later on, you have missed this critical window of time during early development."

The researchers looked at genes that were affected in the Down syndrome stem cells and neurons, and found that genes on the extra chromosome were increased 150 percent, consistent with the contribution of the extra chromosome.

However, the output of about 1,500 genes elsewhere in the genome was strongly affected. "It's not surprising to see changes, but the genes that changed were surprising," says Bhattacharyya.

The predominant increase was seen in genes that respond to oxidative stress, which occurs when molecular fragments called free radicals damage a wide variety of tissues.

"We definitely found a high level of oxidative stress in the Down syndrome neurons," says Bhattacharyya.

"This has been suggested before from other studies, but we were pleased to find more evidence for that. We now have a system we can manipulate to study the effects of oxidative stress and possibly prevent them."

Down syndrome includes a range of symptoms that could result from oxidative stress, Bhattacharyya says, including accelerated aging.

"In their 40s, Down syndrome individuals age very quickly. They suddenly get gray hair; their skin wrinkles, there is rapid aging in many organs, and a quick appearance of Alzheimer's disease. Many of these processes may be due to increased oxidative stress, but it remains to be directly tested."

Oxidative stress could be especially significant, because it appears right from the start in the stem cells.

"This suggests that these cells go through their whole life with oxidative stress," Bhattacharyya adds, "and that might contribute to the death of neurons later on, or increase susceptibility to Alzheimer's."

More information: Deficits in human trisomy 21 iPSCs and neurons,www.pnas.org/cgi/d… s.1216575110

ADHD: Brain activity in sleep may impact emotional disturbances in children

Sleep consolidates emotional memories in healthy children but not in children with attention-deficit hyperactivity disorder (ADHD).

This is the findings of research published May 29 in the open access journal PLOS ONE by Alexander Prehn-Kristensen and colleagues from University Hospital Schleswig-Holstein.

The study suggests these deficits in sleep-related emotional processing may exacerbate emotional problems experienced in the daytime by children with ADHD.

Prehn-Kristensen
For the study, healthy adults, healthy children and children with ADHD were shown pictures that had emotional relevance, such as a scary animal, or neutral pictures showing an umbrella or lamp.

Participants were shown pictures in the evening, their brain activity was monitored as they slept, and recollections were tested the following morning.

The researchers found that during sleep, regions of the brain thought to support consolidation of emotional memories were most active in healthy children, less so in healthy adults and least active in children with ADHD.

The study states, "While several studies reported a benefit from sleep with respect to emotional memory in healthy individuals, our results showed for the first time that healthy children outperform healthy adults." 

However, the authors added that this may be, in part, attributable to the child-oriented pictures used as stimuli.

Their results support the idea that frontal brain activity is critically to the consolidation of emotional memory in sleep, and this brain region is also implicated in the emotional symptoms seen in children suffering from ADHD.

The authors add that further studies are needed to confirm whether this function of sleep in forming emotional memories develops with time in adults with ADHD, or whether the dysfunction persists in ADHD sufferers of all ages.

More information: Prehn-Kristensen A, Munz M, Molzow I, Wilhelm I, Wiesner CD, et al. (2013) Sleep Promotes Consolidation of Emotional Memory in Healthy Children but Not in Children with Attention-Deficit Hyperactivity Disorder. PLOS ONE 8(5): e65098. doi:10.1371/journal.pone.0065098

Autism: Early brain responses to words predict developmental outcomes

A 2-year-old in the study sits on his mother's lap playing with toys while researchers record his brain's responses to words. 

Credit: Institute for Learning & Brain Sciences, University of Washington. 

The pattern of brain responses to words in 2-year-old children with Autism spectrum disorder predicted the youngsters' linguistic, cognitive and adaptive skills at ages 4 and 6, according to a new study.

The findings, to be published May 29 in PLOS ONE, are among the first to demonstrate that a brain marker can predict future abilities in children with autism.

"We've shown that the brain's indicator of word learning in 2-year-olds, already diagnosed with autism, predicts their eventual skills on a broad set of cognitive and linguistic abilities and adaptive behaviours," said lead author Patricia Kuhl, co-director of the University of Washington's Institute for Learning & Brain Sciences.

Patricia Kuhl
"This is true four years after the initial test, and regardless of the type of autism treatment the children received," she said.

In the study, 2-year-olds – 24 with autism and 20 without – listened to a mix of familiar and unfamiliar words while wearing an elastic cap that held sensors in place (EEG).

The sensors measured brain responses to hearing words, known as event-related potentials.

The research team then divided the children with Autism into two groups based on the severity of their social impairments and took a closer look at the brain responses.

Youngsters with less severe symptoms had brain responses that were similar to the typically developing children, in that both groups exhibited a strong response to known words in a language area located in the temporal parietal region on the left side of the brain.

