Category: Child Psychology

— Babies born prematurely to low-income parents have a disproportionately high risk for developing dangerous brain bleeds that require multiple surgeries and extensive follow-up, according to a small Johns Hopkins Children's Center study.

 

The findings — published online Sept. 28 in the journal Pediatric Neurosurgery and based on an analysis of 38 patients referred to Johns Hopkins for treatment of brain hemorrhages related to premature birth — offer a sobering reminder of the role socio-economic factors can play in health outcomes, the researchers say.

The link between poverty and premature birth has been well-documented, the investigators say, but the new findings go a step further and focus on the consequences of one particularly dire and fairly common complication of prematurity — brain hemorrhages.

"Our study shows just how detrimental and far-reaching the effects of prematurity can be, medically and otherwise, highlighting the critical need to better identify high-risk pregnancies and reduce the number of premature births," says Edward Ahn, M.D., pediatric neurosurgeon and senior author on the research.

"Brain hemorrhages can have a lifelong impact on a child's neurological and cognitive development, but also create a financial burden on the families, many of whom in our study were already economically challenged," Ahn adds.

The premature brain's blood vessels are highly vulnerable to rapid changes in blood and brain pressure that occur around birth. While some brain bleeds are small and contained within the blood vessel, others can spread further and significantly damage the brain, particularly if not diagnosed and treated promptly. Serious hemorrhages require surgery, intensive follow-up and, often, long-term care to deal with the neurological and developmental after-effects of the condition.

The study tracked 38 babies treated at Hopkins Children's between 2007 and 2010 for complications of brain hemorrhages they had suffered during preterm birth. Most infants in the study (65 percent) were from low-income families and received public health insurance(63 percent). Household income is not part of a standard medical record, but the researchers used zip code and Medicaid status as proxies for income. Medicaid is the public health insurance program for low-income children.

In addition to the higher risk for brain bleeds, the study showed babies from lower-income homes and those with public health insurance had fewer scheduled follow-up appointments and more emergency room visits, compared with babies with private health insurance and with those from higher income homes. The researchers note the differences were clear, even though they didn't reach statistical significance due to the small number of patients in the study.

"If a family foregoes a scheduled follow-up and instead ends up in the ER with a serious, yet likely preventable complication, the medical and financial consequences can be far worse not only for the family but for the health care system as a whole because ER care is more expensive than routine check-ups," Ahn says.

The investigators said their findings need to be replicated on a wider scale in order to further tease out the reasons behind the disproportionate risk.

About 73 percent of online American teens use social networking sites, such as Facebook, to share photos, interests and experiences with others, according to Pew Research Center. For youths in the foster care system, sharing information online presents additional safety and privacy issues. A University of Missouri researcher recommends that child welfare agencies develop policies to guide how adolescents in foster care use social media.

Dale Fitch, an assistant professor in the MU School of Social Work, says agencies usually advocate restricting how youths in the foster system use social media in order to avoid potential liabilities that could result in lawsuits. However, like other teens who ignore adults' instructions concerning information disclosure online, teens in foster care turn to the Internet to express their identities and share their stories. Social media is a positive tool that helps adolescents in foster care connect with society, but the lack of guidelines leaves them at risk for cyber-bullying, unintentional disclosure of identifying information and personal harm, Fitch said.

"Foster parents and caseworkers might tell teens not to use Facebook, but they're using it anyway, which opens them up to negative consequences," Fitch said. "They need to be able to share instances of unwanted social media contact with their guardians, and they might not reveal information if they've been told not to use Facebook."

Extensive policies regulate how records of youths in the foster system are shared with others such as foster parents, school personnel, health care professionals and caseworkers, so encouraging teens in foster care to use the Internet allows them a sense of privacy and control over their own information, Fitch said.

"Although adolescents in foster care are very much aware of their own safety issues and are very protective of their foster families and biological siblings, they may not know the implications of sharing information online," Fitch said. "Working with them to safely use social media is a huge step."

Additionally, allowing youths in foster care to use social media could give their caretakers insight into the youths' lives they might not have otherwise, which could help adults identify development issues, Fitch said.

"If adolescents have few friends on Facebook, foster parents need to find out whether they have other, hidden online profiles or if they're having problems making friends," Fitch said. "Adults could learn a lot more about what's going on in the teens' lives and what they're thinking about. Those conversations happen on a limited basis now."

