Sunday, July 17, 2016

‘Adult-Onset ADHD’: Is It A Real Thing, Or Must It Have Started In Childhood?

June 10, 2016

Zoe Kessler, a Canadian writer and performer, was diagnosed with attention deficit hyperactivity disorder at age 46. At the time, she says, her life was "falling apart" and she was desperate to figure out why.
"I was struggling financially, I'd had any number of romantic relationships gonebad, I felt socially awkward, and, working as a freelance writer, I couldn't concentrate or focus," she said in an interview. "I was so scattered. I'd stand in the middle of a room in my apartment and literally not know what I was supposed to be doing."
Kessler sought help from "psychologists, social workers, psychiatrists, previous life regression therapists and rebirthers." None of them raised the possibility of ADHD, she said.
But when a friend suggested she might have the brain disorder that is most typically associated with "little boys bouncing off the walls," she went to see her doctor.
"Not long after, I left with a prescription for stimulant medication in my hand," she said. That diagnosis and treatment radically changed her life.
And only then did it dawn on Kessler, who wrote a book about her experience, that she'd likely suffered with the condition for decades, beginning in elementary school.

Controversial Findings
ADHD, the thinking goes, generally begins in childhood. In fact, to get diagnosed with ADHD as an adult, a patient needs to demonstrate they've had traits of the condition by age 12. But new research is fueling questions about the origins and trajectory of the brain disorder.
Several reports — two population studies from the U.K. and Brazil, and an earlier study from New Zealand — suggest not only that ADHD can begin in adulthood, but also that there may exist two distinct syndromes: adult-onset ADHD and childhood ADHD.
But as it is with many issues surrounding the disorder, it's controversial and complicated.
In one of the new papers, published last month in the journal JAMA Psychiatry, researchers from King's College, London, assessed a cohort of more than of 2,000 twins born in England and Wales in the mid 1990s. They found that among those over 18 with ADHD, more than two-thirds were not diagnosed during childhood assessments.  Based on that, the researchers said, two different groups emerged: "a large, late-onset ADHD group with no childhood diagnosis, and a smaller group with persistent ADHD" from childhood into late adolescence or adulthood.
They conclude that "adult ADHD is more complex than a straightforward continuation of the childhood disorder," and suggest the possibility that "childhood-onset and late-onset adult ADHD may reflect different causes."
One of the study authors, Dr. Jessica Agnew-Blais from King’s College, offers several theories on what might be driving this "late-onset" ADHD. In a statement, she said:
• The disorder could have been masked in childhood due to protective factors, such as a supportive family environment;
• It could be entirely explained by other mental health problems;
• Late-onset ADHD could be a distinct disorder altogether.

A second report  similarly concludes that adult ADHD may not necessarily be a continuation of childhood ADHD. Rather, researchers say, their results "suggest the existence of 2 syndromes that have distinct developmental trajectories."
"The key message here is that … ADHD [does] not always begin in childhood," said Luis Augusto Rohde, a professor in the department of psychiatry at the Federal University of Rio Grande do Sul in Brazil, and one of the study authors, in an email.
Why does this matter?
Rohde said that for patients, it can be a crucial distinction.  "The majority of clinicians worldwide are trained to only diagnose ADHD in adults when a clear history of ADHD symptoms would be detected during childhood," he said. "According to the data from the two studies, a substantial proportion of adults in the population with clear ADHD symptoms and impairments during adulthood are not receiving diagnosis and treatment."
The researchers say more study is needed to determine the nuances of the disorder. But the findings also raise provocative questions, for instance, are there treatments that might work better for adult patients, and how should clinicians evaluate adults who report no childhood history?

Premature Conclusions?