This suggests that the brains of children with less severe symptoms can process words in ways that are similar to children without the disorder.

In contrast, children with more severe social impairments showed brain responses more broadly over the right hemisphere, which is not seen in typically developing children of any age.

"We think this measure signals that the 2-year-old's brain has reorganized itself to process words. This reorganization depends on the child's ability to learn from social experiences," Kuhl said.

She cautioned that, identifying a neural marker that predicts future Autism diagnoses with assurance, is still some way off.

The researchers also tested the children's language skills, cognitive abilities, and social and emotional development, beginning at age 2, then again at ages 4 and 6.

The children with autism received intensive treatment and, as a group, they improved on the behavioural tests over time.

But the outcome for individual children varied widely and the more their brain responses to words at age 2 were like those of typically developing children, the more improvement in skills they showed by age 6. 

In other studies, Kuhl has found that social interaction accelerates language learning in babies. Infants use social cues, such as tracking adults' eye movements to learn the names of things, and must be interested in people to learn in this way.

Paying attention to people is a way for babies to sort through all that is happening around them and serves as a guide or gauge to determine what is important.

But with autism, social impairments impede children's interest in, and ability to pick up on, social cues. They find themselves paying attention to many other things, especially inanimate objects, instead of people. 

"Social learning is what most humans are about," Kuhl said. "If your brain can learn from other people in a social context you have the capability to learn just about anything."

She hopes that the new findings will lead to brain measures that can be used much earlier in development – at 12 months or younger – to help identify children at risk for autism.

"This line of work may lead to new interventions applied early in development, when the brain shows its highest level of neural plasticity," Kuhl said.

More information: dx.plos.org/10.137… pone.0064967

Wednesday, May 29, 2013

Does stuttering stop children from doing more than just speaking?

Dr Lisa Iverach and Professor Ron Rapee AM from the Centre for Emotional Health, Macquarie University, are investigating the social and emotional impact of childhood stuttering.

Stuttering is a disorder that affects approximately 5% of Australians, and usually develops in early childhood when children are first learning to create sentences.

"While some children recover naturally from stuttering, the disorder can persist for others. Not only does it inhibit effective communication, it can be the source of bullying, teasing, social isolation and rejection," says Dr Iverach.

Previous research by Dr Iverach and the Australian Stuttering Research Centre, University of Sydney, has shown adults who stutter report increased social phobia, however virtually nothing is known about the presence of social phobia among children who stutter.

"We need to know whether school-age children who stutter experience the same psychological difficulties as adults, and at what age these difficulties begin to emerge," says Dr Iverach.

This is the first Australian study to assess anxiety disorders in children who stutter, and will be conducted in collaboration with researchers from Macquarie University, the University of Sydney, and the University of Newcastle.

Results of this research will help psychologists and speech pathologists gain a clearer picture of the social and emotional experiences of school-age children, and will contribute to the development of more effective treatments for children who stutter in the future.

The research team are seeking children aged 7-11 years, both those who stutter and those who don't, to participate in this research.

"We really want the community to become involved. Not just the families who have experienced stuttering in their children but also those who haven't, they can all play a part in helping us understand childhood stuttering," says Dr Iverach.

Monday, May 27, 2013

Military families need more help with mental health - Pediatrics

A leading pediatricians' group is highlighting the plight of children in military families in a new report.

Tours of duty can last up to 18 months, and studies have shown that one in four children of active-duty service members has symptoms of depression.

One in three children experiences excessive worry, and half of children have trouble sleeping, according to the American Academy of Pediatrics (AAP) report.

These problems can be even worse when there are other psychological issues in the family, according to the report, which was published online May 27 and in the June print issue of the journal Pediatrics.

During deployments, preschoolers could become anxious and withdraw. Children between 5 and 17 years old also are at greater risk for emotional and behavioural problems, the report said.

And the situation can get worse when kids' parents are on extended deployments. Meanwhile, the AAP advised that parents or caregivers who remain at home also are under greater stress.

This could, in turn, affect the mental health and well-being of children.

Because half of all children of active-duty military service members are taken care of by nonmilitary pediatricians before, during and after deployment, the AAP emphasized that all health care providers must recognize the mental-health needs of their patients with deployed parents, and those of other family members.

"By understanding the military family and the stressful experiences of parental wartime deployment, all pediatricians—both active duty and civilian—and other health care providers can be the front line in caring for U.S. military children and their families," report co-author Dr. Benjamin Siegel said.

"In the past 10 years, more than 2 million children in the U.S. have experienced the emotional and stressful event of being separated from a loved one deployed for active duty," report co-author Dr. Beth Ellen Davis said in the release.

"Most children cope and adapt quite well, but all children experience a heightened sense of fear and worry during a parent's deployment. It's important for pediatricians caring for these families to be aware of their family's situation so they can guide them appropriately."

