High-fructose diet in adolescence may exacerbate depressive-like behavior

What do you think of this article? "Animal study shows that diet alters important pathways associated with brain's response to stress The consumption of a diet high in fructose throughout adolescence can worsen depressive- and anxiety-like behavior and alter how the brain responds to stress, according to new animal research scheduled for presentation at Neuroscience 2014, the annual meeting of the Society for Neuroscience and the world's largest source of emerging news about brain science and health. "Our results offer new insights into the ways in which diet can alter brain health and may lead to important implications for adolescent nutrition and development," said lead author Constance Harrell of Emory University in Atlanta. Harrell is presenting her work Saturday, Nov. 15, Halls A-C, 3-4 pm and participating in an "Unhealthy diet, unhealthy mind"-themed press conference on Tuesday, Nov. 18 at 12:30 pm. Harrell is a graduate student working with Gretchen Neigh, PhD, assistant professor of physiology, psychiatry and behavioral sciences at Emory University School of Medicine. Fructose, a sugar found naturally in fruits and vegetables but also added to many processed foods and beverages, can promote negative cardiovascular effects. It also stimulates neural pathways that affect how the brain responds to stress, which can have important behavioral effects, including the worsening of symptoms related to depression and anxiety. Such effects are of particular concern during the teen years, which is a critical time for the development of the brain's stress response. To determine whether fructose consumption has the potential to create long-term changes in metabolism and behavior during adolescence, Harrell and her colleagues gave both adolescent and adult rats either a standard or a high-fructose diet. After 10 weeks, the adolescent but not adult rats on the high-fructose diet had a different stress hormone response to an acute stressor, which was consistent with their depressed-like behavior. A genetic pathway in the brain that plays a key role in regulating the way the brain responds to stress was also altered. These findings indicate that consuming a diet high in fructose throughout adolescence may exacerbate depressive behaviors and affect the way the body and the brain respond to stress." ### For more mental health topics and Continuing education in 3 easy steps, please visit Online MFT Continuing Education

Teens whose parents exert more psychological control have trouble with closeness, independence

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"For teenagers, learning to establish a healthy degree of autonomy and closeness in relationships (rather than easily giving in to peer pressure) is an important task. A new longitudinal study has found one reason adolescents struggle with balancing autonomy and closeness in relationships: parents' psychological control. Teens whose parents exerted more psychological control over them when they were 13 had more problems establishing friendships and romantic relationships that balanced closeness and independence, both in adolescence and into early adulthood. The study, by researchers at the University of Virginia, appears in the journal Child Development. The researchers looked at whether parents' greater use of psychological control in early adolescence can hinder teens' development of autonomy in relationships with peers. Parents' psychological control involved such tactics as using guilt, withdrawing love, fostering anxiety, or other psychologically manipulative tactics aimed at controlling youths' motivations and behaviors. "These tactics might pressure teens to make decisions in line with their parents' needs and motivations rather than their own," explains Barbara A. Oudekerk, a statistician with the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, who led the study while a research associate at the University of Virginia. "Without opportunities to practice self-directed, independent decision making, teens might give in to their friends' and partners' decisions." Oudekerk and her colleagues found that parents' use of psychological control at age 13 placed teens at risk for having problems establishing autonomy and closeness in relationships with friends and romantic partners that persisted eight years later, into early adulthood. Previous studies have shown that adolescents who fail to develop the capacity to establish autonomy and closeness are at risk for using methods that are hostile or that undermine autonomy in their own relationships, as well as for experiencing depression and loneliness in close relationships in adulthood. The study included 184 ethnically and socioeconomically diverse teens. At ages 13 and 18, the youths reported the degree to which their parents used psychological control. For example, some parents used psychological control by saying, "If you really cared for me, you wouldn't do things to worry me," while others acted less friendly toward their teens when the adolescents didn't see things in the same way the parents did. The study also assessed teens' autonomy (their ability to reason, be their own people, and express confidence) and relatedness (their ability to show warmth and connection) in friendships when the adolescents were 13, 18, and 21, and in romantic relationships at ages 18 and 21. Throughout adolescence, teens became increasingly less skilled at establishing autonomy and closeness in friendships and romantic relationships the more psychological control they experienced from their parents. In addition, teens' abilities (or lack thereof) to express autonomy and maintain close relationships with friends and partners at age 18 predicted the degree of autonomy and closeness in future relationships at age 21. Despite romantic relationships being relatively new in adolescence, the better teens were at establishing autonomy and relatedness with partners at age 18, the better they were at establishing autonomy and relatedness with both friends and partners at age 21. "Parents often fear the harmful consequences of peer pressure in adolescence," says Oudekerk. "Our study suggests that parents can promote or undermine teens' ability to assert their own views and needs to close friends and romantic partners. In addition, teens who learn—or fail to learn—how to express independence and closeness with friends and partners during adolescence carry these skills forward into adult relationships." The study illustrates the importance of intervening early and encouraging healthy relationships between parents and their adolescents. It also documents that adolescent relationships with peers and partners offer opportunities for learning and practicing healthy relationship skills that can shape the quality of adult relationships. ### The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health. Summarized from Child Development, The Cascading Development of Autonomy and Relatedness From Adolescence to Adulthood by Oudekerk, BA (now at the Department of Justice, formerly at the University of Virginia), Allen, JP, Hessel, ET, and Molloy, LE (University of Virginia). Copyright 2014 The Society for Research in Child Development, Inc. All rights reserved." For more information on mental health topics, please visit Continuing Education for Counselors

Mental Rest and Reflection Boost Learning, Study Suggests

What do you think of this article supported by the NIH and published by University of Texas at Austin?: "The patterns of brain activity recorded in this fMRI scanner revealed how mental rest and reflection on past learning activities can boost future learning. Photo credit: Jeff Luci. AUSTIN, Texas — A new study, which may have implications for approaches to education, finds that brain mechanisms engaged when people allow their minds to rest and reflect on things they've learned before may boost later learning. Scientists have already established that resting the mind, as in daydreaming, helps strengthen memories of events and retention of information. In a new twist, researchers at The University of Texas at Austin have shown that the right kind of mental rest, which strengthens and consolidates memories from recent learning tasks, helps boost future learning. The results appear online this week in the journal Proceedings of the National Academy of Sciences. Margaret Schlichting, a graduate student researcher, and Alison Preston, an associate professor of psychology and neuroscience, gave participants in the study two learning tasks in which participants were asked to memorize different series of associated photo pairs. Between the tasks, participants rested and could think about anything they chose, but brain scans found that the ones who used that time to reflect on what they had learned earlier in the day fared better on tests pertaining to what they learned later, especially where small threads of information between the two tasks overlapped. Participants seemed to be making connections that helped them absorb information later on, even if it was only loosely related to something they learned before. "We've shown for the first time that how the brain processes information during rest can improve future learning," says Preston. "We think replaying memories during rest makes those earlier memories stronger, not just impacting the original content, but impacting the memories to come. Until now, many scientists assumed that prior memories are more likely to interfere with new learning. This new study shows that at least in some situations, the opposite is true. "Nothing happens in isolation," says Preston. "When you are learning something new, you bring to mind all of the things you know that are related to that new information. In doing so, you embed the new information into your existing knowledge." Preston described how this new understanding might help teachers design more effective ways of teaching. Imagine a college professor is teaching students about how neurons communicate in the human brain, a process that shares some common features with an electric power grid. The professor might first cue the students to remember things they learned in a high school physics class about how electricity is conducted by wires. "A professor might first get them thinking about the properties of electricity," says Preston. "Not necessarily in lecture form, but by asking questions to get students to recall what they already know. Then, the professor might begin the lecture on neuronal communication. By prompting them beforehand, the professor might help them reactivate relevant knowledge and make the new material more digestible for them." This research was conducted with adult participants. The researchers will next study whether a similar dynamic is at work with children. This work was supported by the National Institute of Mental Health of the National Institutes of Health, the National Science Foundation (NSF) through the NSF CAREER Award and the Department of Defense through the National Defense Science and Engineering Graduate Fellowship Program." For more information on mental health topics, please visit CEUs for Counselors