An editorial in JAMA Psychiatry accompanying the papers cautions about potential flaws in the studies, among them, underestimating the persistence of ADHD into adulthood and overestimating the prevalence of adult-onset ADHD.  In general, the editorial authors suggest, the conclusions of the new research "seem premature."
ADHD, with its telltale traits, including inattentiveness, a need for constant movement and rash, impulsive, sometimes scattered behavior, used to be considered an illness solely of childhood. And while an understanding of ADHD has evolved to include adult sufferers, there remains controversy around the diagnosis.  Some have suggested that the broader definition of ADHD was fueled, at least in part,  to broaden the market for medication manufacturers; and as the criteria for the condition loosened, reports emerged about clinicians involved in diagnosing ADHD also receiving money from drug makers.
These days, much attention has focused on the very young children who are now being diagnosed with ADHD — 4-year-olds and younger — and treated with powerful medications. Earlier this year, for instance, there was public outcry when a new chewable, fruit-flavored ADHD medication hit the market.
And, of course, numerous reports have documented how the medication,  aka "the good grade pill" can be abused by students and others seeking to improve test scores, focus and academic performance.

Pinpointing The Onset of ADHD

Despite all that, the conventional wisdom remains that adults with ADHD also had it as children.  (If you’re wondering if you might have ADHD, the full criteria for diagnosis is on the CDC website.)
Ron Kessler -- a psychiatric epidemiologist and professor of health care policy at Harvard Medical School, and no relation to Zoe Kessler -- says much of the recent literature on adult ADHD  "is just trying to figure out the nature of the beast" since it's a relatively new diagnosis.
"Nobody stands on their desks and jumps up and down as an adult like a fourth grader might," Kessler said, so it's clear the condition can look very different at different ages. Still, says Kessler: "I'd be very cautious jumping to a conclusion that says there are adults who have it who didn't have it as kids."
Based on his own research, which includes a broader view of adult ADHD that involves so-called "executive function" problems, Kessler said "it seems unlikely that out of the clear blue sky, there are all these adults who didn't have symptoms when they were young."
The lead author of the ADHD editorial, Stephen V. Faraone, with the department of psychiatry and behavioral sciences at the State University of New York Upstate Medical University, said in an interview that he's not convinced adult-onset ADHD is a distinct condition but rather that signs of the disorder were there much earlier, but missed.
"My interpretation," he said, is that the researchers involved in the recent studies, "found a group of people with sub-threshold ADHD [patients who have some characteristics of ADHD but don't meet the official criteria for a diagnosis] in their youth. There may have been signs that things weren't going too well, but they weren't bad enough to go to a doctor."
Perhaps these were smart kids with particularly supportive parents or teachers who provided the "scaffolding" needed to help the children cope with their attention problems, he says, but then, "later in life something happen[ed] to trigger full blown ADHD."

'I Don't Care What We Call It'
More than a decade after her diagnosis, Kessler now uses her own ADHD as material for stand-up comedy (An example: "They say people with ADHD think outside the box. That's ridiculous. I lost the box...years ago.")
For Kessler, the question of whether there's really a separate condition known as adult-onset ADHD is more an intellectual pursuit, rather than a pragmatic one.
"Is there adult-onset ADHD? Who knows," she said. "The bottom line is I don't care what we call it — I care that we get help and support and strategies for everyone who suffered from the things I suffered from."

Wednesday, July 6, 2016

Deep TMS Promising for OCD, ADHD, Other Mental Illnesses

Pauline Anderson

May 17, 2016

ATLANTA ― Deep transcranial magnetic stimulation (dTMS), already approved for treatment-resistant depression, is proving beneficial for obsessive compulsive disorder (OCD), adult attention- deficit/hyperactivity disorder (ADHD), and other psychiatric conditions, according to new research.
The success of the technology depends on targeting the most appropriate brain regions, the research suggests.
Results from some of these new studies were presented here at American Psychiatric Association (APA) 2016 Annual Meeting.

