Connection, Screens, CTE, Suicide and Guns
More on the Importance of Connection
I had written about this on an earlier Substack post.
In May 2023, US Surgeon General Vivek Murthy highlighted loneliness and isolation as public health crises that significantly impact health, potentially leading to serious conditions like heart disease and depression, and even premature death. Two key measures for assessing this issue are social isolation, which is the lack of social contact quantified by the frequency of interactions, and loneliness, a subjective feeling of being alone. To combat these issues, the Surgeon General's Advisory has recommended establishing a National Strategy to Advance Social Connection with six pillars, including strengthening social infrastructure, enacting supportive public policies, involving the health sector, reforming digital environments, expanding research, and fostering a culture of connection. For clinicians, recognizing the severity, utilizing assessment tools, and prescribing socialization through community programs are initial steps. Ultimately, nurturing strong social bonds is vital for our well-being and happiness, an understanding underscored by the longest study on happiness which associates good health and robust social ties with a joyful life.
Kindergarteners and Screens
A recent study involving 15,965 kindergarten children aged 3 to 6 years examined the impact of different types of screen content on their mental health. The study found that overall screen time was consistently linked to an increased risk of mental health problems. However, the type of content viewed made a significant difference. Children who spent more time watching educational programs had a lower risk of mental health issues, whereas exposure to non-child-directed programs was associated with a higher risk. These findings suggest that both the amount and nature of screen content are important factors in the mental well-being of young children. It highlights the need for parents and caregivers to monitor not just how much time children spend in front of screens, but also what they are watching. Limiting screen time overall, and choosing educational content over non-child-directed programs, is recommended to support children's mental health. My advice: educational screen content is ok, and minimize or eliminate everything else. Read stories to and with your kids.
Autism and Screens
A comprehensive study published in JAMA Network Open analyzed whether screen time is associated with autism spectrum disorder (ASD) in children. The systematic review and meta-analysis incorporated 46 of 4682 observational studies, involving a total of 562,131 participants. Initial findings indicated a significant association between screen time and ASD, particularly in studies focusing on general screen use among children. However, after accounting for publication bias, the association was no longer statistically significant. This suggests that while excessive screen time may potentially impact developmental outcomes negatively, the results are not conclusive due to the observational nature of the studies and the presence of publication bias. Therefore, while the study raises concerns about the potential risks of excessive screen time in relation to ASD, it also highlights the need for more definitive research to fully understand this relationship. However, screen time in children who are autistic is extremely addictive, leads to an exacerbation of scripting, and I would minimize or avoid it, particularly if it is unmonitored or not educational. Kids with ASD tend to watch the same things over and over, and it is often inane content of one kind or another, such as on Youtube.
Better to get your autistic child outside: A recent study published in JAMA Network Open conducted a systematic review and meta-analysis of nature-based interventions (NBIs) for children with autism spectrum disorder (ASD). This study, which included 24 research papers involving 717 participants, found that NBIs, especially those involving group-based recreational therapy with experiential learning in natural settings, were beneficial in improving the sensory, social, and behavioral functioning of children with ASD in the short term. These interventions, conducted outside traditional settings like clinics or homes, showed a significant positive impact on aspects such as social communication, hyperactivity, irritability, and sensory processing issues. However, the study also highlighted the need for more robust research to further understand the long-term effects and benefits of NBIs for children with ASD. This research underscores the potential of alternative therapeutic settings and approaches, like NBIs, in supporting the development and well-being of children with ASD.
Using Sesame Street to Explain Opioid Addiction to Kids
Sesame Workshop, the organization behind the beloved Sesame Street, is using its influence to address the difficult topic of opioid addiction and its impact on children. By introducing characters like Karli, whose mother is in recovery for addiction, alongside familiar faces like Elmo, the Workshop provides free online resources to help young children understand and cope with the challenges of having a parent or caregiver who misuses opioids. These resources aim to build emotional resilience in children, offering age-appropriate explanations and tools like coloring books, videos, and storybooks that discuss addiction and recovery. The initiative, backed by a grant, also equips parents, caregivers, and professionals with developmentally appropriate materials to guide conversations about addiction, ensuring children understand that they are not to blame and can express their emotions, make healthy choices, and celebrate themselves despite the difficult circumstances.
Effects of Covid on Learning in Children and Teens
A study explored the mental well-being of children with special educational needs (SEN) as they returned to in-person learning after COVID-19 pandemic school closures. The research, which included 456 children during school closure and 519 after reopening, revealed that preschoolers with SEN experienced fewer behavioral and emotional difficulties once schools reopened. However, older children, adolescents, and those with intellectual disabilities faced increased emotional and behavioral challenges, along with a decline in overall quality of life. This study highlights the varying mental health impacts on children with SEN based on their age and type of disability. It suggests that particular attention and additional support may be necessary for vulnerable groups to help them adjust back to the school environment effectively.