Public feels more negative toward drug addicts than mentally ill

What do you think about this article from NIH? "While both are treatable health conditions, stigma of drug addiction much more pronounced, seen as 'moral failing' People are significantly more likely to have negative attitudes toward those suffering from drug addiction than those with mental illness, and don't support insurance, housing, and employment policies that benefit those dependent on drugs, new Johns Hopkins Bloomberg School of Public Health research suggests. A report on the findings, which appears in the October issue of the journal Psychiatric Services, suggests that society seems not to know whether to regard substance abuse as a treatable medical condition akin to diabetes or heart disease, or as a personal failing to be overcome. "While drug addiction and mental illness are both chronic, treatable health conditions, the American public is more likely to think of addiction as a moral failing than a medical condition," says study leader Colleen L. Barry, PhD, MPP, an associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. "In recent years, it has become more socially acceptable to talk publicly about one's struggles with mental illness. But with addiction, the feeling is that the addict is a bad or weak person, especially because much drug use is illegal." Between Oct. 30 and Dec. 2, 2013, Barry and her colleagues surveyed a nationally representative sample of 709 participants about their attitudes toward either mental illness or drug addition. The questions centered on stigma, discrimination, treatment and public policy. Not only did they find that respondents had significantly more negative opinions about those with drug addiction than those with mental illness, the researchers found much higher levels of public opposition to policies that might help drug addicts in their recovery. Only 22 percent of respondents said they would be willing to work closely on a job with a person with drug addiction compared to 62 percent who said they would be willing to work with someone with mental illness. Sixty-four percent said that employers should be able to deny employment to people with a drug addiction compared to 25 percent with a mental illness. Forty-three percent were opposed to giving individuals addicted to drugs equivalent health insurance benefits to the public at-large, while only 21 percent were opposed to giving the same benefits to those with mental illness. Respondents agreed on one question: Roughly three in 10 believe that recovery from either mental illness or drug addiction is impossible. The researchers say that the stories of drug addiction portrayed in the media are often of street drug users in bad economic conditions rather than of those in the suburbs who have become addicted to prescription painkillers after struggling with chronic pain. Drug addicts who fail treatment are seen as "falling off the wagon," as opposed to people grappling with a chronic health condition that is hard to bring under control, they say. Missing, they say, are inspiring stories of people who, with effective treatment, are able to overcome addiction and live drug-free for many years. Barry says once it would have been taboo for people to casually discuss the antidepressants they are taking, which is often the norm today. That kind of frank talk can do wonders in shaping public opinion, she says. "The more shame associated with drug addiction, the less likely we as a community will be in a position to change attitudes and get people the help they need," says another study author, Beth McGinty, PhD, MS, an assistant professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. "If you can educate the public that these are treatable conditions, we will see higher levels of support for policy changes that benefit people with mental illness and drug addiction." ### "Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness," was written by Colleen L. Barry, PhD, MPP; Emma E. McGinty, PHD, MS; Bernice A. Pescosolido, PhD; and Howard H. Goldman, MD, PhD. The study was supported by grants from AIG Inc.; the National Institutes of Health's National Institute on Drug Abuse (R01 DA026414); the NIH's National Institute of Mental Health (1R01MH093414-01A1); the National Science Foundation and the College of Arts and Sciences, Indiana University." For more information on mental health topics, please visit Continuing Education for Counselors

Teenage Girls Are Exposed to More Stressors that Increase Depression Risk

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"Adolescence is often a turbulent time, and it is marked by substantially increased rates of depressive symptoms, especially among girls. New research indicates that this gender difference may be the result of girls’ greater exposure to stressful interpersonal events, making them more likely to ruminate, and contributing to their risk of depression. The findings are published in Clinical Psychological Science, a journal of the Association for Psychological Science. This is a photo of a pensive looking girl sitting on steps.“These findings draw our focus to the important role of stress as a potential causal factor in the development of vulnerabilities to depression, particularly among girls, and could change the way that we target risk for adolescent depression,” says psychology researcher and lead author on the study, Jessica Hamilton of Temple University. “Although there is a range of other vulnerabilities that contribute to the emergence of girls’ higher rates of depression during adolescence, our study highlights an important malleable pathway that explains girls’ greater risk of depression.” Research has shown that cognitive vulnerabilities associated with depression, such as negative cognitive style and rumination, emerge during adolescence. Teens who tend to interpret events in negative ways (negative cognitive style) and who tend to focus on their depressed mood following such events (rumination) are at greater risk of depression. Hamilton, a doctoral student in the Mood and Cognition Laboratory of Lauren Alloy at Temple University, hypothesized that life stressors, especially those related to adolescents’ interpersonal relationships and that adolescents themselves contribute to (such as a fight with a family member or friend), would facilitate these vulnerabilities and, ultimately, increase teens’ risk of depression. The researchers examined data from 382 Caucasian and African American adolescents participating in an ongoing longitudinal study. The adolescents completed self-report measures evaluating cognitive vulnerabilities and depressive symptoms at an initial assessment, and then completed three follow-up assessments, each spaced about 7 months apart. As expected, teens who reported higher levels of interpersonal dependent stress showed higher levels of negative cognitive style and rumination at later assessments, even after the researchers took initial levels of the cognitive vulnerabilities, depressive symptoms, and sex into account. Girls tended to show more depressive symptoms at follow-up assessments than did boys — while boys’ symptoms seemed to decline from the initial assessment to follow-up, girls’ symptoms did not. Girls also were exposed to a greater number of interpersonal dependent stressors during that time, and analyses suggest that it is this exposure to stressors that maintained girls’ higher levels of rumination and, thus, their risk for depression over time. The researchers emphasize that the link is not driven by reactivity to stress — girls were not any more reactive to the stressors that they experienced than were boys. “Simply put, if boys and girls had been exposed to the same number of stressors, both would have been likely to develop rumination and negative cognitive styles,” Hamilton explains. Importantly, other types of stress — including interpersonal stress that is not dependent on the teen (such as a death in the family) and achievement-related stress — were not associated with later levels of rumination or negative cognitive style. “Parents, educators, and clinicians should understand that girls’ greater exposure to interpersonal stressors places them at risk for vulnerability to depression and ultimately, depression itself,” says Hamilton. “Thus, finding ways to reduce exposure to these stressors or developing more effective ways of responding to these stressors may be beneficial for adolescents, especially girls.” According to Hamilton, the next step will be to figure out why girls are exposed to more interpersonal stressors: “Is it something specific to adolescent female relationships? Is it the societal expectations for young adolescent girls or the way in which young girls are socialized that places them at risk for interpersonal stressors? These are questions to which we need to find answers!” Co-authors on the study include Jonathan P. Stange and Lauren B. Alloy of Temple University and Lyn Y. Abramson of the University of Wisconsin-Madison. This work was supported by NIMH Grants MH79369 and MH101168 to Lauren B. Alloy. Jonathan P. Stange was supported by National Research Service Award F31MH099761 from NIMH." For more information on mental health topics, please visit CEUs for MFTs

How Career Dreams are Born: Study shows how to convince those with low self-confidence to pursue their career choice