Immediate Treatment
A number of psychiatric disorders are associated with abnormal neuronal activity patterns in deep brain regions. Such abnormal activity is the target of TMS.
The noninvasive technology involves applying brief magnetic pulses to the brain. The pulses are administered by passing high currents through an electromagnetic coil placed adjacent to the patient's scalp. The pulses induce an electric field in the underlying brain tissue.
Conventional TMS was approved in 2008 for the treatment of major depressive disorder, which affects an estimated 15 million Americans a year. But this approach misses the target about 30% of the time, according to Aron Tendler, MD, chief medical officer, Brainsway Ltd.
By contrast, the company's Deep TMS System has a "wider, broader, and significantly deeper field," said Dr Tendler.
The Brainsway device, which is encased in a helmet that holds a large magnet, was approved for use in depression in 2013. The company is now investigating different coils and stimulation targets to treat other conditions, including OCD, ADHD, and smoking cessation.
In one study, deep TMS was used in 12 patients who had failed not only drug therapy but also at least one course of electric convulsive therapy, which is considered "the most aggressive treatment for depression," said Dr Tendler.
Ten of these patients underwent an adequate dTMS treatment trial. When the daily pulse intensity, but not the number of sessions, was increased, depression improved.
"We got them to remit," said Dr Tendler. "Seven out of those 10 patients had remission from their depression."
An advantage of this deep TMS approach, he said, is that a physician can treat a suicidal or depressed patient who comes into the office right away; there is no need for laboratory work or x- rays.

In addition, he said, the treatment takes only 20 minutes per session. "The patient sits down, you put a helmet on their head, and you do the stimulation."
A typical round of treatment consists of 22 to 44 sessions 5 days a week. The treatment, he said, is covered by most insurance plans, typically under certain conditions ― for example, in patients in whom medications have failed medications.
OCD, ADHD, Schizophrenia
The device also appears promising for OCD. It is believed that this condition involves dysfunctional cortico-striato-thalamo-cortical circuits. 

Whereas conventional TMS coils cannot directly target these circuits, dTMS apparently can.
To test this, researchers first provoked 40 patients to "obsess" and then treated them with dTMS (high [20-Hz] or low [1-Hz)] frequency) or a sham coil 5 days a week for 5 weeks in a double- blind, controlled setting. They targeted the current to the medial prefrontal cortex and the anterior cingulate cortex beneath.

For the group that received high-frequency active treatment, scores on the Yale-Brown Obsessive Compulsive Scale improved significantly in comparison with the groups that received low-frequency treatment and placebo (P = .0243)
A multicenter, randomized controlled trial is now underway and has enrolled about 60 of the target 96 patients with OCD, said Dr Tendler. The study will again compare active stimulation to sham treatment. Results are expected later this year.
Dr Tendler also presented promising results of another randomized, sham-controlled study of the device ― this time in 42 adult patients with ADHD. Here, the target of the stimulation was the right prefrontal cortex.

Although stimulants are an effective treatment for ADHD, some patients cannot tolerate them, said Dr Tendler. "Taking stimulants for a long time is not necessarily the best thing for everybody," he said.
Another area of research is schizophrenia. The investigators conducted a study of the use of stimulation of the prefrontal cortex in four patients with schizoaffective disorder and one with schizophrenia, all of whom had comorbid depression. In all five patients, depression improved ― two patients responded, and three patients went into remission.
"This is probably the only treatment that we know of that works for the negative symptoms of schizophrenia," said Dr Tendler.

He believes that when it comes to dTMS, location of the stimulation is the key to success. Sometimes it takes trial and error or attempts at several different target sites to achieve success.
Yet another study showed that the medial prefrontal, medial orbitofrontal, and anterior cingulate cortices could be alternative targets of stimulation for the treatment of severe depression. Combining treatment targets in patients whose conditions fail to respond might improve the remission rate, said Dr Tendler.
The Brainsway device costs about $200,000 but can be leased for $72,000 per year. The cost includes maintenance.

It is not difficult to learn to use the technology, although there is still a risk, albeit slim, of seizures, said Dr Tendler.
"Exciting, Positive"
Commenting on the findings for Medscape Medical News, David Feifel, MD, PhD, professor, Departments of Psychiatry and Neurosciences, University of California, San Diego, and founding director, UCSD Center for Advanced Treatment of Mood and Anxiety Disorders, estimates that in the past 2 years, he has used the Brainsway device on more than 100 patients with treatment-resistant major depressive disorder.

Although deep TMS is currently approved only for major depression, the preliminary results of studies of the device in OCD, PTSD, nicotine addiction, and for the negative symptoms of schizophrenia are "exciting" and "positive," said Dr Feifel.
Dr Tendler is an employee of Brainsway. Dr Feifel is participating in Brainsway multisite studies in OCD, PTSD, and smoking cessation, for which he receives research funding.
American Psychiatric Association (APA) 2016 Annual Meeting: Abstract 131, presented May 16, 2015.