Severe Childhood Epilepsies: Finding a genetic cause

A large scientific study has discovered new genes causing severe seizure disorders that begin in babies and early childhood.

The finding will lead to new tests to diagnose these conditions and promises to lead to improved outcomes. 

Epileptic encephalopathies are severe seizure disorders occurring in infants and children.

The seizures are accompanied by slow development and intellectual problems.

Ingrid Scheffer
Paediatric neurologist and researcher Professor Ingrid Scheffer from the University of Melbourne and the Florey Institute of Neuroscience and Mental Health, and the clinical leader of the study said "these children have devastating disorders. Finding the cause is the first step in developing targeted treatments."

"Overall, our findings have important implications for making a diagnosis in patients, optimizing therapy and genetic counseling for families," she said.

The study published in Nature Genetics today revealed two new genes associated with these severe epilepsies. In the study, researchers analysed the genes of 500 children who have epileptic encephalopathies.

Using recent advances in genetic testing, next generation sequencing of a gene panel was performed.

Researchers analysed 65 genes of which 19 had previously been associated with epileptic encephalopathies and 46 were hypothesized to potentially cause these devastating disorders.

Results revealed that mutations that cause epileptic encephalopathy were found in 52 out of the 500 patients (more than 10% of the study population).

Mutations were found in 15 of the 65 genes, including two new genes, CHD2 and SYNGAP1, which have not previously been found to cause epileptic encephalopathies.

"This is a very exciting breakthrough which could lead to dramatic benefits in the lives of the children who suffer this condition," Professor Scheffer said.

These genes will now become a diagnostic test for children with these severe epilepsies and enable genetic counseling in their families.

Collaborators on the study included geneticists from the University of Washington, US and paediatric neurologists from around Australia, New Zealand, Denmark and Israel.

The study was funded by the National Health and Medical Research Council, Australia and the National Institutes of Health, US.

More information: Targeted resequencing in epileptic encephalopathies identifies de novo mutations in CHD2 and SYNGAP1, DOI: 10.1038/ng.2646

Obesity in Children: Overeating learned in infancy

In the long run, encouraging a baby to finish the last ounce in their bottle might be doing more harm than good. Though the calories soon burn off, a bad habit remains.

 Renata Forste
Brigham Young University sociology professors Ben Gibbs and Renata Forste found that clinical obesity at 24 months of age strongly traces back to infant feeding.

"If you are overweight at age two, it puts you on a trajectory where you are likely to be overweight into middle childhood and adolescence and as an adult," said Forste. "That's a big concern."

The BYU researchers analyzed data from more than 8,000 families and found that babies predominantly fed formula were 2.5 times more likely to become obese toddlers than babies who were breastfed for the first six months.

But, the study authors argue, this pattern is not just about breastfeeding.

Ben Gibbs
"There seems to be this cluster of infant feeding patterns that promote childhood obesity," said Gibbs, lead author of the study that appears in the journal Pediatric Obesity.

Putting babies to bed with a bottle increased the risk of childhood obesity by 36 percent. And introducing solid foods too soon -- before four months of age -- increased a child's risk of obesity by 40 percent.

"Developing this pattern of needing to eat before you go to sleep, those kinds of things discourage children from monitoring their own eating patterns so they can self-regulate," Forste said.

Forste said that the nature of breastfeeding lends itself to helping babies recognize when they feel full and should stop. But that same kind of skill can be developed by formula-fed infants.

"You can still do things even if you are bottle feeding to help your child learn to regulate their eating practices and develop healthy patterns," Forste said. "When a child is full and pushes away, stop! Don't encourage them to finish the whole bottle."

Sally Findley
Breastfeeding rates are lowest in poor and less educated families. Sally Findley, a public health professor at Columbia University, says the new BYU study shows that infant feeding practices are the primary reason that childhood obesity hits hardest below the poverty line.

"Bottle feeding somehow changes the feeding dynamic, and those who bottle feed, alone or mixed with some breastfeeding, are more likely to add cereal or sweeteners to their infant's bottle at an early age, even before feeding cereal with a spoon," said Findley.

The next project for Gibbs and Forste is to re-evaluate the link between breastfeeding and cognitive development in childhood.

Forste has previously published research about why women stop breastfeeding.

"The health community is looking to the origins of the obesity epidemic, and more and more, scholars are looking toward early childhood," Gibbs said.

"I don't think this is some nascent, unimportant time period. It's very critical."

Journal Reference:
  1. B. G. Gibbs, R. Forste. Socioeconomic status, infant feeding practices and early childhood obesity†.Pediatric Obesity, 2013; DOI: 10.1111/j.2047-6310.2013.00155.x

Sunday, May 19, 2013

Young children appear to reject story characters who are Obese

Research by the University of Leeds has shown that very young children appear to reject story book characters who are overweight, but not those who are disabled. 