What do you think of this article by Jeff Grabmeier? Published on September 29, 2014 "COLUMBUS, Ohio – A new study shows just what it takes to convince a person that she is qualified to achieve the career of her dreams. Researchers found that it’s not enough to tell people they have the skills or the grades to make their goal a reality. Instead, many people need a more vivid and detailed description of just how pursuing their dream career will help make them successful. This is especially important for people who have the skills and potential to pursue a particular career, but lack the self-confidence, said Patrick Carroll, author of the study and associate professor of psychology at The Ohio State University’s Lima campus. Students who have chronic self-doubt may need an extra boost to pursue the dreams they are certainly able to achieve,” Carroll said. Dr. Patrick J. Carroll Patrick Carroll “This study finds that what they really need is a vivid picture of what will happen if they succeed.” The study was published online this week in the journal Basic and Applied Social Psychology. The study involved 67 undergraduate business and psychology students at Ohio State. The students signed up to meet with a career adviser to learn about a supposedly new master’s degree program in business psychology that would train them for “high-paying consulting positions as business psychologists.” However, the program didn’t actually exist. The goal was to get the students interested in the program, and see how they reacted when faced with varying levels of validation to their new dreams of becoming a business psychologist. (The researchers followed a protocol to help students who may have been disappointed that there wasn’t a real program. More on that below.) All the students read a brochure about the program and then filled out several questionnaires. They were asked to rate their self-confidence that they could become a business psychologist, whether they were excited about the possibility of becoming a business psychologist, whether they thought they could be admitted to the business psychology program and whether they intended to apply. They also reported their overall GPA. The students were then separated into four groups. Students in the control group were given an information sheet indicating no GPA requirement for the program. The other three groups were given sheets indicating the GPA requirement was .10 below whatever they had listed as their own GPA. In one of these groups, the “career adviser” –- who actually worked with the researchers -- simply pointed out that the students’ GPA was higher than the requirement. In another group, the validation was raised slightly: The adviser told the participants that they were exactly what the program was looking for and that it was unlikely they would be rejected if they applied. The last group received the strongest validation to their hopes of becoming a business psychologist: They were also told they were qualified and were unlikely to be rejected if they applied. But the adviser added that it was likely that the student would be accepted with full funding and excel in the program and would graduate with numerous job offers in business psychology. Afterward, the participants once again filled out forms asking how confident and excited they were about becoming a business psychologist and whether they expected they would be admitted. In addition, the students were given the opportunity to actually apply to the program. The results were striking. The students in the control group and those who were simply told their GPA exceeded the program requirements didn’t embrace the possible new goal of becoming a business psychologist. These participants did not show any elevations in self-confidence related to becoming a business psychologist and were unlikely to apply to the program or even ask for more information. Even when students learn that they exceed some external admissions requirement to become a business psychologist, they still have to decide whether that means they should pursue that career dream instead of any others,” Carroll said. “They may need more validation than that to pursue this career goal.” However, when the adviser clearly detailed the vivid prospect of success, the students were willing to embrace the pursuit of that new business psychology goal. Specifically, students given the most vivid validation had higher levels of self-confidence immediately after meeting with the adviser and were more likely to actually apply to the business psychology program. “Self-confidence played a key role here. Students felt more confident that they could really be successful as a business psychologist when they received a detailed picture from their adviser,” Carroll said. Following the study, the researchers thoroughly debriefed all participants on why it was necessary to use deception to study how students, like them, naturally respond to social validation to pursue new career goals. In addition, researchers provided all participants with detailed information on career counseling services that they could utilize on campus for help in making future career choices. This extensive debriefing was designed to remove any adverse influence of the study feedback on participants before they left, Carroll said. After the purpose of the study was explained to them, many participants were enthusiastic about the research and its relevance in revealing how others can shape their own career decisions, he said. Carroll said he sees the relevance of this research nearly every day, as students seek his input about career plans or the possibility of graduate school. “Sometimes students have the grades, the motivation and the ability but simply lack the necessary self-confidence to whole-heartedly invest in the pursuit of a realistic new goal,” he said. “This work shows how parents, teachers and counselors can steer students into the right direction to achieve their dreams.” The findings are especially relevant now as students prepare for an uncertain job market and they, along with their teachers and guidance counselors, try to find the best career choices for them. “Educators are trying to lead students to the most realistic career options,” Carroll said. “This research is important to understanding how students make revisions in their career goals and decide which career possibilities they should embrace.” This research was supported by a grant from the National Institute of Mental Health." For more informatio0n on mental health and social work topics, please visit Aspira Continuing Education and LPC Continuing Education

To curb violent tendencies, start young Working with aggressive children prevents some from becoming violent, criminal adults

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DURHAM, N.C. -- Aggressive children are less likely to become violent criminals or psychiatrically troubled adults if they receive early intervention, says a new study based on more than two decades of research. "These findings from researchers at Duke, Pennsylvania State and Vanderbilt universities and the University of Washington are based on the Fast Track Project, a multi-faceted program that is one of the largest violence-prevention trials ever funded by the federal government. Beginning in 1991, the researchers screened nearly 10,000 5-year-old children in Durham, Nashville, Seattle and rural Pennsylvania for aggressive behavior problems, identifying those who were at highest risk of growing up to become violent, antisocial adults. Nearly 900 children were deemed at high risk, and of those, half were randomly assigned to receive the Fast Track intervention, while the other half were assigned to a control group. Participating children and their families received an array of interventions at school and at home. Nineteen years later, the authors found that Fast Track participants at age 25 had fewer convictions for violent and drug-related crimes, lower rates of serious substance abuse, lower rates of risky sexual behavior and fewer psychiatric problems than the control group. "We can prevent serious violence and psychopathology among the group of children who are highest-risk," said Duke's Kenneth Dodge. "That's the essential finding from this study. It provides the strongest evidence yet that, far from being doomed from an early age, at-risk children can be helped to live productive lives." Dodge directs the Duke Center for Child and Family Policy and is the William McDougall Professor of Public Policy at Duke's Sanford School of Public Policy. The program's positive effects held true across four different sites around the country, among both males and females and among both white and African-American children. The study appears online Sept. 15 in the American Journal of Psychiatry. From first through 10th grade, the Fast Track children received reading tutoring and specialized intervention aimed at improving self-control and social-cognitive skills. Parents learned problem-solving skills through home visits and parent training groups. When program participants turned 25, researchers reviewed court records and conducted interviews with participants and control group members, as well as individuals who knew the participants well. Along with fewer criminal convictions, Fast Track participants had lower rates of antisocial personality disorder and avoidant personality disorder, lower rates of risky sexual behavior and lower rates of harsh parenting. The latter finding suggests that the intervention may interrupt the inter-generational cycle of problem behavior. Fast Track is among very few studies to test the long-term effect of environment on children's development through a clinical trial. It provides strong evidence for the critical role environment plays in shaping a child's development. "This study adds to the experimental evidence for the important role that environment plays," Dodge said. "Genes do not write an inalterable script for a child's life. And not only does the environment matter greatly in a child's development, we've shown that you can intervene and help that child succeed in life." Fast Track's positive effects do not come cheap. The 10-year intervention costs $58,000 per child. However, that cost should be weighed against the millions of dollars that each chronic criminal costs society in imprisonment and harm to others, Dodge said. "Prevention takes a considerable investment, but that investment is worth it," Dodge said. "Our policies and practices should reflect the fact that these children can have productive lives." In future studies, Dodge and his colleagues plan to examine the cost-benefit question more closely. ### The research was supported by grants from the National Institute of Mental Health (NIMH R18 MH48043, R18 MH50951, R18 MH50952, R18 MH50953, K05MH00797 and K05MH01027), the Department of Education (grant S184U30002) and the National Institute on Drug Abuse (NIDA grants DA16903, DA017589, K05DA015226, and P30DA023026). The Center for Substance Abuse Prevention and the National Institute on Drug Abuse also provided support through a memorandum of agreement with the NIMH. Financial disclosure: Study authors Kenneth Dodge, Karen Bierman, John Coie, Mark Greenberg, John Lochman and Robert McMahon are the developers of the Fast Track curriculum and have a publishing agreement with Guilford Press. Greenberg is also an author of the PATHS curriculum, which is used in the Fast Track program. McMahon is a co-author of Helping the Noncompliant Child and has a royalty agreement with Guilford Publications. He is also a member of the Treatments that Work Scientific Advisory Board with Oxford University Press. The other authors have no financial relationships to disclose." CITATION: "Impact of Early Intervention on Psychopathology, Crime and Well-Being at Age 25," Kenneth A. Dodge and the Conduct Problems Prevention Research Group. American Journal of Psychiatry, September 15, 2014. DOI: 10.1176/appi.ajp.2014.13060786. For more information on mental health topis, please visit CEUs for Counselors