Wednesday, June 29, 2016

The Rules of the Game for Children with ADHD

2 Jun 2016

Children with Attention Deficit Hyperactivity Disorder (ADHD) often display behaviours that are inappropriate for the situation in which they are in. They might move around in the classroom during a lesson, or talk non-stop and interrupt others’ conversations. ADHD is a neuro-developmental disorder that affects about 5% of children. Despite a considerable amount of research over many years, the causes of ADHD are still debated. A team of researchers from Japan and New Zealand has published a paper in the Journal of Child Psychology and Psychiatry that may help to explain the difficulties children with ADHD experience in adapting their behaviour to given situations.
“All of us tend to repeat those actions that get rewarded,” said Prof Gail Tripp, one of the authors of the paper and director of the Human Developmental Neurobiology Unit at the Okinawa Institute of Science and Technology Graduate University (OIST). “That’s how we learn: we do the things that have a positive outcome for us.” Even if the rules to get rewarded are rarely stated, the majority of us seamlessly move between different settings, adapting our behaviour to maximize the chances to get – socially – rewarded. For example, we behave differently during a lunch break than in a lab meeting even if we are dealing with the same group of people.
However, children with ADHD struggle to match their behaviour with the surrounding context. The scientists studied this issue exploring how children with ADHD behave when they play a game that has rules that change slightly, without explanation. The researchers tested 167 English-speaking children, aged between 8 and 13, in Japan and New Zealand. More than half of these children were diagnosed with ADHD. All the children played a simple game in which they had to decide if there were more blue or red faces on the screen in front of them. The screen showed a ten by ten grid full of mixed blue and red faces, and the children had just to hit a blue or red button according to the predominant colour they saw on the screen.
The game had some specific rules. The researchers explained to the children that they were going to be rewarded, with verbal praise and a plastic token, when giving the right answer, but only sometimes and not each time they gave the correct answer. During the game, the children were first rewarded four times more often for correct ‘blue’ answers. Then, after 20 rewards, the game started to reward the children more often for correct ‘red’ answers. Finally, after another 20 rewards, the game switched back to reward more frequently ‘blue’ answers. The rewarding system was not explained to the children.
The experiment showed that, initially, the children developed a bias for blue: when in doubt, the children started to give the answer that was rewarded more often during the first part of the game. However, when the rewarding system switched to red, differences began to emerge among the children. Typically developing children started showing a clear bias for red, while children with ADHD shifted only slightly their answers towards red.
Furthermore, when the rewarding system reverted back to blue, the gap in behaviour widened. Typically developing children went back to favour blue, while children with ADHD almost did not change their answers’ pattern. Hence, as the rewarding system swapped between blue and red, the children had to intuitively adapt to maximize their chances to get a reward. The data suggests that children with ADHD were not as good as typically developing children at responding to such un-signalled changes.
“I am really excited about this research, because I think it has important implications for how we manage the behaviour of children with ADHD,” Prof Tripp commented. “What we argue is that, for these children, we need to make explicit what the requirements are in any given situations. So, we are not relying on them to identify what the conditions are, but we are actually explicitly telling them: this is what you will be rewarded for. And we also need to tell them when we are no longer going to reward them for that.”
Children with ADHD are not naughty children. They may appear to misbehave and they may appear not to follow the rules, but this research suggests that this happens because they are not picking up on subtle rules changes. “Explaining the requirements in any given situation, and rewarding them accordingly, is not spoiling them,” Prof Tripp concluded. “It is a good parenting strategy. It is about trying to give them the same life opportunities.”

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Friday, June 24, 2016

People with ADHD don't receive enough support, Finnish research suggests

Date:May 19, 2016
Source:University of Helsinki

The aim of a new study was to collect and describe the experiences of Finnish families in which the symptoms of ADHD such as attention deficit, hyperactivity and impulsiveness are strongly present. Over 200 families participated in the study sharing their experiences of the support provided by educational, social and health sectors as well as the co-operation between these different bodies.