Led by Professor Andrew Hill from the Leeds Institute of Health Sciences, the research investigated young children's ratings of, and choices between, story characters drawn as overweight, normal weight, or disabled.

Andrew Hill
It found that children voiced negative views about the fictional book character 'fat Alfie'.

More than 100 UK reception and primary school pupils were read a storybook which covered the same plot, showing three children and what happened when their cat got stuck in a tree.

Using colour illustrations and a simple text narrative, the books only differed in the way that the main character was drawn.

After the story, children rated Alfie and also Thomas, one of the other children in the book who was always normal weight, on several attributes and behaviours.

Clear differences were apparent when children chose between Alfie and Thomas. Fat Alfie was less likely to win a race, do good school work, be happy with the way he looks, get invited to parties, and more likely to be naughty at school.

In contrast, wheelchair Alfie was less likely to do good school work or get invited to parties. Both fat Alfie and wheelchair Alfie were rejected in favour of Thomas as a personal friend.

In particular, only one of 43 children chose fat Alfie over Thomas. Professor Andrew Hill said: "This research confirms young children's awareness of the huge societal interest in body size.

It shows that by school entry age UK children have taken on board the negativity associated with fatness and report it's penalties in terms of appearance, school activities, and socially.

The researchers also included a female version of the story, which was shown to a second group of reception and schoolchildren, with just two of 30 children choosing fat Alfina over Holly.

"This negativity was shared by another visibly different characterization, a child in a wheelchair, but to a far smaller extent. Children rejected the fat character regardless of whether the character was male or female," Professor Hill continued.

"Children's own gender made no difference to their choices. But there was some evidence that older children expressed more negative views.

"Young children have negative perceptions of overweight that are not common to other visibly different conditions, and most apparent as social rejection. These responses are early indications of the views accepted as typical of older children and which may underpin weight-related victimisation of peers."

The results of the study were presented at the European Congress on Obesity (ECO) in Liverpool.

Childrens' menus: It Doesn't have to be chips with everything!

Nothing is certain but death and taxes. And chicken nuggets on children's menus. For a nation glittering with awards for the quality of its restaurants, there's a decided lack of sparkle when it comes to bills of fare for junior. 

Breadcrumbed bits, burgers, pasta, pizza, macaroni cheese and bangers all dominate – it's groundhog day out there and now, researchers from the University of Edinburgh have found that kids who eat the same food as adults are healthier. So isn't it time to wave bye-byes to cartes for kiddies?

The Scottish study chimes with research by the US Centre for Science in the Public Interest (pdf), which discovered that obesity is being dished up at most restaurant chains, with 97% failing to meet expert nutrition standards for children's meals. So what are kids being offered in the UK?

I spend many a pleasant hour drooling over restaurant menus but, picking through the children's offerings of British food chains, I felt my taste buds starting to wither.

What a dull old landscape it is in kid-food land: processed nuggets and fish fingers, mini burgers and pizzas, pasta with vapid sauces, chips and lots of carrot sticks plonked on the side as a nod to healthy eating.

Most of it falls into the category of what food writer Joanna Blythman describes as the "ghetto" of mass-produced, highly refined, additive-filled "children's food".

There are some exceptions. My kids like Wagamama's options (pdf) (vaguely adventurous noodles, ramen and curry) and Nando's (for spicy grilled chicken or vegetables and a good selection of veggie sides).

But overall they find kids' menus an unappetising let-down and in many cases, the food is more than simply disappointing.

Most restaurants don't provide nutritional information about their children's meals but some do – and it's an eye-opener.

Chicken nuggets, chips and beans at Wetherspoons ,for example, contains a whopping 700 calories (almost 40% of a child's recommended daily calorie intake and 80% of their guideline daily amount (GDA) of salt.

Sadly, uninspiring kids' menus are not just the preserve of mass-market chains.

While mum and dad feast on delicious roasts and braises at Gordon Ramsay's Savoy Grill, kids are offered this barely legible little selection (pdf).

Jamie must have been at a low ebb when the kids' selection on his menu was devised for Jamie's Italian.

Or how about beans on toast at this luxe country house hotel (pdf) (£6.50, no less). If chefs want to offer kids their own bill of fare, surely they can do better than this?

As a parent, I'm familiar with the warm embrace of the kids' menu: a safe and less expensive option, smaller portions.

At the same time, I worry that these menus of dumbed-down food enable picky eating habits and discourage children from trying wonderful new tastes.

Do kids' menus have to be the culinary equivalent of painting a room magnolia?

Henry Dimbleby
Henry Dimbleby, who runs the healthy fast-food chain Leon and was appointed by the government to review school meals, believes there is a place for children's menus but says pint-sized diners deserve better.

