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Behavioral Problems in Childhood Doubles the Risk of Chronic Widespread Pain in Adult Life
ScienceDaily (Mar. 9, 2010) — Bad behaviour in childhood is associated with long-term, chronic widespread pain in adult life, according to the findings of a study following nearly 20,000 people from birth in 1958 to the present day.
Chronic widespread pain is a common complaint that can have a major adverse effect on quality of life, often requiring referral to a hospital specialist for investigation and treatment. The research, published online in the journal Rheumatology on March 10, found that children with severe behaviour disturbances had approximately double the risk of chronic widespread pain by the time they reached the age of 45 than children who did not have behaviour problems.
The researchers found that this association was not explained by social class, early reporting of symptoms or an already-known link between adult psychological distress and chronic widespread pain (CWP). Instead, they believe that a dysfunction in the interaction between the nervous system and hormones, occurring in early life, may have long-term consequences for adult health.
The lead author of the study, Dr Dong Pang, an epidemiologist at the University of Aberdeen (UK), said: “We know already that severe adverse events in childhood such as hospitalisation after a road traffic accident and separation from mothers are linked to CWP in adulthood. In addition, aspects of childhood behaviour are strongly related to children reporting CWP. However, until now, it was unknown whether maladjusted behaviour in children was a long-term marker for CWP in adulthood. Our study shows that it is.
“We are not sure what underlying biological mechanism underpins this relationship, but one possible explanation might be that both the childhood behaviour and the adult CWP are due to a long-term neuroendocrine dysfunction beginning in early life. The hypothalamic-pituitary-adrenal (HPA) axis, the primary neuroendocrine stress response system, has been shown to be associated with childhood behaviour. Similarly, altered HPA axis function has been reported to be associated with CWP. Early life experience, such as emotional stress due to past trauma, may have a lifelong impact on the neuroendocrine system (HPA axis), which in turn leads to behavioural problems in childhood and CWP in adulthood as well as other mental problems. Further research at molecular and genetic level are needed to clarify this.”
The researchers followed a group of 18,558 children who were born in one week in 1958 in England, Scotland and Wales, and an additional 920 children who were born in the same week overseas and who came to the UK before the age of 16. Information was collected at regular intervals, including at the ages of 7, 11 and 16, and at 42 and 45 in adulthood. Parents and teachers independently assessed the children’s behaviour on aspects such as restlessness, worrying, solitariness, ability to make friends, obedience, stealing, sucking thumbs and biting nails, lying, bullying, truanting etc. At the age of 42 the participants completed a questionnaire asking about psychological distress in adult life, and at the age 45 they completed another one about pain.
The study found that CWP was slightly more common in women than in men (12.9% versus 11.7%). Children whose teachers had reported severe persistent behaviour problems at all ages (7, 11 and 16) had more than double the risk of CWP in adulthood compared with children without behaviour problems at all ages. If the children had severe behaviour problems at 11 and 16, then they had nearly double the risk of CWP in later life. Similar, but weaker associations were shown for parent-reported behaviour, which the researchers believe is because teachers tend to be better at providing objective assessments of behaviour as they have more children to compare.
The researchers say that it is not just CWP that is associated with bad behaviour in childhood. Other adult problems that are associated with childhood behavioural problems include long-term psychiatric problems such as depression and anxiety, suicidal behaviour, substance abuse and treatment for psychiatric illness. They suggest that all these problems may be outcomes of the chain of events set in motion by the dysfunctioning neuroendocrine system. If further research proves this to be the case, then it might be possible to intervene in early life to prevent these problems occurring later.
Professor Gary Macfarlane, the leader of the research group, said: “This study helps us to understand the factors in childhood that can lead someone to get on a trajectory of ill-health, including chronic pain. The disruption to the hypothalamic-pituitary-adrenal (stress-response) axis is one biological marker of the effect of such experiences and this could help to identify persons at higher risk of chronic pain. Interventions would be lifestyle focussed and would include identification and treatment of behavioural and emotional factors, but would also address lifestyle factors such as increased physical activity.
“We plan to undertake some studies in children to understand what range of factors cause a disturbance to the stress-response axis; such work can then inform what intervention studies may be appropriate.”