The aim of the study provided by the Master of Arts (Education), Erja Sandberg, was to collect and describe the experiences of Finnish families in which the symptoms of ADHD such as attention deficit, hyperactivity and impulsiveness are strongly present. Over 200 families participated in the study sharing their experiences of the support provided by educational, social and health sectors as well as the co-operation between these different bodies.
Sandberg worries about the unequal opportunities families have in getting support from educational, social and health sectors. People who have symptoms of ADHD may have to wait for a long time before they get support.
"Families don't have equal chances of getting the needed services on the state level even though the services are statutory. It is a coincidence if a family meets a professional who identifies the symptoms of ADHD and the need for multidisciplinary supportive services," Sandberg says.
Since ADHD is a familial disorder, it is important to define the need of support for the whole family. According to Sandberg, this is not happening. Adults who have symptoms of ADHD have waited for the support even over decades. Three out of five families describe that the co-operation between professionals does not meet the statutory level.
The educational capital was seen as a protective factor when the supportive services were provided within the family. Highly educated families were able to seek the needed services better and therefore had a greater chance to better function in Finnish society. These families also criticized the one-sidedness of the supportive services.

For example a family counselling center that works under the social services often offers guidance in the child's upbringing instead of sending the child to medical research." According to Sandberg, offering the wrong kind of support can be very expensive and useless for the society and it definitely does not help the family.
ADHD symptoms lower performance
As medicine has become more refined, it is nowadays possible to categorize more behavioral and cerebral disorders. These can be seen as invisible disabilities and they are even more common than traditional physical disabilities. Finnish legislation takes notice only of visible, physical malfunctioning that causes disability.
"Neuropsychiatric syndrome, ADHD, causes different functional impairments which are not identified by professionals when planning the support. Due to these functional impairments, young people may have difficulties in graduating if allocated supportive measures are not provided by multidisciplinary groups."
Families in need of support can be socially excluded
The difficult situations of the families were demonstrated in the research material in that every third family participating in this study included a socially excluded person or someone at risk of social exclusion. Socially excluded people report about low self-esteem and the sense of being less valuable and even incompetent to function in the surrounding society. The participants stated that social exclusion is a vicious circle from which escape is difficult when no support is available.
Families wished also for the professionals especially in educational and social services to see them through their strengths instead of their weaknesses. Attention deficit and hyperactivity disorder often includes behavioral problems that draw attention and are often noticed. This negative feedback may cause negative outcomes and even psychological malfunctioning. Stigmatization causes underachievement and lowers self-esteem
Current reseach
Sandberg executed the study with the assistance of netnography and the research data was collected from a social network group -- a nationwide ADHD peer support group. Over 200 Finnish families participated in the study for three years. The material is complemented with interviews. Sandberg's study provides information about multidisciplinary supportive measures and the experienced effects within the family as well as for the person with ADHD through his/her life course, even during decades.
ADHD is seen as one of the most common neuropsychiatric disorders; worldwide approximately 5% of people suffer from ADHD. It is very common that similar genetic problems run in the family. Therefore, supportive measures should be addressed to the whole family.
Master of Arts (Education) Erja Sandberg defends her doctoral thesis at the University of Helsinki in the Faculty of Behavioural Sciences on the 28th of May. The thesis belongs to the area of special education and is called ADHD in the family -- The support provided by the educational, social and health sectors, and their experienced impact.
Story Source:
The above post is reprinted from materials provided by University of Helsinki. Note: Materials may be edited for content and length.

Monday, June 20, 2016

How to Raise Concerns about a Child’s Speech and Language Development: Do’s and Don’ts