"All of our research shows that children love having their own menu," he says.

"It is a really good opportunity for restaurants to do something imaginative and entertaining. It doesn't have to be too out there, but they deserve better than a culinary desert of chicken nuggets."

But food blogger and parenting author Liat Hughes Joshi says restaurants need to fundamentally rethink their approach.

Liat Hughes Joshi
"I despair at the lack of imagination in kids' menus in many restaurants," she says. "When we're tucking into a fabulous piece of fish and my son's getting nuggets, his heart sinks and I don't blame him."

She's started a No More Nuggets lobby to encourage restaurants to overhaul their children's menus, while the Scottish Soil Association, in partnership with Organix babyfood, has launched the Out To Lunch campaign and a national survey.

"Some restaurants are doing positive things to improve children's menus but there's still a long way to go," says the Soil Association's Amy Leech.

"We're not just looking to see healthier food, we want to see more choices so children don't just get everything with chips."

In Italy, children's menus are virtually non-existent and chefs will cheerfully prepare tasty dishes that individual bambini diners like.

Some restaurants in the UK – notably the better ones that cook fresh food from scratch – do this too, offering half-size portions and flexibility in the kitchen. I reckon we've outgrown the kiddie menus. Another course please!

Preschoolers With ADHD: 90 Percent of Pediatric Specialists Not Following Treatment Clinical Guidelines

A recent study by pediatricians from the Cohen Children's Medical Center of New York examined to what extent pediatric physicians adhere to American Academy of Pediatrics (AAP) clinical guidelines regarding pharmacotherapy in treating young patients with Attention Deficit Hyperactivity Disorder (ADHD).

The results showed that more than 90 percent of medical specialists who diagnose and manage ADHD in preschoolers do not follow treatment guidelines recently published by the AAP.

Andrew Adesman
"It is unclear why so many physicians who specialize in the management of ADHD -- child neurologists, psychiatrists and developmental pediatricians -- fail to comply with recently published treatment guidelines," said Andrew Adesman, MD, senior investigator and chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park.

"With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten.

Primary care physicians and pediatric specialists should recommend behavior therapy as the first line treatment."

Current clinical guidelines for pediatricians and child psychiatrists associated with the American Academy of Child & Adolescent Psychiatry (AACAP) recommend that behaviour therapy be the initial treatment approach for preschoolers with ADHD, and that treatment with medication should only be pursued when counseling in behavior management is not successful.

The study also found that more than one-in-five specialists who diagnose and manage ADHD in preschoolers recommend pharmacotherapy as a first-line treatment alone or in conjunction with behavior therapy.

Although the AAP recommends that pediatricians prescribe methylphenidate when medication is indicated, more than one-third of specialists who prescribe medication for preschool ADHD said they 'often' or 'very often' choose a medication other than methylphenidate initially (19.4 percent amphetamines; 18.9 percent non-stimulants).

"Although the AAP's new ADHD guidelines were developed for primary care pediatricians, it is clear that many medical subspecialists who care for young children with ADHD fail to follow recently published guidelines," said Jaeah Chung, MD, the study's principal investigator who also practices at Cohen Children's.

"At a time when there are public and professional concerns about over-medication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children."

Saturday, May 18, 2013

US DSM-5 for diagnosing mental disorders published - Asperger's is Out!

In the manual, grief is newly medicalised as major depressive disorder (MDD). 

Credit: Adam G. Gregor /Alamy

The field of mental health will face its greatest upset in years on Saturday with the publication of the long-awaited and deeply-controversial US manual for diagnosing mental disorders.

Early drafts of the book, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, have divided medical opinion so firmly that authors of previous editions are among the most prominent critics.

Known informally as the psychiatrists' bible, the $199 tome from the American Psychiatric Association is the guidebook that US doctors will use to diagnose mental disorders. The latest edition is the first major update in 20 years.

Though not used in the UK, where doctors turn to the World Health Organisation's International Statistical Classification of Diseases (ICD), the US manual has global influence. It defines groups of patients, and introduces new names for disorders.

Those names can spread, and become the norm elsewhere, but more importantly, the categories redefine the populations that are targeted by drugs companies.

Criticisms have come from almost every corner. There are claims of expansionism, with common experiences and behaviours becoming newly medicalised.

Allen Frances
Temper tantrums become Disruptive Mood Dysregulation Disorder (DMDD); grief becomes major Depressive Disorder (MDD), according to Allen Frances, an American psychiatrist who chaired the task force behind the fourth edition of the manual.

Other behaviours get their own labels: overeating becomes binge eating disorder; keeping too much junk, a hoarding disorder; a bit forgetful could be mild neurocognitive disorder.