Intervention in 6-month-olds with autism eliminates symptoms, developmental delay

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'Infant Start' therapy removes disabling delay before most children are diagnosed "Treatment at the earliest age when symptoms of autism spectrum disorder (ASD) appear – sometimes in infants as young as 6 months old – significantly reduces symptoms so that, by age 3, most who received the therapy had neither ASD nor developmental delay, a UC Davis MIND Institute research study has found. The treatment, known as Infant Start, was administered over a six-month period to 6- to 15-month-old infants who exhibited marked autism symptoms, such as decreased eye contact, social interest or engagement, repetitive movement patterns, and a lack of intentional communication. It was delivered by the people who were most in tune with and spent the most time with the babies: their parents. “Autism treatment in the first year of life: A pilot study of Infant Start, a parent-implemented intervention for symptomatic infants,” is co-authored by UC Davis professors of Psychiatry and Behavioral Sciences Sally J. Rogers and Sally Ozonoff. It is published online today in the Journal of Autism and Developmental Disorders. "Most of the children in the study, six out of seven, caught up in all of their learning skills and their language by the time they were 2 to 3," said Rogers, the study's lead author and the developer of the Infant Start therapy. "Most children with ASD are barely even getting diagnosed by then." "For the children who are achieving typical developmental rates, we are essentially ameliorating their developmental delays," Rogers said. "We have speeded up their developmental rates and profiles, not for every child in our sample, but for six of the seven." Rogers credited the parents in the small, pilot study with making the difference. "It was the parents – not therapists – who did that," she said. "Parents are there every day with their babies. It's the little moments of diapering, feeding, playing on the floor, going for a walk, being on a swing, that are the critical learning moments for babies. Those moments are what parents can capitalize on in a way that nobody else really can." Early identification crucial Children diagnosed with autism typically receive early intervention beginning at 3 to 4 years, six to eight times later than the children who participated in the study. But the earliest symptoms of autism may be present before the child’s first birthday. Infancy is the time when children first learn social interaction and communication, so autism researchers and parents of children with the condition have been working to identify autism and begin intervention sooner. Effective autism treatment relies on early detection so that a child can begin therapy as soon as possible, to prevent or mitigate the full onset of symptoms and sometimes severe and lifelong disability. "We were very fortunate to have this treatment available for the affected infants identified through our study," said Ozonoff, who directs the MIND Institute's Infant Sibling Study, an early detection project that follows babies at risk for autism or ADHD from birth through age 3. "We want to make referrals for early intervention as soon as there are signs that a baby might be developing autism," Ozonoff said. "In most parts of the country and the world, services that address autism-specific developmental skills are just not available for infants this young." Of the seven babies in the study, four were part of the Infant Sibling Study. In addition to these four, the other three children were referred by community parents. The treatment group was compared with four other groups of children that included: High-risk children with older siblings with autism who did not develop autism Low-risk children who were the younger siblings of typically developing children Infants who developed autism by the age of 3 Children who also had early autism symptoms but chose to receive treatment at an older age Treatment based on Early Start Denver Model The treatment was based on the highly successful Early Start Denver Model (ESDM) intervention developed by Rogers and her colleague, Geraldine Dawson, professor of psychiatry, psychology and pediatrics at Duke University in North Carolina. ESDM is usually provided in the home by trained therapists and parents during natural play and daily routines. Parents were coached to concentrate their interactions on supporting their infants’ individualized developmental needs and interests, and embedded these practices into all of their play and caretaking, focusing on creating pleasurable social routines to increase their children’s opportunities for learning. Parents were encouraged to follow their infants’ interests and subtle cues and gauge activities in ways that optimized their child's attention and engagement. The intervention focused on increasing: Infant attention to parent faces and voices Parent-child interactions that attract infants' attention, bringing smiles and delight to both Parent imitation of infant sounds and intentional actions Parent use of toys to support, rather than compete with, the child's social attention The treatment sessions included: Greeting and parent progress sharing A warm-up period of parent play, followed by discussion of the activity and intervention goals Discussion of a new topic, using a parent manual Parents interacting in a typical daily routine with their child while fostering social engagement, communication and appropriate play, with coaching from therapists Parents practicing the approach with their child across one or two additional home routines with toys or caregiving activities Autism scores lowered by 18 to 36 months All of the participants who received treatment were between 6 and 15 months old, lived within a one-hour drive of the MIND Institute, and came from families where English was the primary language. They had normal vision and hearing and no significant medical conditions. All received assessments prior to their participation and at multiple points throughout the study. The treatment group of seven children received scores on the Autism Observation Scale for Infants (AOSI) and the Infant-Toddler Checklist that indicated they were highly symptomatic and at risk of developing ASD. Their symptoms also elicited clinical concern from professors Rogers and Ozonoff. The study measured the children’s and parents’ responses to the intervention. Treatment began immediately after enrollment and consisted of 12 one-hour sessions with infant and parent. It was followed by a six-week maintenance period with biweekly visits, and follow-up assessments at 24 and 36 months. The treatment sessions focused on parent–child interactions during typical daily life and provided parent coaching as needed to increase infant attention, communication, early language development, play and social engagement. The children who received the intervention had significantly more autism symptoms at 9 months, but significantly lower autism severity scores at 18- to 36-months of age, when compared with a small group of similarly symptomatic infants who did not receive the therapy. Overall, the children who received the intervention had less impairment in terms of autism diagnosis, and language and development delays than either of the other affected groups. Treating severe disability Given the preliminary nature of the findings, the study only suggests that treating these symptoms so early may lessen problems later. Larger, well controlled studies are needed to test the treatment for general use. However, the researchers said that this initial study is significant because of the very young ages of the infants, the number of symptoms and delays they exhibited early in life, the number of comparison groups involved, and because the intervention was low intensity and could be carried out by the parents in everyday routines. “I am not trying to change the strengths that people with ASD bring to this world," Rogers said when asked whether she is seeking to "cure" autism. "People with ASD contribute greatly to our culture," she said. "The diversity of human nature is what makes us a powerful and strong species. We are trying to reduce the disability associated with ASD." “My goal is for children and adults with autism symptoms to be able to participate successfully in everyday life and in all aspects of the community in which they want to participate: to have satisfying work, recreation, and relationships, education that meets their needs and goals, a circle of people they love, and to be generally happy with their lives.” ### Other study authors are Laurie Vismara of UC Davis and York University, Toronto; and A.L. Wagner, C. McCormick and Gregory Young, all of UC Davis. The study was funded by grants from the National Institute of Child Health and Human Development R21 HD 065275 to Sally Rogers and National Institute of Mental Health grant MH068398 to Ozonoff. At the UC Davis MIND Institute, world-renowned scientists engage in collaborative, interdisciplinary research to find the causes of and develop treatments and cures for autism, attention-deficit/hyperactivity disorder (ADHD), fragile X syndrome, 22q11.2 deletion syndrome, Down syndrome and other neurodevelopmental disorders. For more information, visit mindinstitute.ucdavis.edu." For more informationon this topic and other related subjects, please visit Counselor CEUs

Combined drugs and therapy most effective for severe nonchronic depression

What do you think of this article released by NIMH?