Journal Reference:
- Dong Pang, Gareth T. Jones, Chris Power and Gary J. Macfarlane. Influence of childhood behaviour on the reporting of chronic widespread pain in adulthood: results from the 1958 British Birth Cohort Study. Rheumatology, (in press) DOI: 10.1093/rheumatology/keq052
http://www.sciencedaily.com/releases/2010/03/100309202920.htm
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By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 1, 2010
Researchers report that magnetic resonance imaging (MRI) can detect structural changes in the brain among abused or emotionally neglected children.
The alterations appear to occur when children with a particular genetic makeup are abused predisposing the child to depression.
The study was led by scientists at Trinity College Dublin and is published in the international scientific journal, Neuropsychopharmacology.
Commenting on the significance of the findings, Trinity’s Professor Thomas Frodl at the School of Medicine and Trinity Institute for Neuroscience said:
“This improved neurobiological understanding shows how stress and genetic variants interact and affect brain structure and function. In turn it demonstrates how it could affect a person’s propensity for depression. These structural alterations of the brain are associated with a higher vulnerability to depression and a more chronic course of the depression might be associated with further structural changesâ€.
“Therefore, early intervention in the case of major depression is necessary to increase the chance of a good disease outcome. Fortunately, depression can be treated very well by psychotherapy and antidepressant medication. Moreover, prevention strategies for childhood neglect and misuse are highly important to increase public health and to avoid in later life for these individuals, the burden of major depression.â€
The world health organization (WHO) found that major depression is one of the most important human diseases with a prevalence of about 10% worldwide. Approximately 500,000 people in Ireland have or will develop major depression in their life. The WHO has forecast that major depression will be the second most common cause of disability by 2020. Advances in this area will have a high impact on overall disease costs.
The study was conducted on a total of 24 patients (aged 18-65 years) being treated as inpatients for major depression. They were investigated with high-resolution structural MRI and childhood stress assessments. Special analysis programs were used to measure brain regions. These patients were compared with 27 healthy control subjects from the local community who were matched for age and gender.
Further research is needed in a larger number of patients and controls to identify the underlying causes of depression and stress-gene interaction on brains structure as well as function.
Source: Trinity College Dublin
Repeated Anesthesia Can Affect Children’s Ability to Learn
ScienceDaily (Mar. 9, 2010) — There is a link between repeated anaesthesia in children and memory impairment, though physical activity can help to form new cells that improve memory, reveals new research from the Sahlgrenska Academy at the University of Gothenburg, Sweden.
The study has been published in the Journal of Cerebral Blood Flow & Metabolism.
“Paediatric anaesthetists have long suspected that children who are anaesthetised repeatedly over the course of just a few years may suffer from impaired memory and learning,” says Klas Blomgren, professor at the Queen Silvia Children’s Hospital and researcher at the Sahlgrenska Academy. “This is a theory that is also supported by foreign research.”
His research team discovered, by chance, a link between stem cell loss and repeated anaesthesia when working on another study. They wanted to find out what happens to the brain’s stem cells when exposed to strong magnetic fields, for example during an MRI scan. The study was carried out using rats and mice, and showed that while the magnetic fields did not have any tangible effects on the animals, the repeated anaesthesia did.
“We found that repeated anaesthesia wiped out a large portion of the stem cells in the hippocampus, an area of the brain that is important for memory,” says Blomgren. “The stem cells in the hippocampus can form new nerve and glial cells, and the formation of nerve cells is considered important for our memory function.”
Their results could also be linked to impaired memory in animals as they got older. The effect was evident only in young rats or mice that had been anaesthetised, not when adult animals were anaesthetised. This may be because stem cells are more sensitive in an immature brain, even though there are fewer of them as we get older.
“Despite extensive attempts, we have not been able to understand exactly what happens when the stem cells are wiped out,” says Blomgren. “We couldn’t see any signs of increased cell death, but are speculating that the stem cells lose their ability to divide.”
Another treatment that wipes out the brain’s stem cells is radiotherapy, which is used with cancer patients. Blomgren and his research team have previously used animal studies to show that physical activity after radiotherapy can result in a greater number of new stem cells and partly replace those that have been lost.