David Clark
David Clark, professor of experimental psychology at Oxford University, said "Mental health disorders are often hard to divide into clear categories, because too little is known about them, and there can be major overlaps. But the definitions are often valuable. For example, greater distinctions between various types of anxiety have led to more specific and effective treatments."

Nick Craddock, professor of psychiatry at Cardiff University, and director of the National Centre for Mental Health in Wales, said "Some of the stranger aspects of the US manual will have no impact in Britain. DSM-5 was flawed because definitions of disorders were sometimes changed on the basis of too little fresh scientific evidence."

"I don't believe the science has advanced sufficiently in 20 years since DSM-4 to warrant making a new system," he said. "That essentially is just a group of people agreeing on tweaking things and making them appear a little bit different. That to me is not a very helpful stage in the develop of psychiatric diagnosis. This is the wrong time in history to change the diagnostic system."

Changing the definitions of disorders alters who has them. That affects who gets drugs and other support, and who interventions are trialled on. If the criteria for attention Deficit Hyperactivity Disorder (ADHD) are broadened, then more people are likely to be diagnosed with the condition.

The arrival of DSM-5 will mean the end of Asperger's syndrome in the professional eyes of the US psychiatric arena.

Along with some other autism-related conditions, Asperger's will now be consumed by the new category of "autism spectrum disorder".

Carol Povey
Some people diagnosed with Asperger's are unhappy about the coming change. Carol Povey, director of the National Autistic Society's Centre for Autism, said: "The term Asperger Syndrome is a core part of their identity for many people and they understandably feel anxious about moves to remove the term. The changes won't prevent people from continuing to use it to define themselves and nor should it," she said.

Debbie Tucker, chair of the Asperger's Syndrome Foundation, said the label can be useful in treating people, but that some did not want to be labelled. "Labels only become unhelpful and sometimes dangerous if used to discriminate. People with Aspergers are vulnerable to this," she said.

Thomas Inse
Last month, Thomas Insel, director of the National Institute of Mental Health, declared that the organisation would not use DSM-5 definitions to set its research priorities. Writing about DSM-5 on his blog, he said: "The weakness is its lack of validity. Unlike our definitions of ischaemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."

Instead, he said the NIHM would lay the foundations for a new classification system, based on brain imaging, genetics, cognitive science and other research.

"We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response," he said.

Friday, May 17, 2013

Boys, perceive sadness of depressed parents

Children of depressed parents pick up on their parents' sadness—whether mom or dad realizes their mood or not.

A new University of Michigan study indicates that children who have at least one parent suffering from depression are very skilled at picking up on facial cues.

Boys living in this environment are highly sensitive to facial expressions of sadness, said Nestor Lopez-Duran, assistant professor of psychology and one the study's authors.

Researchers analyzed data on 104 children ages 7-13, of whom about 60 percent were at high-risk for depression because at least one of their parents were diagnosed with depression.

The participants looked at pictures of facial expressions that varied from neutral to sadness and anger, or viewed images of faces morphing from anger to sadness.

After each picture was shown, the children indicated whether the face showed sadness, anger or no emotion.

Lopez-Duran said high-risk boys were more sensitive to subtle expressions of sadness than their peers, including high-risk girls. There are a few reasons why this may be the case, he said.

There's growing evidence suggesting that the underlying processes that put kids at risk for depression and other conditions may be different for boys and girls.

It may be that high sensitivity to sadness influences how boys see their social world, which may make them less social in important situations, Lopez-Duran said.

For instance, unlike girls, who tend to be highly social, boys are less likely to use others as sources of comfort when they are sad.

On the other hand, it's also possible that this unique skill does not reflect an underlying vulnerability, he said.

This skill may be an adaptive strategy that develops in response to the environment. Specifically, boys are more likely than girls to receive harsh punishment, and parental depression increases the risk of using harsh punishment.

"It is possible that these high-risk boys developed this skill in order to reduce the possibility of getting harsh punishment by essentially recognizing when mom or dad is upset and getting out of the way," Lopez-Duran said.

The takeaway message is that boys of depressed parents appear to be very perceptive of sadness, he said. In fact, these boys may be able to tell when parents are upset even when parents think they are not showing signs.

The findings appear in the Journal of Child Psychology and Psychiatry: onlinelibrary.wile… e-5/issuetoc

Thursday, May 16, 2013

One in five U.S. kids has a mental health disorder, CDC reports

As many as one in five American children under the age of 17 has a diagnosable mental disorder in a given year, according to a new federal report.

Released Thursday, the report represents the government's first comprehensive look at mental disorders in children.

It focuses on diagnoses in six areas: attention-deficit/hyperactivity disorder (ADHD), behavioural or conduct disorders, mood and anxiety disorders, autism spectrum disorders, substance abuse, and Tourette syndrome.