"The odds that a person who suffers from severe, nonchronic depression will recover are improved by as much as 30 percent if they are treated with a combination of cognitive therapy and antidepressant medicine rather than by antidepressants alone. However, a person with chronic or less severe depression does not receive the same additional benefit from combining the two. That is the result of a major new clinical trial published online by the journal JAMA Psychiatry on Aug. 20. In North America, about one in five women and one in 10 men suffer from major depression in her or his lifetime. "Our results indicate that combining cognitive therapy with antidepressant medicine can make a much bigger difference than we had thought to about one-third of patients suffering from major depressive disorder," said Steven Hollon, the Gertrude Conaway Professor of Psychology at Vanderbilt University, who directed the study. "On the other hand, it does not appear to provide any additional benefit for the other two-thirds." Previous studies have found that about two-thirds of all patients with major depressive disorder will improve on antidepressant medications and about one-third of patients will achieve full remission, but half then relapse before fully recovering. Cognitive therapy has proven to be about as effective as medication alone but its effects tend to be longer lasting. Combining the two has been estimated to improve recovery rates by 6 to 33 percent. "Now, we have to reconsider our general rule of thumb that combining the two treatments keeps the benefits of both," said Hollon. The new study was a randomized clinical trial involving 452 adult outpatients with chronic or recurrent major depressive disorder. Unlike previous studies that followed subjects for a set period of time, this study treated them for as long as it took first to remission (full normalization of symptoms) and then to recovery (six months without relapse), which in some cases took as long as three years. "This provided us with enough data so that we could drill down and see how the combined treatment was working for patients with different types and severity of depression: chronic, recurrent, severe and moderate," Hollon said. According to the psychologist, the results could have a major impact on how major depressive disorder is treated. The most immediate effect is likely to be in the United Kingdom, which, he said, is 10 years ahead of the United States in treatment of depression. The use of combined cognitive therapy and antidepressive medicine is standard for severe cases in the UK, and the English National Health Service is actively training its therapists in cognitive therapy and other empirically supported psychotherapies." ### Collaborators in the study were Robert DeRubeis and Jay Amsterdam from the University of Pennsylvania; Jan Fawcett from the University of New Mexico, Albuquerque; Richard Shelton from the University of Alabama, Birmingham; John Zajecka and Paula Young from Rush University; and Robert Gallop from West Chester University. The study was supported by grants MH60713, MH01697, MH60998 and MH060768 from the National Institute of Mental Health. For more information on mental health and counseling related topics, please visit Counselor CEUs

Director's Blog: Robin Williams

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By Thomas Insel on August 13, 2014

"Once again a tragedy has mental illness in the news. Much has been written about the suicide of Robin Williams this week; print stories, television news, and social media have all covered the loss of an extraordinarily talented man. They’ve also talked about the facts about mental illness: the toxic mix of addiction and depression, the high rates of suicide among middle- and older-aged men, and managing mental illness as a long-term challenge.

In view of the challenges of managing multiple disorders—in this case addiction and depression—what makes the story of Robin Williams so remarkable is his many years of success as a comedic genius. This is like finding out that a world-class marathoner was battling congestive heart failure—an achievement that seems almost too much to believe. The character Williams played in Good Will Hunting, the therapist Sean, has a wonderful line when he talks about people’s imperfections: “That’s the good stuff,” he says. Surely, the “good stuff” in this story with such a tragic ending is the long history of successful struggle to be productive, generous, and authentic in spite of an illness that ultimately prevailed. Despite the energy and focus it often takes to cope with and manage mental illness, Robin Williams was able to bring joy and laughter to millions of people around the world.

We in the mental health community speak a lot about recovery, but the inconvenient truth is that for too many people, mental illness can be fatal. While shame or prejudice, lack of access, or poor quality of care can all contribute to fatal outcomes, even those who have been very public about their struggle and have had access to the best available care still, too often, die from depression. Of course, this is true of many forms of cancer and end stage heart disease as well. But our discussions of mental illness rarely focus on this inconvenient truth: these illnesses are currently just as fatal as the “big killers.” We must continue to invest in research to develop new and more effective treatments for people with depression and other mental illnesses. The goal must be a future in which no lives are lost as a result of suicide.Once again a tragedy has mental illness in the news. Much has been written about the suicide of Robin Williams this week; print stories, television news, and social media have all covered the loss of an extraordinarily talented man. They’ve also talked about the facts about mental illness: the toxic mix of addiction and depression, the high rates of suicide among middle- and older-aged men, and managing mental illness as a long-term challenge.

In view of the challenges of managing multiple disorders—in this case addiction and depression—what makes the story of Robin Williams so remarkable is his many years of success as a comedic genius. This is like finding out that a world-class marathoner was battling congestive heart failure—an achievement that seems almost too much to believe. The character Williams played in Good Will Hunting, the therapist Sean, has a wonderful line when he talks about people’s imperfections: “That’s the good stuff,” he says. Surely, the “good stuff” in this story with such a tragic ending is the long history of successful struggle to be productive, generous, and authentic in spite of an illness that ultimately prevailed. Despite the energy and focus it often takes to cope with and manage mental illness, Robin Williams was able to bring joy and laughter to millions of people around the world.

We in the mental health community speak a lot about recovery, but the inconvenient truth is that for too many people, mental illness can be fatal. While shame or prejudice, lack of access, or poor quality of care can all contribute to fatal outcomes, even those who have been very public about their struggle and have had access to the best available care still, too often, die from depression. Of course, this is true of many forms of cancer and end stage heart disease as well. But our discussions of mental illness rarely focus on this inconvenient truth: these illnesses are currently just as fatal as the “big killers.” We must continue to invest in research to develop new and more effective treatments for people with depression and other mental illnesses. The goal must be a future in which no lives are lost as a result of suicide."

For more resources and education regarding suicide, please see our free course http://www.aspirace.com/courses/course-browser.aspx

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Veterans' alcohol problems linked to stress on the home front

Returning national guardsmen more likely to turn to alcohol than general public when faced with issues at home, according to new study in the American Journal of Preventive Medicine What do you think of this article? "Ann Arbor, MI, July 31, 2014 — Regardless of traumatic events experienced during deployment, returning National Guard soldiers were more likely to develop a drinking problem if faced with civilian life setbacks, including job loss, legal problems, divorce, and serious financial and legal problems — all commonplace in military families. Results of the study by researchers at Columbia University's Mailman School of Public Health are published online in the American Journal of Preventive Medicine. Alcohol abuse is a major concern for reservists returning home. Nearly 7% of Americans abuse or are dependent on alcohol, but among reserve soldiers returning from deployment, the rate of alcohol abuse is 14%, almost double that of the civilian population. The study looked at a group of 1,095 Ohio National Guard soldiers, who had primarily served in either Iraq or Afghanistan in 2008 and 2009. Over three years, the soldiers were interviewed three times via telephone and were asked about their alcohol use, exposure to deployment-related traumatic events and stressors like land mines, vehicle crashes, taking enemy fire, and witnessing casualties, and any stress related to everyday life since returning from duty. "Guardsmen who return home need help finding jobs, rebuilding their marriages and families, and reintegrating into their communities," says Karestan Koenen, PhD, Professor of Epidemiology at the Mailman School and senior author of the study. "Too many of our warriors fall through the cracks in our system when they return home. This is particularly true of Guardsmen who do not have the same access to services as regular military personnel. We need to support our soldiers on the home front just as we do in the war zone." More than half (60%) of the responding soldiers experienced combat-related trauma, 36% of soldiers experience civilian stressors, and 17% reported being sexually harassed during their most recent deployment. Among the group, 13% reported problems consistent with an alcohol use disorder in the first interview, 7% during the second, and 5% during the third. Alcohol use disorder is defined as alcohol abuse or dependence. The researchers found having at least one civilian stressor or a reported incident of sexual harassment during deployment raised the odds of alcohol use disorders. The effect of the stressors was restricted to cases of new-onset alcohol use disorders, and was not seen among those with a history of problem drinking. In contrast, combat-related traumatic events were only marginally associated with alcohol problems. The study highlights the important role civilian life and the accompanying stress play in cases of alcohol use disorder in the National Guard. "Exposure to the traumatic event itself has an important effect on mental health in the short-term, but what defines long-term mental health problems is having to deal with a lot of daily life difficulties that arise in the aftermath — when soldiers come home," explains lead investigator Magdalena Cerdá, DrPH, MPH, Assistant Professor of Epidemiology, Mailman School of Public Health, Columbia University. "The more traumatic events soldiers are exposed to during and after combat, the more problems they are likely to have in their daily life — in their relationships, in their jobs — when they come home. These problems can in turn aggravate mental health issues, such as problems with alcohol that arise during and after deployment." With high rates of alcohol abuse among soldiers, there is a critical need for targeted interventions to help soldiers handle stressful life events without alcohol, the investigators observe. More than 1.6 million service members have been deployed in support of war efforts Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. ### The findings from this study are consistent with two reports the Institute of Medicine released this year, which call attention to the serious mental health issues faced by the military population upon return from Iraq and Afghanistan, and highlight the need for the Department of Defense to develop an evidence base on the effectiveness of prevention and treatment programs targeted at service members and their families. A co-author of the current study, Sandro Galea, MD, DrPH, chair of Epidemiology at the Mailman School, led the Commission that issued one of the reports; Dr. Koenen was a co-author of the same." For more information and free clinical resources on drug/alcohol abuse, please visit Alcoholism and Drug Abuse Counselors Continuing Education