Grandparents, friends, or neighbors who are worried about a child's speech and/or language development may hesitate to bring it up for fear of upsetting or offending a parent. While raising any concern to parents about their child is difficult, it is in a child's best interest to have any speech and/or language issues identified and treated as early as possible. 
Below are some do's and don'ts for talking respectfully and productively about a potential communication delay.
  • DO learn developmental milestones. Before sounding the alarm, refer to a list of speech and language milestones by age. Also look at the early signs of speech and language disorders. There may be no reason to worry. Share the milestones and your concerns with parents, especially if a child is not doing what is expected. 
  • DO know that not all children are the same. At 12 months, one child may be saying one word while another may be speaking 10 or more. This variability is typical—not every child has the same communication skills at the same age. The developmental milestones account for an expected range in skills. 
    • If a child is learning more than one language, be sure to count words in both languages. His or her development may be different than children who are only learning one language. Also, note that learning more than one language does not cause or worsen speech or language delays. 
  • DO be sensitive when raising the issue. Try saying, "I saw a story on the news about children's speech and language development…," or phrasing your concern as a question, e.g., "What do you think of Tommy's speech? Has he been using new words?"
  • DO share your family history of speech and language disorders, if known. Some disorders have a strong genetic component (a good example is stuttering), so this is important information to share.
  • DO tell parents to ask for professional assistance. Encourage parents to set up an appointment with their child's doctor to discuss concerns. If concerns are confirmed, the doctor will make a referral for a speech and language evaluation.  If the doctor is not concerned but the parents still are, the parents should trust their instincts and get a second opinion or have their child evaluated by a speech-language pathologist. A certified speech-language pathologist may determine there is no need to worry, and then the result is peace of mind. However, if there is a speech and/or language delay, it can be treated in a timely manner. 
  • DO provide resources to find help, if the child's doctor has not made any referrals for a speech and language evaluation.
    • If the child is less than 3 years old: Parents can access their state's  early intervention program. for a free evaluation. See What is Early Intervention?.  
    • If the child is 3 years or older: Parents can contact a local elementary school and ask to speak with someone who can help and have their child evaluated — even if their child does not go to that school. This is a free service provided by local school districts. 
    • For the assistance of a private speech-language pathologist: Search the ASHA ProFind database. 
  • DO be sensitive to the family's values and norms. Individuals handle concerns about developmental delays differently based on their background, family values, and norms. There may be different approaches to how children are being raised. Be mindful and respectful of those differences as you consider talking with people outside of your family (e.g., neighbor, friend).
  • DON'T compare siblings to each other. An older child may have been advanced for his or her age, resulting in concern when the second child is developing in a typical way. Again, look more broadly to expected developmental language milestones.
  • DON'T place blame. Parents don't cause speech and language disorders. It is inaccurate and hurtful to tell a parent he or she should have done something differently.
  • DON'T give labels. Do not try to diagnose the child. Instead, describe what you see. Leave a diagnosis to a speech-language pathologist, who is specially educated for identifying communication disorders. Share what the child does well also (e.g., "I know Sarah uses a few single words, and I was curious when she should starting putting multiple words together.") 
  •  DON'T assume treatment is too expensive. Services may be free through the state's early intervention program or school system, offered on a sliding scale, or may be covered in part or full by insurance. There are options for families.
  • DON'T "wait and see" if the child outgrows the problem. This is probably the most important point. Speech and language delays are highly treatable. The best outcomes occur when a child is seen by a professional early. Ideally, children will be treated long before entering kindergarten—and even before age 3, when children are in their most rapid period of development. Acting early can improve academic and social success, so speak up early.
Still Have Questions?
Contact the American Speech Hearing Association (ASHA) Consumer Action Center at 800-638-8255 or contact the ASHA National Office.
Additional Information:
Last Updated 4/26/2016
Source Copyright © 2016 American Academy of Pediatrics and American Speech-Language-Hearing Association

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Friday, June 17, 2016

Apple WWDC Opens With A Moment Of Silence For Orlando Victims

Apple CEO Tim Cook opened the company’s major software launch event WWDC Monday with a moment of silence for the 49 victims killed in a mass shooting at a gay nightclub in Orlando.
With a tearful reaction, Cook called Sunday’s shooting a “senseless and unconscionable act of terror and hate.”
“The Apple community is made up of people from all around the world,” he added. “We celebrate our diversity. We know that it makes us stronger, and moves everyone forward.”
Cook, who is one of the only openly gay CEOs of a Fortune 500 company, has been noted for his activism regarding issues of diversity, marriage equality, and government surveillance .
The outspoken CEO has most recently took on the FBI after the agency filed a court order to compel Apple to bypass the security features of an iPhone that belonged to one of the San Bernardino shooters.