The most common mental disorder among children aged 3 through 17 is ADHD. Nearly 7 percent—about one in 15 children—in that age group have a current diagnosis, according to the report from the U.S. Centers for Disease Control and Prevention.

For other disorders, 3.5 percent of children currently have behavioral or conduct problems, 3 percent suffer from anxiety, about 2 percent have depression and about 1 percent have autism.

About two children out of 1,000 aged 6 to 17 have Tourette Syndrome. Among teens, about 5 percent had abused or were dependent on illegal drugs within the past year.

More than 4 percent were abusers of alcohol, and nearly 3 percent reported being regular cigarette smokers.

The report, which supplements the May 17 issue of the CDC's Morbidity and Mortality Weekly Report, also noted gender differences in mental disorders.

"Boys are more likely than girls to have most of the disorders overall," said Ruth Perou, the team leader for child development studies at the CDC.

Boys specifically are more prone to ADHD, behavioral or conduct problems, autism spectrum disorders, anxiety and Tourette syndrome, and are more likely to be smokers than girls, Perou said. They're also more likely to die by suicide.

"On the other hand, girls are more likely to have depression or an alcohol-use disorder," she said.

Although this is the first time the CDC has tried to compile prevalence estimates for some of the most common mental disorders in a single report, the agency has long tracked rates of many of these illnesses through population surveys.

"We are seeing increases across the board in a lot of mental disorders," Perou said. Some of the biggest jumps have been in ADHD and autism.

"We don't know if it's due to greater awareness, or if these conditions actually are going up," she said. Perou said that is a question they will try to answer as they continue to track children's mental disorders going forward.

"The good news is that mental disorders are diagnosable and treatable," she said. "If we act early, we can really make a huge difference in children's live and in families' lives overall."

British children's on-screen reading overtakes books

For the first time British children are reading more on computers and other electronic devices than they are reading books, magazines, newspapers and comics, according to a study of nearly 35,000 youngsters.

For the first time, British children are reading more on computers and other electronic devices than they are reading books, magazines, newspapers and comics, according to a study of nearly 35,000 youngsters published Thursday.

Some 52 percent of children say they would rather read on electronic devices while only a third (32 percent) would rather read a hard copy, the National Literacy Trust said.

It added that the trend could be "detrimental" to children's reading and urged a "healthier reading balance" between books and electronic devices. Nearly all children have access to a computer at home and four out of 10 now own a tablet or a smartphone, said the trust, an independent charity promoting literacy.

The number of children reading e-books has doubled in the last two years, from six to 12 percent, it added. The research among 34,910 young people aged eight to 16 also found that girls are significantly more likely than boys to read in print—68 percent versus 54 percent.

Girls are also more likely to read on a range of on-screen devices including mobile phones (67 percent of girls versus 60 percent of boys), e-readers (84 percent versus 69), and tablets (70 percent versus 67).

However, those who read daily only on-screen are barely half as likely to be above-average readers than those who read daily in print or in print and on-screen (15.5 percent versus 26), the research said.

Jonathan Douglas, the trust's director, said: "While we welcome the positive impact which technology has on bringing further reading opportunities to young people, it's crucial that reading in print is not cast aside.

"We are concerned by our finding that children who only read on-screen are significantly less likely to enjoy reading and less likely to be strong readers. "Good reading skills and reading for pleasure are closely linked to children's success at school and beyond. We need to encourage children to become avid readers, whatever format they choose."

ADHD /ADD: Long Term Ritalin Treatment alters the density of the Dopamine Transporter

Long-term treatment of attention deficit/hyperactivity disorder (ADHD) with certain stimulant medications may alter the density of the dopamine transporter, according to research published May 15 in the open access journal PLOS ONE by Gene-Jack Wang and colleagues from Brookhaven National Laboratory and the intramural program at NIH.

ADHD is commonly treated using drugs to target dysfunctional dopamine signaling in the brain, such as methylphenidate (commonly known as Ritalin).

The researchers found that adults with ADHD who had been prescribed the drug methylphenidate for a period of 12 months had a 24% increase in the density of the dopamine transporter in some brain regions, which after treatment was significantly higher than in adults without ADHD who had not been treated with the drug.

Prior to the 12-month treatment, there were no significant differences in the two groups' dopamine transporter levels.

The authors conclude that the elevated dopamine transporter density, suggested by some as a biological test for diagnosis of ADHD, may be a consequence of chronic treatment rather than a marker for the disorder.

These findings may offer an explanation for discrepancies in the literature describing dopamine transporter levels in ADHD patients, as differences in dopamine transporter levels in the brain may be due to differences in prior treatment.

Many studies have shown that an acute increase in dopamine signaling while on methylphenidate treatment can improve ADHD symptoms in the short term, but this is the first study to analyze the long-term effects of treatment.