Seeing the inner workings of the brain made easier by new technique from Stanford

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"Last year Karl Deisseroth, a Stanford professor of bioengineering and of psychiatry and behavioral sciences, announced a new way of peering into a brain – removed from the body – that provided spectacular fly-through views of its inner connections. Since then laboratories around the world have begun using the technique, called CLARITY, with some success, to better understand the brain's wiring. However, Deisseroth said that with two technological fixes CLARITY could be even more broadly adopted. The first problem was that laboratories were not set up to reliably carry out the CLARITY process. Second, the most commonly available microscopy methods were not designed to image the whole transparent brain. "There have been a number of remarkable results described using CLARITY," Deisseroth said, "but we needed to address these two distinct challenges to make the technology easier to use." In a Nature Protocols paper published June 19, Deisseroth presented solutions to both of those bottlenecks. "These transform CLARITY, making the overall process much easier and the data collection much faster," he said. He and his co-authors, including postdoctoral fellows Raju Tomer and Li Ye and graduate student Brian Hsueh, anticipate that even more scientists will now be able to take advantage of the technique to better understand the brain at a fundamental level, and also to probe the origins of brain diseases. This paper may be the first to be published with support of the White House BRAIN Initiative, announced last year with the ambitious goal of mapping the brain's trillions of nerve connections and understanding how signals zip through those interconnected cells to control our thoughts, memories, movement and everything else that makes us us. "This work shares the spirit of the BRAIN Initiative goal of building new technologies to understand the brain – including the human brain," said Deisseroth, who is also a Stanford Bio-X affiliated faculty member. Eliminating fat When you look at the brain, what you see is the fatty outer covering of the nerve cells within, which blocks microscopes from taking images of the intricate connections between deep brain cells. The idea behind CLARITY was to eliminate that fatty covering while keeping the brain intact, complete with all its intricate inner wiring. The way Deisseroth and his team eliminated the fat was to build a gel within the intact brain that held all the structures and proteins in place. They then used an electric field to pull out the fat layer that had been dissolved in an electrically charged detergent, leaving behind all the brain's structures embedded in the firm water-based gel, or hydrogel. This is called electrophoretic CLARITY. The electric field aspect was a challenge for some labs. "About half the people who tried it got it working right away," Deisseroth said, "but others had problems with the voltage damaging tissue." Deisseroth said that this kind of challenge is normal when introducing new technologies. When he first introduced optogenetics, which allows scientists to control individual nerves using light, a similar proportion of labs were not initially set up to easily implement the new technology, and ran into challenges. To help expand the use of CLARITY, the team devised an alternate way of pulling out the fat from the hydrogel-embedded brain – a technique they call passive CLARITY. It takes a little longer, but still removes all the fat, is much easier and does not pose a risk to the tissue. "Electrophoretic CLARITY is important for cases where speed is critical, and for some tissues," said Deisseroth, who is also the D.H. Chen Professor. "But passive CLARITY is a crucial advance for the community, especially for neuroscience." Passive CLARITY requires nothing more than some chemicals, a warm bath and time. Many groups have begun to apply CLARITY to probe brains donated from people who had diseases like epilepsy or autism, which might have left clues in the brain to help scientists understand and eventually treat the disease. But scientists, including Deisseroth, had been wary of trying electrophoretic CLARTY on these valuable clinical samples with even a very low risk of damage. "It's a rare and precious donated sample, you don't want to have a chance of damage or error," Deisseroth said. "Now the risk issue is addressed, and on top of that you can get the data very rapidly." Fast CLARITY imaging in color The second advance had to do this rapidity of data collection. In studying any cells, scientists often make use of probes that will go into the cell or tissue, latch onto a particular molecule, then glow green, blue, yellow or other colors in response to particular wavelengths of light. This is what produces the colorful cellular images that are so common in biology research. Using CLARITY, these colorful structures become visible throughout the entire brain, since no fat remains to block the light. But here's the hitch. Those probes stop working, or get bleached, after they've been exposed to too much light. That's fine if a scientist is just taking a picture of a small cellular structure, which takes little time. But to get a high-resolution image of an entire brain, the whole tissue is bathed in light throughout the time it takes to image it point by point. This approach bleaches out the probes before the entire brain can be imaged at high resolution. The second advance of the new paper addresses this issue, making it easier to image the entire brain without bleaching the probes. "We can now scan an entire plane at one time instead of a point," Deisseroth said. "That buys you a couple orders of magnitude of time, and also efficiently delivers light only to where the imaging is happening." The technique is called light sheet microscopy and has been around for a while, but previously didn't have high enough resolution to see the fine details of cellular structures. "We advanced traditional light sheet microscopy for CLARITY, and can now see fine wiring structures deep within an intact adult brain," Deisseroth said. His lab built their own microscope, but the procedures are described in the paper, and the key components are commercially available. Additionally, Deisseroth's lab provides free training courses in CLARITY, modeled after his optogenetics courses, to help disseminate the techniques. Brain imaging to help soldiers The BRAIN Initiative is being funded through several government agencies including the Defense Advanced Research Projects Agency (DARPA), which funded Deisseroth's work through its new Neuro-FAST program. Deisseroth said that like the National Institute of Mental Health (NIMH, another major funder of the new paper), DARPA "is interested in deepening our understanding of brain circuits in intact and injured brains to inform the development of better therapies." The new methods Deisseroth and his team developed will accelerate both human- and animal-model CLARITY; as CLARITY becomes more widely used, it will continue to help reveal how those inner circuits are structured in normal and diseased brains, and perhaps point to possible therapies. ### Other arms of the BRAIN Initiative are funded through the National Science Foundation (NSF) and the National Institutes of Health (NIH). A working group for the NIH arm was co-led by William Newsome, professor of neurobiology and director of the Stanford Neurosciences Institute, and also included Deisseroth and Mark Schnitzer, associate professor of biology and of applied physics. That group recently recommended a $4.5 billion investment in the BRAIN Initiative over the next 12 years, which NIH Director Francis Collins approved earlier this month." In addition to funding by DARPA and NIMH, the work was funded by the NSF, the National Institute on Drug Abuse, the Simons Foundation and the Wiegers Family Fund. For more information on the brain, mental health, and social work topics please visit Professional Counselor Continuing Education