Fitch used a tool called Critical Systems Heuristics to create a framework child welfare agencies can use to develop privacy guidelines to ensure the safe use of social media. He says youths in the foster system should be included in the policy-making process in addition to child welfare workers, foster parents or guardians, juvenile officers and judges.

The paper, "Youth in Foster Care and Social Media: A Framework for Developing Privacy Guidelines," was published in the Journal of Technology in Human Services. The School of Social Work is part of the MU College of Human Environmental Sciences.

 Men who experienced childhood sexual abuse are three times more likely to have a heart attack than men who were not sexually abused as children, according to a new study from researchers at the University of Toronto. The researchers found no association between childhood sexual abuse and heart attacks among women.

In a paper published online this week in the journal Child Abuse & Neglect, investigators examined gender-specific differences in a representative sample of 5095 men and 7768 women aged 18 and over, drawn from the Center for Disease Control's 2010 Behavioral Risk Factor Surveillance Survey. A total of 57 men and 154 women reported being sexually abused by someone close to them before they turned 18 and 377 men and 285 women said that a doctor, nurse or other health professional had diagnosed them with a heart attack or myocardial infarction. The study was co-authored by four graduate students at the University of Toronto, Raluca Bejan, John Hunter, Tamara Grundland and Sarah Brennenstuhl.

"Men who reported they were sexually abused during childhood were particularly vulnerable to having a heart attack later in life," says lead author Esme Fuller-Thomson, Professor and Sandra Rotman Chair at University of Toronto's Factor-Inwentash Faculty of Social Work. "We had expected that the abuse-heart attack link would be due to unhealthy behaviors in sexual abuse survivors, such as higher rates of alcohol use or smoking, or increased levels of general stress and poverty in adulthood when compared to non-abused males. However, we adjusted statistically for 15 potential risk factors for heart attack, including age, race, obesity, smoking, physical inactivity, diabetes mellitus, education level and household income, and still found a three-fold risk of heart attack."

Co-author and PhD candidate Sarah Brennenstuhl notes that, "It is unclear why sexually abused men, but not women, experienced higher odds of heart attack; however, the results suggest that the pathways linking childhood sexual abuse to physical health outcomes in later life may be gender-specific. For example, it is possible that females adopt different coping strategies than males as women are more likely to get the support and counselling needed to deal with their sexual abuse."

"These findings need to be replicated in future scientific studies before we can say anything definitive about this link," cautions Fuller-Thomson. "But if other researchers find a similar association, one possible explanation is that adverse child experiences become biologically embedded in the way individuals react to stress throughout their life, particularly with respect to the production of cortisol, the hormone associated with the "fight-or-flight" response. Cortisol is also implicated in the development of cardiovascular diseases.

Teens who play mature-rated, risk-glorifying video games may be more likely than those who don't to become reckless drivers who experience increases in automobile accidents, police stops and willingness to drink and drive, according to new research published by the American Psychological Association.

"Most parents would probably be disturbed to learn that we observed that this type of game play was more strongly associated with teen drivers being pulled over by the police than their parenting practices," said study lead author Jay G. Hull, PhD, of Dartmouth College. "With motor vehicle accidents the No. 1 cause of adolescent deaths, popular games that increase reckless driving may constitute even more of a public health issue than the widely touted association of video games and aggression."

Researchers conducted a longitudinal study involving more than 5,000 U.S. teenagers who answered a series of questions over four years in four waves of telephone interviews. The findings were published online in APA's journal Psychology of Popular Media Culture.

Fifty percent of the teens reported in the first interview that their parents allowed them to play mature-rated games and among those, 32 percent said they had played Spiderman II, 12 percent had played Manhunt and 58 percent had played Grand Theft Auto III. Playing video games such as Grand Theft Auto III, Manhunt and Spiderman II was associated with increases in sensation seeking, rebelliousness and self-reported risky driving, the study said. Higher rankings in sensation seeking and rebelliousness were directly linked to risky driving habits, automobile accidents, being stopped by police and a willingness to drink and drive, according to the analysis.