More information:
Wang G-J, Volkow ND, Wigal T, Kollins SH, Newcorn JH, et al. (2013) Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder. PLoS ONE 8(5): e63023. doi:10.1371/journal.pone.0063023

Wednesday, May 15, 2013

How to Avoid the Talk-Persuade-Argue-Yell-Hit Trap

Many adults enter parenthood with visions of "picture perfect" children. 

They imagine a warm and loving home, as well as respectful and polite kids, all eagerly doing whatever is asked with only an occasional explanation from Mom or Dad.

These people are living in Rainbow Town.

As a veteran parent, you know this is not reality but many parents have the idea that kids are just smaller versions of adults: reasonable and unselfish. This is the "Little Adult Assumption."

Moms and Dads who embrace this myth often prefer the "modern method" of discipline—talking and reasoning.

Unfortunately, words and reasons alone can prove unsuccessful. Sometimes they have no impact at all, and then parent and child fall into the trap known as the Talk-Persuade-Argue-Yell-Hit Trap.

This tragic sequence results from the very best of parental intentions. Your child is doing something you don't like. You tell her to stop. She continues with her mis-behaviour, so you try persuading her to see things your way.

When persuasion fails, you start arguing. When arguing is not successful, you yell. Yelling fails, so, feeling there is nothing left to do some parents turn to hitting.

The two biggest parenting mistakes, too much talking and too much emotion, trigger the Talk-Persuade-Argue-Yell-Hit Syndrome.

Changing Kids’ Behaviour Begins By Changing Your Expectations
If you have a child who is doing something you don't like, get real upset about it on a regular basis and sure enough he'll repeat it for you.

Too much yelling and too much anger on the part of a parent are destructive for several reasons. First, they move the focus off of the child's misbehavior and on to the parent's own outburst.

Second, many children take the emotional eruption of a parent as a challenge to a fight, and there are plenty of kids who love a good fight.

Third, parents who over explain and give three, four or five reasons to a child to encourage right behaviour are almost saying "You really don't have to behave unless I can give a number of good arguments as to why you should."

This is not discipline, it is begging, and the shrewd enough child will simply take issue with the parent's reasons.

Changing children's behaviour often begins by changing parents' expectations of their children. Trying to teach young children appropriate behaviour is actually closer to training than it is to teaching "little adults."

This means choosing a method and repeating it consistently until the "trainee" does what the trainer wants. Very little of the training involves extensive verbal explanations.

Most important, the trainer remains calm, patient and gentle, but also persistent and firm. Keep in mind, children need consistency and repetition in a warm and loving environment.

Take Care of Your Own Behaviour First!
Check your own behaviour. If remaining calm, patient and gentle is most often a struggle for you, perhaps your life needs a little work. It’s very hard to be a good parent, especially if you don’t take good care of your own behaviour first!

Depression in Adolescent Girls linked to Father Absence

New research from the Children of the 90s study at the UK University of Bristol shows that girls whose fathers were absent during the first five years of life were more likely to develop depressive symptoms in adolescence than girls whose fathers left when they were aged five to ten years or than boys in both age groups (0-5 and 5-10). 

This finding has been found to be true, even after a range of factors was taken into account.

While previous studies have looked at the effect of childhood separation and divorce on the risk of depression in adolescence, this new research, published 15 May in Psychological Medicine, is one of only a few studies to look specifically at the effect of a father's absence and the timing of his departure on adolescents' mental health.

The study is one of the largest of its kind (5,631 children) and because Children of the 90s has charted the health and well-being of its participants since birth, it is one of only a few able to demonstrate a strong link between early childhood father absence and teenage girls' risk of depressive symptoms.

The finding has been found to be true, even after a wide range of other factors that can contribute to depression – including home ownership, social status, financial problems, family size, parental conflict, the mother's educational background and history of depression – are taken into account.

The authors say their findings are in line with previous studies suggesting that young children are more likely to suffer depression because they have developed fewer 'coping mechanisms' than older children, who also have more opportunities and resources to cope, as well as more social support networks, e.g. friends, outside the family.

Previous studies suggest that the stronger negative effect of father absence on the mental health of teenage girls over boys could be because girls are more vulnerable to negative interpersonal and family life events.

Iryna Culpin, the paper's lead author, said: "These findings indicate a need to include fathers in research related to child and adolescent mental health issues."

She also suggests that support for depression could be aimed at teenage girls whose father left before the age of five.

The authors highlight that it does not necessarily follow that a teenage girl who experiences depression as a teenager will continue to be affected later in life.

They also point out that the study did not examine the level of contact nor the quality of the relationship between a child and an absent father, all of which could influence the risk of depression.

More information: Culpin, I. et al. Father absence and depressive symptoms in adolescence: findings from a UK cohort, Psychological Medicine.