Having a Sense of Purpose May Add Years to Your Life

What do you think about this article originally published by The Assoc for Psychological Science? "Feeling that you have a sense of purpose in life may help you live longer, no matter what your age, according to research published in Psychological Science, a journal of the Association for Psychological Science. The research has clear implications for promoting positive aging and adult development, says lead researcher Patrick Hill of Carleton University in Canada: “Our findings point to the fact that finding a direction for life, and setting overarching goals for what you want to achieve can help you actually live longer, regardless of when you find your purpose,” says Hill. “So the earlier someone comes to a direction for life, the earlier these protective effects may be able to occur.” This is an image of a sunrise over a road in the countryside.Previous studies have suggested that finding a purpose in life lowers risk of mortality above and beyond other factors that are known to predict longevity. But, Hill points out, almost no research examined whether the benefits of purpose vary over time, such as across different developmental periods or after important life transitions. Hill and colleague Nicholas Turiano of the University of Rochester Medical Center decided to explore this question, taking advantage of the nationally representative data available from the Midlife in the United States (MIDUS) study. The researchers looked at data from over 6000 participants, focusing on their self-reported purpose in life (e.g., “Some people wander aimlessly through life, but I am not one of them”) and other psychosocial variables that gauged their positive relations with others and their experience of positive and negative emotions. Over the 14-year follow-up period represented in the MIDUS data, 569 of the participants had died (about 9% of the sample). Those who had died had reported lower purpose in life and fewer positive relations than did survivors. Greater purpose in life consistently predicted lower mortality risk across the lifespan, showing the same benefit for younger, middle-aged, and older participants across the follow-up period. This consistency came as a surprise to the researchers: “There are a lot of reasons to believe that being purposeful might help protect older adults more so than younger ones,” says Hill. “For instance, adults might need a sense of direction more, after they have left the workplace and lost that source for organizing their daily events. In addition, older adults are more likely to face mortality risks than younger adults.” “To show that purpose predicts longer lives for younger and older adults alike is pretty interesting, and underscores the power of the construct,” he explains. Purpose had similar benefits for adults regardless of retirement status, a known mortality risk factor. And the longevity benefits of purpose in life held even after other indicators of psychological well-being, such as positive relations and positive emotions, were taken into account. “These findings suggest that there’s something unique about finding a purpose that seems to be leading to greater longevity,” says Hill. The researchers are currently investigating whether having a purpose might lead people to adopt healthier lifestyles, thereby boosting longevity. Hill and Turiano are also interested in examining whether their findings hold for outcomes other than mortality. “In so doing, we can better understand the value of finding a purpose throughout the lifespan, and whether it provides different benefits for different people,” Hill concludes. Preparation of the manuscript was supported through funding from the National Institute of Mental Health (Grant T32-MH018911-23), and the data collection was supported by Grant P01-AG020166 from the National Institute on Aging. ### All data and materials have been made publicly available via the Interuniversity Consortium for Political and Social Research and can be accessed at the following URLs: http://doi.org/10.3886/ICPSR04652.v6 and http://midus.colectica.org/. The complete Open Practices Disclosure for this article can be found at http://pss.sagepub.com/content/by/supplemental-data. This article has received badges for Open Data and Open Materials. More information about the Open Practices badges can be found at https://osf.io/tvyxz/wiki/view/ and http://pss.sagepub.com/content/25/1/3.full." For more information and resources on mental health and social work, please visit Marriage and Family Therapist Continuing Education

Study finds family-based exposure therapy effective treatment for young children with OCD

What do you think of this article on kids and OCD? "Bradley Hasbro Children’s Research Center study finds family-based exposure therapy effective treatment for young children with OCD 5/5/2014 • Children five to eight years old with emerging OCD can benefit from therapies used for older children A new study from the Bradley Hasbro Children’s Research Center has found that family-based cognitive behavioral therapy (CBT) is beneficial to young children between the ages of five and eight with Obsessive-Compulsive Disorder (OCD). The study, now published online in JAMA Psychiatry, found developmentally sensitive family-based CBT that included exposure/response prevention (EX/RP) was more effective in reducing OCD symptoms and functional impairment in this age group than a similarly structured relaxation program. Jennifer Freeman, PhD, a staff psychologist at the Bradley Hasbro Children’s Research Center and clinical co-director of the Intensive Program for OCD at Bradley Hospital, led the study. “CBT has been established as an effective form of OCD treatment in older children and adolescents, but its effect on young children has not been thoroughly examined,” said Freeman. “These findings have significant public health implications, as they support the idea that very young children with emerging OCD can benefit from behavioral treatment.” During the 14-week randomized, controlled trial, which was conducted at three academic medical centers over a five-year period, the team studied 127 children between the ages of five and eight with a primary diagnosis of OCD. Each child received either family-based CBT with EX/RP or family-based relaxation therapy. The family-based CBT focused on providing the child and parent “tools” to understand, manage and reduce OCD symptoms. This includes psychoeducation, parenting strategies, and family-based exposure treatment, so children can gradually practice facing feared situations while learning to tolerate anxious feelings. The family-based relaxation therapy focused on learning about feelings and implementing muscle relaxation strategies aimed at lowering the child’s anxiety. At the end of the trial period, 72 percent of children receiving CBT with EX/RP were rated as “much improved” or “very much improved” on the Clinical Global Impression-Improvement scale, versus 41 percent of children receiving the family-based relaxation therapy. According to Freeman, the traditional approach for children this young presenting with OCD symptoms has been to watch and wait. “This study has shown that children with early onset OCD are very much able to benefit from a treatment approach that is uniquely tailored to their developmental needs and family context,” said Freeman. “Family-based EX/RP treatment is effective, tolerable and acceptable to young children and their families.” Freeman hopes that the family-based CBT model will become the first-line choice for young children with OCD in community mental health clinics where they first present for treatment. Earlier intervention may better address the chronic issues many children have with OCD, as well as the impact the debilitating illness can have on their overall development. “We use this family-based CBT model for treating children in this age range in both our Pediatric Anxiety Research Clinic and our Intensive Outpatient Program with much success,” said Freeman. “My hope is that others will utilize this treatment model to the benefit of young children at the onset of their illness.” “The findings from this study support extending downward the age range that can benefit from CBT with EX/RP for pediatric OCD treatment,” said Freeman. “With appropriate parental support, young children with OCD can make significant gains beyond what can be expected from having parents attempt to teach relaxation strategies to their children with OCD.” This study was funded by the National Institute of Mental Health (NIMH) under grant number 1R01MH079217. Freeman’s principal affiliation is the Bradley Hasbro Children’s Research Center, a division of the Lifespan health system in Rhode Island. She is also co-director of the Pediatric Anxiety Research Clinic at the Bradley Hasbro Children’s Research Center and clinical co-director of the Intensive Program for OCD at Bradley Hospital. She is an associate professor (research) at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior." For more information on PTSD and other mental health resources, please visit, Aspira Continuing Education Online Courses or our Anxiety Disorders CE Course

Neurobiologists find chronic stress in early life causes anxiety, aggression in adulthood