“What’s more, the new nerve cells seem to work better in animals that exercise. Now that we know this, we can come up with treatments that prevent or reverse the loss of ostem cells after repeated anaesthesia,” says Blomgren, who believes that the findings will lead to greater awareness of the problems and inspire further research into the reasons for the loss of stem cells.
Journal Reference:
- Zhu et al. Isoflurane anesthesia induced persistent, progressive memory impairment, caused a loss of neural stem cells, and reduced neurogenesis in young, but not adult, rodents. Journal of Cerebral Blood Flow & Metabolism, 2010; DOI: 10.1038/jcbfm.2009.274
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Abused Children More Likely to Suffer Unexplained Abdominal Pain, Nausea or Vomiting
ScienceDaily (Mar. 9, 2010) — Children who have been abused psychologically, physically or sexually are more likely to suffer unexplained abdominal pain and nausea or vomiting than children who have not been abused, a study led by University of North Carolina at Chapel Hill researchers concludes.
“Therefore, when young patients complain about unexplained gastrointestinal symptoms, their doctors should ask questions to determine if they might have been abused,” said Miranda van Tilburg, Ph.D., lead author of the study, an assistant professor of gastroenterology and hepatology in the UNC School of Medicine and a member of UNC’s Center for Functional GI & Motility Disorders.
The study is published in the March/April 2010 issue of Annals of Family Medicine. In the study, van Tilburg and study co-authors analyzed data that was obtained as part of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Their analysis included 845 children ages 4 through 12 years. Every two years they collected information about the childrens’ gastrointestinal symptoms from their parents and maltreatment allegations concerning these children from child protective services agencies. Then the children, at age 12, gave their own reports of GI symptoms, life-time maltreatment and psychological distress. A statistical method called logistic regression was used to analyze the data.
The results showed that among children in the study, sexual abuse preceded or coincided with abdominal pain in 91 percent of cases. In addition, in children who said they recalled ever being abused physically, psychologically or sexually, there was a statistically significant association between abuse and both abdominal pain and nausea/vomiting.
An additional analysis aimed at separating the effect of psychological distress alone from physical or sexual abuse showed that most effects dropped below the level of statistical significance, except for the relationship between physical abuse and nausea/vomiting. This is consistent with other results reported in the medical literature, van Tilburg said, but psychological distress was only partly responsible for weakening the relation between physical abuse and nausea. Other factors, such as permanent changes in the nervous system due to injury associated with physical abuse, must play a role as well, she said.
In addition to van Tilburg, UNC co-authors of the study are Desmond K. Runyan, M.D. Dr.P.H., Adam J. Zolotor, M.D., M.P.H., Denesh K. Chitkara, M.D. and William E. Whitehead, Ph.D.
Co-authors from outside UNC include J. Christopher Graham, Ph.D. (University of Washington), Howard Dubowitz, M.D., M.S. (University of Maryland), Alan J. Litrownik, Ph.D. (San Diego State University), Emalee Flaherty, M.D. (Northwestern University Feinberg School of Medicine).
Source:Â http://www.sciencedaily.com/releases/2010/03/100308170957.htm
Classroom Problems Reduced By Teaching Self-Control Skills To Children
Article Date: 08 Mar 2010 – 2:00 PST
Children taught skills to monitor and control their anger and other emotions improved their classroom behavior and had significantly fewer school disciplinary referrals and suspensions, according to a study by University of Rochester Medical Center researchers.
Children in a school-based mentoring program were about half as likely to have any discipline incident over the three-month period of the study, according to an article published online by the Journal of Abnormal Child Psychology. They also had a 43 percent decrease in mean suspensions as compared to the control group, which did not receive mentoring of the self-control skills. In the four-month interval after the intervention began, 1.8 percent of children in the mentored group were suspended compared to 6.1 percent of the control group. Children taught the new skills also had a 46 percent decrease in mean office disciplinary referrals as compared to the children in the study’s control group
“It is exciting that adult mentors, who are not mental health professionals, taught children a set of skills that significantly strengthened the children’s ability to function well in their classrooms and meet school expectations,” said Peter Wyman, Ph.D., lead author of the article and associate professor of Psychiatry at the Medical Center. “This study suggests that with appropriate guidance from a trained adult, young children are capable of learning a great deal about their emotions and skills for handling their emotions effectively and those skills can have direct, positive benefits for their functioning in school.”