In an interview with Time magazine, Cook said, “We felt like it trampled on civil liberties, not only for our customers but in the broader sense. It felt like different points in history, almost, in the U.S., where the government overreached for whatever reason. And we were dead set in the path of it. So we knew it was wrong. It was wrong on so many levels.

Apple CEO Tim Cook Honors Orlando Shooting Victims
pple CEO Tim Cook began the Worldwide Developers Conference with a moment of silence to honor the victims of the Orlando nightclub shooting. Cook called the event a "senseless, unconscionable act of terrorism and hate." He appeared visibly emotional and his voice was choked throughout his speech. Cook said, At Apple, we celebrate our diversity. We know that it makes us stronger and moves everyone

Thursday, June 16, 2016


STONY BROOK, N.Y., May 9, 2016 – A study using functional-MRI brain scanning reveals certain areas of the brain have higher activity in children who are socially withdrawn or reticent compared to children who are not withdrawn. Led by Stony Brook University psychologist Johanna M. Jarcho, PhD, the study involved fMRI of the children while they experienced a “cartoon classroom” that featured themselves as the new student in the school involved in various social interactions. The findings, published online first in Psychological Science , provide a better understanding of the brain activity of socially withdrawn children and could help form a foundation to teach children how to think differently about social interactions and thus prevent further socially withdrawn behavior or social anxiety.

In a brain scanning study of children with high social reticence, high activity is displayed in the left and right insula, brain regions implicated in processing salience and distress.
Social reticence is expressed as shy, anxiously avoidant behavior in early childhood. Some mental health professionals believe that social reticence in childhood and pre-teen years is a precursor to more socially withdrawn behavior and social anxiety that develops through the teen years and adulthood.
In the paper titled “Early-Childhood Social Reticence Predicts Brain Function in Preadolescent Youths During Distinct Forms of Peer Evaluation,” Dr. Jarcho, an Assistant Professor in the Department of Psychology at Stony Brook University and colleagues evaluated 53 children by way of fMRI. The children were part of a study beginning at 2 years of age with follow-ups at multiple ages to age 11. Thirty of the children were evaluated as those functioning with high social reticence; 23 were considered to have low social reticence.
The research team created a novel interactive paradigm around a virtual classroom in a cartoon form. Each of the 11-year-old children created an avatar character of himself or herself and completed an online personality profile. The experimenters created other characters for the child to interact with, such as the “unpredictable kid,” “bully,” or “nice student.” While undergoing fMRI, social interactions inside the classroom were played out, with each child reacting to these social interactions with their avatar character.
“Few techniques have been able to test the effects of such nuanced social landscape on brain function during real-time, ongoing, peer-based interactions where peers embody distinct social qualities,” said Dr. Jarcho. “This paradigm proved very effective in mapping brain activity of pre-teens who are socially reticent and appears to be a valuable tool for ongoing research.”
The scanning revealed that high (but not low) social reticence predicted greater activity in the dorsal anterior cingulate cortex and left and right insula, brain regions implicated in processing salience and distress. High social reticence was also associated with negative functional connectivity between insula and ventromedial prefrontal cortex, a region commonly implicated in affect regulation. Also, participants with high social reticence showed increased amygdala activity but only during feedback from the “unpredictable” peers in the cartoon classroom.
The findings provide scientists with a measure of brain functioning of pre-teens with high social reticence. A critical next step is to isolate neural circuits that promote risk for or resilience against expressions of psychopathology related to high social reticence.
Dr. Jarcho and colleagues are currently conducting interviews with the same group of 53 participants who are now approaching their teens. The idea is to determine if the pattern of brain function that differentiated pre-teens with high and low childhood social reticence also predicts expression of social anxiety symptoms.
Co-authors on the paper include scientists from Stony Brook University, the University of Maryland, the National Institute of Mental Health, University of Illinois, University of Haifa, University of Waterloo, Nationwide Children’s Hospital in Ohio, and Ohio State University.
The research is supported in part by the National Institute of Mental Health and the National Institute of Child Health and Human Development.