Chronic Traumatic Encephalopathy (CTE) in Young Athletes
A recent study published in JAMA Neurology, the largest of its kind, revealed that 41% of young athletes who experienced repetitive head impacts (RHIs) and died before the age of 30 had chronic traumatic encephalopathy (CTE), a neurodegenerative disease. The study analyzed brain tissue from 152 athletes, including the first known American female athlete with CTE. The majority of those diagnosed with CTE (71%) had only played amateur sports like football, soccer, hockey, and wrestling. Most cases of CTE were mild and found in individuals who had played contact sports for an average of 11.6 years. The study's findings challenge the assumption that CTE is primarily a concern for professional athletes, indicating that it can also affect amateur athletes and manifest at a young age. This study underscores the importance of understanding CTE's risks even in younger, non-professional athletes. Take care of your kids’ brains!
And, along those lines:
New Concussion Management Guidelines
An international panel of experts has updated the guidelines for managing concussions in athletes, introducing significant changes. The new consensus, developed from the 6th International Conference on Concussion in Sport, emphasizes avoiding complete rest and cocooning after a concussion. Instead, it recommends controlled physical and cognitive activities like light exercise and simple daily tasks within the first 48 hours post-injury. The panel found that such activity aids recovery, while strict rest can delay it. This revised approach also includes limiting screen time in the initial 48 hours to support recovery, highlighting the importance of good-quality sleep for healing. Newly introduced tools like the Concussion Recognition Tool–6 (CRT6) and Sport Concussion Assessment Tool–6 (SCAT6 and Child SCAT6) are designed to help healthcare professionals assess and manage sports-related concussions more effectively. The recommendations, which took over five years to develop and are informed by systematic reviews, were published in the British Journal of Sports Medicine and aim to improve care for athletes at risk of concussion worldwide.
At the 2023 American Academy of Neurology meeting, Dr. Nina Riggins, an expert in headache management from UC San Diego, discussed posttraumatic headache treatment. Dr. Riggins highlighted the shift from prescribing complete rest to encouraging controlled physical activity and even aerobic exercise for recovery. She emphasized the need for patients to return to their baseline before resuming normal activities, especially sports. To manage posttraumatic headaches, treatments similar to those for migraines or tension headaches are used, such as calcitonin-gene related peptide–blocking medications. Lifestyle factors, including regular sleep, hydration, and gradual increase in physical activity, are also important. Dr. Riggins mentioned using devices like vagal nerve stimulators and exploring virtual reality therapies for various posttraumatic syndromes. Collaboration among medical professionals is vital to determine the best treatments for posttraumatic headaches.
Suicide Rates in African American Girls
A study from Columbia Mailman School of Public Health, recently published in the American Journal of Psychiatry, indicates a concerning rise in suicide rates among young Black females in the United States. Analyzing data from 1999 to 2020 provided by the CDC's National Center for Health Statistics, the researchers observed a significant increase in suicide deaths among Black females aged 15 to 84, from 289 in 1999 to 652 in 2020. Notably, the increase was more pronounced among those aged 15 to 24, with rates more than doubling from 1.9 to 4.9 per 100,000. This trend aligns with the overall rise in suicides across the U.S., which saw nearly 49,500 deaths in 2022. Factors contributing to this increase could include cyberbullying, online racial attacks, intimate partner violence, neighborhood violence, and inadequate support systems. The findings highlight the need for targeted interventions and improved mental health support for young Black women facing these stressors.
Five Times Greater Suicide Risk for Trans, Gender-Diverse Teens in ED
A recent study presented at the American Academy of Pediatrics meeting revealed that transgender and gender-diverse youth have a significantly higher risk of suicide, more than five times greater than their cisgender counterparts. This finding emerged from an analysis of emergency department (ED) visits at a single institution. The study, led by Dr. Amanda Burnside, used innovative methods to identify gender-diverse youth in healthcare settings, often a challenging task due to limited or inconsistent record-keeping. Among the patients screened for suicide risk, a staggering 81% of gender-diverse youths tested positive, compared to 23% of the general ED visitors. This alarming disparity underscores the urgent need for comprehensive screening and enhanced mental health support for these vulnerable young individuals.