The study evaluated the effectiveness of the Rochester Resilience Project that was developed by Wyman and Wendi Cross, Ph.D., associate professor of Psychiatry and Pediatrics at the Medical Center, to address the needs of young children with emerging behavioral and social-emotional problems by providing an accessible school-based intervention. In a relationship with an intervention mentor over four months, children learn and practice behavioral and cognitive skills designed to strengthen their self-regulation of emotions and address specific goals to improve school adaptation.
“Our goal in developing the Rochester Resilience Project was to ‘translate’ findings from research about how children learn skills to be more resilient in relationships with adults into an accessible program in schools,” Wyman said. “Being a successful student in elementary school classrooms establishes a foundation that makes healthy development more likely in the future.”
Activities establish the Resilience Project mentor as an empathic adult informed about each child’s life context, strengths and challenges. Through adult-led interactive learning and practice in natural settings, children are taught to monitor their own emotions and the emotion of others, using cues to identify feelings and intensities of feelings. Mentors introduce ‘feelings check-in’ as a standard practice that serves as a teaching tool about feelings and a transition to skills focused on managing feelings.
Self-control and reducing escalation of emotions is taught through the concept of a “feelings thermometer” to depict intensity. Children learn to use “mental muscles” as a tool to monitor feelings and to stop feelings from entering a hot zone. They also learn to maintain control and regain equilibrium through strategies such as taking a deep-breath, stepping back from emotionally intense situations, and using an imaginary umbrella as protection from hurtful words.
For each of the 14 weekly lessons, children met individually with their mentors for approximately 25 minutes in a private setting during the school day. The skills taught to children are labeled in simple terms suited to developmental level. Reinforcement and feedback from mentors in settings in which children use new skills is also critical for children to successfully acquire the skills. Mentors collaborated with teachers to identify classroom situations in which the mentors could provide reminders to children to use new skills, and cues were provided, a sticker or button, for example, for the child to take as a reminder.
In the study, 226 children from kindergarten up to third grade in two urban elementary schools took part. They had manifested emerging behavioral, social-emotional, and/or on-task learning problems at school. This population was selected due to evidence that those problems increase the likelihood that children will be less successful at school and may develop behavioral problems, such as substance abuse.
Children who received the intervention showed improved functioning in all domains of classroom behavior rated by teachers. The intervention had a positive impact on children’s classroom behaviors and rates of disciplinary incidents, including fewer aggressive or disruptive problems, improved on-task learning behaviors and peer social skills, and less shy-withdrawn and more assertive behaviors, the researchers concluded. After the study was completed, children in the control group also were mentored and taught the self-control skills.
The mentoring improved peer social skills for girls but not for boys.
“We found that girls benefited more than boys in terms of improved peer social skills, and the reasons are unknown,” the researchers state. “We note that all mentors were female. It is possible that congruence of child-mentor pairs on sex and other characteristics may influence the extent to which children perceive mentors as valid models for assisting them with social skills.”
This study demonstrates the potential for the Rochester Resilience Project model to reach large numbers of low-income minority children who have limited access to mental health services, the researchers concluded.
“We are continuing to evaluate the Rochester Resilience Project, including studying how enduring its effects are and experiences that help children to maintain the benefits,” Wyman said. “My colleagues and I applaud the Rochester City School District administration and school staff who worked closely with us to try out this program and carefully test its impact.”
The National Institutes of Health and the Substance Abuse and Mental Health Services Administration funded the research.
In addition to Wyman and Cross, the authors of the article include: C. Hendricks Brown, Ph.D., professor of Epidemiology and Public Health at the University of Miami; Qin Yu, Ph.D., research associate at the University of Pennsylvania; Xin Tu, Ph.D., professor of Biostatistics and Psychiatry at the Medical Center; Shirley Eberly, M.S., research associate in the Department of Biostatistics and Computational Biology at the Medical Center.
Source:
Michael Wentzel
University of Rochester Medical Center Â
http://www.medicalnewstoday.com/articles/181500.php