Between the second and third interviews, teens who said they had been pulled over by the police increased from 11 percent to 21 percent; those who said they had a car accident went from 8 percent to 14 percent. In the third interview, when the teens were about 16 years old, 25 percent said "yes" when asked if they engaged in any unsafe driving habits. In the final interview when the teens were about 18, 90 percent said "yes" to at least one of the same risky driving habits: 78 percent admitted to speeding; 26 percent to tailgating; 23 percent to failure to yield; 25 percent to weaving in and out of traffic; 20 percent to running red lights; 19 percent to ignoring stop signs; 13 percent to crossing a double line; 71 percent to speeding through yellow lights; and 27 percent to not using a seatbelt.

The researchers determined the teens' levels of sensation seeking and rebelliousness by asking them to rate themselves on a four-point scale following questions such as "I like to do dangerous things" and "I get in trouble at school." The study controlled for variables such as gender, age, race, parent income and education and parenting styles described as warm and responsive or demanding.

"Playing these kinds of video games could also result in these adolescents developing personalities that reflect the risk-taking, rebellious characters they enact in the games and that could have broader consequences that apply to other risky behaviors such as drinking and smoking," Hull said.

The initial sample was 49 percent female, 11 percent black, 62 percent white, 19 percent Hispanic, 2 percent Asian/Pacific Islander and 6 percent multiple ethnicity. The surveys began when the average age of the participants was about 14; at the second survey, they were about 15; at the third, 16; and at the fourth, 18. Eight months separated the first and second interviews; one-and-a-half years separated the second and third interviews; and two years separated the third and fourth interviews. As is typical in longitudinal surveys, some participants dropped out. The number completing the questions for this study totaled 4,575 for the second interview, 3,653 for the third and 2,718 for the fourth.

The information regarding the teens' driving habits was based on their own reports during the interviews, and therefore interpretation of the causes of their driving habits was speculative, the authors noted. "At the same time, because the study began when the participants were playing video games but were too young to drive, it is clear that the videogame exposure preceded the risky driving," Hull said.

In the first scientific study to test whether doubts about getting married are more likely to lead to an unhappy marriage and divorce, UCLA psychologists report that when women have doubts before their wedding, their misgivings are often a warning sign of trouble if they go ahead with the marriage.

The UCLA study demonstrates that pre-wedding uncertainty, especially among women, predicts higher divorce rates and less marital satisfaction years later.

"People think everybody has premarital doubts and you don't have to worry about them," said Justin Lavner, a UCLA doctoral candidate in psychology and lead author of the study. "We found they are common but not benign. Newlywed wives who had doubts about getting married before their wedding were two-and-a-half times more likely to divorce four years later than wives without these doubts. Among couples still married after four years, husbands and wives with doubts were significantly less satisfied with their marriage than those without doubts.

"You know yourself, your partner and your relationship better than anybody else does; if you're feeling nervous about it, pay attention to that," he added. "It's worth exploring what you're nervous about."

The psychologists studied 464 newlywed spouses (232 couples) in Los Angeles within the first few months of marriage and conducted follow-up surveys with the couples every six months for four years. At the time of marriage, the average age of the husbands was 27, and the average age of the wives was 25. The research is published in the online version of the Journal of Family Psychology, published by the American Psychological Association, and will appear in an upcoming print edition.

When asked, "Were you ever uncertain or hesitant about getting married?" at their initial interview, 47 percent of husbands and 38 percent of wives said yes. Yet while women were less likely than men to have doubts, their doubts were more meaningful in predicting trouble after the wedding, the researchers found.

Among women, 19 percent of those who reported pre-wedding doubts were divorced four years later, compared with 8 percent of those who did not report having doubts. For husbands, 14 percent who reported premarital doubts were divorced four years later, compared with 9 percent who did not report having doubts.

Doubt proved to be a decisive factor, regardless of how satisfied the spouses were with their relationships when interviewed, whether their parents were divorced, whether the couple lived together before the wedding and how difficult their engagement was.

In 36 percent of couples, the husband and wife had no doubts about getting married. Of those couples, 6 percent got divorced within four years. When only the husband had doubts, 10 percent of the couples got divorced. When only the wife had doubts, 18 percent of couples got divorced. When both partners had doubts, 20 percent of the couples got divorced.