Cold Spring Harbor, NY -- In recent years, behavioral neuroscientists have debated the meaning and significance of a plethora of independently conducted experiments seeking to establish the impact of chronic, early-life stress upon behavior – both at the time that stress is experienced, and upon the same individuals later in life, during adulthood. These experiments, typically conducted in rodents, have on the one hand clearly indicated a link between certain kinds of early stress and dysfunction in the neuroendocrine system, particularly in the so-called HPA axis (hypothalamic-pituitary-adrenal), which regulates the endocrine glands and stress hormones including corticotropin and glucocorticoid. Yet the evidence is by no means unequivocal. Stress studies in rodents have also clearly identified a native capacity, stronger in some individuals than others, and seemingly weak or absent in still others, to bounce back from chronic early-life stress. Some rodents subjected to early life stress have no apparent behavioral consequences in adulthood – they are disposed neither to anxiety nor depression, the classic pathologies understood to be induced by stress in certain individuals. Today, a research team led by Associate Professor Grigori Enikolopov of Cold Spring Harbor Laboratory (CSHL) reports online in the journal PlOS One the results of experiments designed to assess the impacts of social stress upon adolescent mice, both at the time they are experienced and during adulthood. Involving many different kinds of stress tests and means of measuring their impacts, the research indicates that a "hostile environment in adolescence disturbs psychoemotional state and social behaviors of animals in adult life," the team says. The tests began with 1-month-old male mice – the equivalent, in human terms of adolescents -- each placed for 2 weeks in a cage shared with an aggressive adult male. The animals were separated by a transparent perforated partition, but the young males were exposed daily to short attacks by the adult males. This kind of chronic activity produces what neurobiologists call social-defeat stress in the young mice. These mice were then studied in a range of behavioral tests. "The tests assessed levels of anxiety, depression, and capacity to socialize and communicate with an unfamiliar partner," explains Enikolopov. These experiments showed that in young mice chronic social defeat induced high levels of anxiety helplessness, diminished social interaction, and diminished ability to communicate with other young animals. Stressed mice also had less new nerve-cell growth (neurogenesis) in a portion of the hippocampus known to be affected in depression: the subgranular zone of the dentate gyrus. Another group of young mice was also exposed to social stress, but was then placed for several weeks in an unstressful environment. Following this "rest" period, these mice, now old enough to be considered adults, were tested in the same manner as the other cohort. In this second, now-adult group, most of the behaviors impacted by social defeat returned to normal, as did neurogenesis, which retuned to a level seen in healthy controls. "This shows that young mice, exposed to adult aggressors, were largely resilient biologically and behaviorally," says Dr. Enikolopov. However, in these resilient mice, the team measured two latent impacts on behavior. As adults they were abnormally anxious, and were observed to be more aggressive in their social interactions. "The exposure to a hostile environment during their adolescence had profound consequences in terms of emotional state and the ability to interact with peers," Dr. Enikolopov observes. ### The research described in this release was supported by the Russian Foundation for Basic Research and by the National Institute of Mental Health. "Extended Effect of Chronic Social Defeat Stress in Childhood on Behaviors in Adulthood" appears online in PlOS One Tuesday, March 25, 2014. The authors are: Irina L. Kovalenko, Anna G. Galyamina, Dmitry A. Smagin, Tatyana V. Michurina, Natalia N. Kudryavtseva and Grigori Enikolopov. About Cold Spring Harbor Laboratory Founded in 1890, Cold Spring Harbor Laboratory (CSHL) has shaped contemporary biomedical research and education with programs in cancer, neuroscience, plant biology and quantitative biology. CSHL is ranked number one in the world by Thomson Reuters for the impact of its research in molecular biology and genetics. The Laboratory has been home to eight Nobel Prize winners. Today, CSHL's multidisciplinary scientific community is more than 600 researchers and technicians strong and its Meetings & Courses program hosts more than 12,000 scientists from around the world each year to its Long Island campus and its China center LCSW Continuing Education

Autism Spectrum Disorder: Uncovering Clues to a Complicated Condition

Autism Spectrum Disorder Uncovering Clues to a Complicated Condition Autism is a complex brain disorder that first appears during early childhood. It affects how a person behaves and interacts with others. People with autism might not look you in the eye when talking. They may spend a lot of time lining up toys or other objects. Or they may say the same sentence over and over. The disorder is so variable—affecting each person in very different ways—that it can be difficult to diagnose and treat. This variability is why autism is called a “spectrum” disorder. It spans the spectrum from mild to severe and includes a wide range of symptoms. NIH-funded scientists have been working to uncover the secrets of autism. They’ve identified genes that may boost the risk for autism. They’ve developed therapies that can help many of those affected. And they’ve found that starting treatment as early as possible can lead to better outcomes. Still, there’s much more we need to learn about this complicated condition. About 1 in 88 children may have autism spectrum disorder, according to the U.S. Centers for Disease Control and Prevention. The number of affected children has been growing in recent years. Many researchers believe this increase is due to better diagnosis and awareness. Others suspect that yet-unknown factors may be partly to blame. Although the exact causes of autism are unclear, research suggests that both genes and the environment play important roles. Autism affects a child’s development in different ways, and so it’s known as a developmental disorder. Parents are often the first to suspect that something may not be quite right with their child’s development. They may notice their baby doesn’t make eye contact, becomes overly focused on certain objects or isn’t “babbling” like other children the same age. “A parent may first have concerns when a child is under 2 years of age,” says Dr. Connie Kasari, a child development expert at the University of California, Los Angeles. “A more certain diagnosis can usually be made by age 2, but some cases might not be clear until much later.” There are no direct tests, like blood tests or brain scans, that can identify autism. Instead, the condition is diagnosed by looking at a child’s behaviors and development. “All affected children have some sort of social impairment, but symptoms vary along a continuum,” Kasari says. “Impairment can range from kids who are in their ‘own world’ and seemingly unaware of others to high-functioning individuals who are just awkward and seem to miss the point of social interactions.” In May 2013, the American Psychiatric Association updated an important book that’s used to diagnose and classify mental disorders. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) includes an updated definition for autism spectrum disorder. The condition is now identified by looking for 2 broad categories of symptoms: problems with social communication and the presence of “stereotyped” behaviors, such as walking in certain patterns or insisting on specific or unusual routines. To be diagnosed with autism, these symptoms must arise during early childhood, even if they’re not noticed until later, when social demands increase. “The new DSM-5 definition moves all the disorders into a single spectrum, rather than the 4 separate autistic disorders described in the past,” says NIH pediatrician and neuroscientist Dr. Susan Swedo. She chaired the expert panel that updated the DSM-5 definition of autism spectrum disorders. “The new criteria are also more inclusive of minorities, adolescents and young adults with autism than the previous edition, which focused more on boys ages 4 to 9.” Getting diagnosed as early as possible is crucial. “Autism is treatable even though it’s not curable,” says Dr. David Mandell, an expert in autism and health services at the University of Pennsylvania. “If we intervene early enough with appropriate and intensive care, we can reduce a lot of impairments for many kids who have autism.” Research has shown that therapies focusing on behavior and communication can be helpful. Some drugs can also reduce certain related symptoms, but no medications have been approved by the U.S. Food and Drug Administration specifically for treating the main symptoms of autism. “Because autism is such a complicated disorder, no one therapy fits everyone,” Kasari explains. Kasari and her colleagues developed and tested several treatments that focus on improving social skills and communication. In one study, preschoolers with autism received intense training in basic skills such as playing and sharing attention. Five years later, these children tended to have stronger vocabularies and better communication skills than children who received standard therapy. “We’ve found that if we can improve these basic skills, we can also improve language learning for these kids,” Kasari says. “We’re now studying 2 potential therapies in at-risk babies, ages 12- to 21-months old, to see if we can push language development along faster for the children.” Scientists are also looking for ways to predict likely outcomes for children with autism. One NIH-funded team found that the brain waves of some 2-year-olds with autism can have a distinctive pattern when they listen to familiar words. The children with more severe social symptoms didn’t have a typical focused response in the brain region that processes language. Follow-up studies showed that these brain responses predicted the children’s developmental abilities 2 and 4 years later. “In the future, we’d like to be able to assess a child based on brain function or their genetic profile and then identify the intervention that might be best for that particular kid,” Mandell says. A growing number of studies are looking at autism in older age groups. “While we think about autism as a disorder of childhood, it actually continues through adolescence and into adulthood,” Mandell says. “Some adults with autism have been misdiagnosed, and they can find themselves being treated for other conditions. We’d like to develop better screening tools and ultimately provide these adults with skills and supports to help them become happy and productive citizens.” While research is ongoing, it’s clear that early diagnosis and treatment can improve outcomes for those with autism. If you’re concerned about your child’s social communication and behaviors, don’t wait. Talk with your child’s doctor. You may be referred to a specialist who can do a thorough evaluation. The earlier autism is diagnosed, the sooner specific therapy can begin Social Worker Continuing Education