Characteristics and Acquisition Methods of Firearms in School Shootings Involving Adolescents
A study analyzed data from The American School Shooting Study, focusing on 262 adolescents involved in 253 U.S. school shootings from 1990 to 2016. The study found that these school shootings mostly involved low- and moderate-powered firearms, predominantly handguns, often acquired from family members or relatives, typically through theft. This discovery challenges the stereotype of mass school shootings involving high-powered assault weapons. The findings suggest that better firearm safety and storage practices, particularly in homes with adolescents, could play a significant role in preventing school shootings. This research provides crucial insights for public health interventions and policy measures, emphasizing the need for secure storage of firearms to limit adolescents' access to weapons and potentially reduce school shooting incidents. Of course if there weren’t any firearms in homes in the first place that would go a long way towards reducing the number of teens getting shot.
In fact, a recent article highlights the alarming rise in firearm-related suicide deaths among children and adolescents in the U.S., noting a 60% increase since 2012. It addresses the stark reality that firearms greatly increase the risk of suicide fatality, pointing out that children in homes with guns are three to four times more likely to die by suicide. The piece argues against the 'futility theory', which suggests that nothing can be done to prevent these deaths, by showing that states with the highest rates of child suicide also have the weakest gun laws, according to the Giffords Law Center. The authors propose that, just as we protect at-risk individuals through counseling and safety measures in homes, states must take responsibility for reducing access to lethal means for vulnerable children. They call for a collective state-level acknowledgment that reducing firearm-related child suicides is both a desired and achievable goal, which would be a critical step away from a stance of futility towards one of active prevention and safety.
And alcohol intoxication is a major risk factor in suicide. A study has found a strong association between alcohol intoxication and the increased likelihood of suicide by firearms, highlighting the need for preventative measures. This study, examining data from over 148,000 suicide cases from 2003 to 2020, found that alcohol intoxication, defined as a blood alcohol content of at least 0.08 g/dL, significantly raises the risk of choosing firearms as a means of suicide. The risk is particularly higher among men and young to middle-aged women. The researchers suggest several preventive strategies, such as prohibiting firearm possession for individuals with alcohol use disorders, screening and interventions for alcohol use in suicidal individuals, implementing safe firearm storage laws, mandatory waiting periods for firearm purchases, and minimum pricing for alcohol. These findings point towards the potential effectiveness of alcohol control policies in reducing firearm-related suicides in the U.S.
More on Covid Vaccines in Children
A report analyzed data on SARS-CoV-2 infections and the effectiveness of COVID-19 mRNA vaccines in children aged 6 months to 4 years. It was found that 86% of children in this age group who were hospitalized or visited emergency departments for acute respiratory illness had not received any COVID-19 vaccine. Despite this low vaccination rate, only 5% of these children tested positive for SARS-CoV-2. The study also found that receiving two doses of the COVID-19 mRNA vaccine was 40% effective in preventing hospital and emergency department visits. These results endorse current recommendations for vaccinating young children against COVID-19 to reduce the risk of severe illness and hospitalization. The study's period coincided with the circulation of various Omicron subvariants, during which there was a noted low hospitalization rate for COVID-19 among young children, suggesting that the illness was generally mild in this age group or that there was existing immunity from previous exposure to the virus.
Mass Shooters and Psychiatric Illness
A recent award-winning study on mass shooters has uncovered a high occurrence of undiagnosed mental illness among such individuals, challenging the hasty stereotype that mass shooters do not suffer from mental health issues. The research, which won the Psychodynamic Psychiatry Journal Prize, utilized the Mother Jones database to retrospectively analyze 115 mass shootings in the U.S. from 1982 to 2019. Researchers developed a comprehensive 62-item questionnaire to conduct detailed psychiatric assessments based on DSM-5 criteria, either through interviews with forensic psychiatrists or through review of court records. Out of 32 cases with adequate information, they found that 87.5% of surviving assailants who carried out mass shootings had a major psychiatric diagnosis, such as schizophrenia or other psychiatric conditions, and none were appropriately medicated at the time of their crimes. The study highlights the urgent need for proper diagnosis and treatment of psychiatric illnesses to prevent violence and reduce the stigma around mental health, thereby allowing those suffering to seek and receive effective treatment.
FDA warns of rare but serious drug reaction to the antiseizure medicines levetiracetam (Keppra, Keppra XR, Elepsia XR, Spritam) and clobazam (Onfi, Sympazan)
The U.S. Food and Drug Administration (FDA) has issued a warning about a severe, albeit uncommon, reaction to the antiseizure medications levetiracetam (Keppra) and clobazam (Onfi), which are marketed under various brand names. This reaction, known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), begins as a skin rash but can escalate rapidly, causing damage to internal organs such as the liver, kidneys, lungs, heart, or pancreas, and can lead to hospitalization or even death. Due to the severity of this reaction, the FDA is mandating that warnings about the potential for DRESS be included in both the prescription information and the patient Medication Guides for these drugs. DRESS symptoms may include fever, rash, swollen lymph nodes, and organ injury, and require immediate medical attention.