"What this tells us," Lavner said, "is that when women have doubts before their wedding, these should not be lightly dismissed. Do not assume your doubts will just go away or that love is enough to overpower your concerns. There's no evidence that problems in a marriage just go away and get better. If anything, problems are more likely to escalate."

Thomas Bradbury, a UCLA psychology professor and co-author of the study, compared the situation to finding something disturbing on your skin that you hadn't noticed before.

"If you see something unusual on your skin, should you ignore it and go to the beach, or see a doctor? Be smart and don't ignore it — and don't ignore your doubts either," said Bradbury, who co-directs the Relationship Institute at UCLA. "Have a conversation and see how it goes. Do you think the doubts will go away when you have a mortgage and two kids? Don't count on that."

The psychologists are not advising women with doubts to necessarily end the relationship, they say.

"Talk about it and try to work through it," Bradbury said. "You hope that the big issues have been addressed before the wedding."

Benjamin Karney, a UCLA professor of psychology and co-director of the Relationship Institute at UCLA, was a co-author of the study.

The research was federally funded by the National Institute of Mental Health (part of the National Institutes of Health) and the National Science Foundation, as well as by UCLA's Academic Senate.

Every year, nervous high school juniors and seniors, clutching #2 pencils and armed with hours of test preparation, sit down and take the SAT. At their most basic, these tests focus on verbal, math, and writing ability, and performance on these tests has been linked to subsequent academic performance. As a result, college admissions teams use SAT scores along with other information, such as high school grades, in choosing their incoming freshman classes.

It is perhaps no surprise, then, that the SAT has been the subject of much scrutiny. Some researchers have asserted that the SAT isn't a good predictor of academic performance in college once socioeconomic status (SES) — usually measured as a combination of parents' education and family income — and high school grade point average are taken into account.

And some critics have argued that the SAT is fundamentally biased against students from low-SES backgrounds, acting as a barrier that prevents them from gaining admission to college.

"This was an eye catching claim," says psychological scientist Paul Sackett of the University of Minnesota. "So we set out to obtain data to examine whether that claim really held up."

Sackett and his colleagues at the University of Minnesota examined data from 143,606 students at 110 colleges and universities and contrasted their findings with data from the University of California system that had been studied in previous research.

Their findings are reported in a new article published in Psychological Science, a journal of the Association for Psychological Science.

They found that in all the datasets, both the SAT and high school grades contributed to predicting academic performance in college. And, contrary to previous research, taking parents' education and family income into account had little effect on the relationship between SAT scores and college performance. These findings suggest that the SAT remains a useful indicator for college admissions decisions.

Moreover, Sackett and his colleagues found that the SES of students actually enrolled in college was very similar to the SES of students who were applying to college. When they examined the data more closely and looked at the entire applicant pool, they found that fewer low-SES students were entering the college admissions process.

Based on these findings, it seems that low-SES students are not underrepresented in colleges because low SAT scores prevent them from gaining admission, but rather because fewer low-SES students apply to college in the first place.

"We view this as broadly relevant," says Sackett. "Entrance tests such as the SAT receive a great deal of public scrutiny and it is important for all involved — students, parents, college officials — that accurate information about how the test functions be available."

A whole-genome scan to identify large-scale chromosomal damage can help doctors choose the best treatment option for children with neuroblastoma, one of the most common types of childhood cancer, finds an international collaboration jointly led by The Institute of Cancer Research, London.

The researchers called for all children diagnosed with neuroblastoma worldwide to have a whole-genome scan as a standard part of their treatment.

Neuroblastoma, a cancer of the developing nervous system, is sometimes very treatable but other forms are highly aggressive, making the disease overall one of the leading causes of death from childhood cancer. As intense treatments can carry life-long side-effects, identifying the form is crucial in giving an accurate prognosis and deciding the most appropriate care.

Scientists examined the medical records of 8,800 neuroblastoma patients from around the world and found that several large-scale genetic faults were strongly linked to survival rates, and that a whole-genome scan would therefore be more effective at predicting prognosis than tests for individual genetic factors. The study is published in the British Journal of Cancer September 17, 2012.

Senior author Professor Andy Pearson, Cancer Research UK professor of pediatric oncology at The Institute of Cancer Research and a pediatric consultant at The Royal Marsden NHS Foundation Trust, said: "Our study has found that every single patient diagnosed with neuroblastoma should have a whole genome assessment. The technology required to carry out these scans has become much more widely available and cheaper over recent years, and we believe most diagnostic labs in developed countries worldwide should have this capacity. These gene tests would help doctors provide a more accurate prognosis and decide the best treatment for their patients, which could potentially save more lives and spare other children the risk of serious side-effects."

The study builds on earlier work by the same international team, called the International Neuroblastoma Risk Group, who proposed classifying tumours based on 13 characteristics including the status of three genetic alterations (ploidy, MYCN and the segmental gene alteration 11q). Since the system was introduced four years ago, scientists' understanding of the genetic causes of aggressive neuroblastoma has improved and evidence has emerged of a number of other mutations that may be relevant to the disease.

The new study links two further segmental gene alterations — mutations that involve the duplication or deletion of large sections of DNA — to patient survival, specifically 1p status and 17q status. It further concluded that scanning the whole genome provided the most prognostic information, as it took all these factors into account along with less frequent but important genetic changes that also had an impact on survival. The team is now planning to update the official classification system to incorporate the new information, which should improve the personalized approach to therapy for neuroblastoma.

Adolescents who are tasered by law enforcement officers do not appear to be at higher risk for serious injury than adults, according to new a new study from Wake Forest Baptist Medical Center researchers.

This latest research from Wake Forest Baptist is the first to specifically investigate Taser use on adolescents. Lead author Alison R. Gardner, M.D., an assistant professor of emergency medicine at Wake Forest Baptist, found no major differences in the injury rates or types of injuries to youth when compared to adults.

"We were looking closely for increased risk of cardiac effects and bodily injuries because of the differing body size and build of adolescents, but there were no significant injuries reported for this age group," said Gardner. "There were 20 mild injuries recorded and the majority of these were expected superficial puncture wounds from the weapons' probes."

The research appears this month online ahead of print in Pediatric Emergency Care. This was a retrospective study of Taser use from law enforcement data collected by the largest, independent multicenter database established in 2005 with funding by the National Institute of Justice. Tasers, or conducted electrical weapons, are non-lethal defense weapons used by law enforcement personnel to shock a person with probes from a distance.

Gardner and colleagues reviewed 2,026 Taser uses and found that 100, or 4.9 percent, were against adolescent suspects ranging in age from 13 to 17, with an average age of 16. Most of the youth were tasered by law enforcement officers during incidents involving civil disturbance, assault, robbery and burglary. Alcohol or other drug intoxication was known or suspected by police in 30 of the 100 cases, according to the study.

A limitation of the study is that the mean age (16), weight (168 pounds) and height (5 feet 8 inches tall) of the individuals reviewed indicates that this "population of minors mirrored the physiology of older adolescents and adults, more so than that of young or small children," Gardner said. "In real-life situations, Tasers were used in adolescents who were larger and older. This implies that law enforcement personnel are using Tasers as apprehension aids when physical apprehension is not easily accomplished, as would be the case in smaller and younger subjects."

This latest research builds on the work of its senior author William P. Bozeman, M.D., also of Wake Forest Baptist, who conducted the world's first large, independent study of injuries associated with Tasers to assess the overall risk and severity of injuries in real world conditions. Published in 2009, those results showed that the rate of significant injuries was low (less than 1 percent) and most injuries appeared to be minor.

Bozeman followed up with additional research in 2009 that evaluated the immediate cardiac and cardiovascular effects on a group of volunteer police officers, finding that CEW exposure overall was safe and well tolerated. His was only the second study to document the heart rhythm before, during and after a Taser application. In June he published a new study of real-life Taser uses by law enforcement agencies and found none in which the devices could be linked to cardiac complications, even when the probes landed on the upper chest area.

"Tasers have been proven to reduce the risk of injury in both suspects and officers and have prevented far more injuries and deaths than they have produced," said Bozeman. "While no tool is risk free, Tasers are clearly safer than alternate force options available to law enforcement officers such as batons, hand-to-hand combat and firearms, and the appropriate use of Tasers by police officers should be supported." William E. Hauda II, M.D., operational medical director, Fairfax County Police Department, Va., was also a co-author.