The causes of severe anti-social behaviour may differ between teenage boys and girls, a new study suggests.
This could pave the way for new sex-specific treatments or prevention programmes as the findings indicate there are differences between the sexes in the causes of anti-social behaviour.
Academics in the UK, Europe and Canada used MRI scanners to map the brains of 200 teenagers aged 14 to 18 years to analyse the differences between children with conduct disorder and those without.
Roughly half of those teenagers in the study had conduct disorder and the findings show the brain's prefrontal cortex – the region responsible for long-term planning, decision-making, and impulse control – is thinner in boys and girls with the condition compared to those without it.
The study found that boys and girls with severe forms of conduct disorder have a more abnormal brain structure. It also revealed specific areas of the brain differ in structure between boys and girls with conduct disorder. For example, some brain areas showed lower cortical thickness in boys with conduct disorder but higher thickness in girls with the condition.
For the first time, this highlights that there may be sex differences in the brain-based causes of conduct disorder.
The academics said conduct disorder was poorly understood and thought to be under-diagnosed and often untreated. Symptoms range from lying and truancy, through to physical violence and using weapons at its more extreme end.
They said it was thought at least 5% of school age children are affected by the disorder and it is three times more common in boys than girls. Previous studies have shown that around half of those who develop conduct disorder in childhood go on to show serious anti-social behaviour or criminality in adulthood.
Current treatments largely depend on parenting programmes, as the condition is often attributed to poor parenting or growing up in a dysfunctional family.
The researchers behind the new study were keen to point out that although sometimes useful, these programmes are not widely available and may not get to the root of the problem.
No specific drug treatment exists yet for conduct disorder although ADHD medication, such as Ritalin, is sometimes given.
Senior author Dr Graeme Fairchild, from the University of Bath, said: "Our results indicate that the development of the brain is disrupted in boys and girls with severe anti-social behaviour.
"These findings suggest that the causes of severe anti-social behaviour, and particularly the biological basis of these behaviours, may differ between boys and girls. This could lead to the development of sex-specific treatments or prevention programmes for at-risk young people."
Lead author Dr Areti Smaragdi, from the Centre for Addiction and Mental Health in Toronto, added: "We hope that our findings will prompt other researchers to consider possible sex differences in future studies of anti-social behaviour and other disorders that are more common in boys, such as ADHD.
"Our findings may also have practical implications for treatment or prevention programmes."
The study, Sex Differences In The Relationship Between Conduct Disorder And Cortical Structure In Adolescents, is published in the Journal of the American Academy of Child and Adolescent Psychiatry.
21 July 2017
New research tracks the effect of early neglect from childhood through adulthood
What are the consequences of deprivation on the developing child? How long-lasting are the effects of early neglect on a child’s emotional well-being and developing intellect later in life? The answer is: it depends, and one of the factors it depends on is timing. As shown by a recent study of young adults who had spent time as children in Romanian orphanages, severe neglect in early life can have different consequences depending on the time window of deprivation, and also depending on the person’s age when skills and well-being are later assessed. Research findings related to the developmental timing of neglect can have implications for child-welfare policies and can also help adoptive families better understand how effects of neglect may play out later in life.
One key finding of the study (published earlier this year in the medical journal Lancet) is that severe early-life deprivation lasting more than 6 months led to more serious consequences. Over a period spanning from early childhood through adulthood, the study followed 165 people adopted in infancy from severely depriving Romanian orphanages. All the children were adopted by British families in the 1990’s, after the fall of Romania’s dictator Nicolai Ceausescu brought to light the shocking conditions of Romanian orphanages. During their time in the orphanages, children were exposed to inadequate food, hygiene, and medical care, combined with a severe lack of nurturance and cognitive stimulation. Since the time of adoption, the children had been raised in British homes. Because the child’s age at the time of adoption varied – between 2 weeks and 43 months of age – researchers could examine how the duration of deprivation affected development. For purposes of comparison, children were placed into two groups: those who had spent less than 6 months in the Romanian orphanages, and those who has spent more than 6 months there.
Researchers compared both of these groups of Romanian-born children to a sample of children adopted domestically within the U.K., who had not experienced institutional care and were adopted before the age of 6 months. The comparison between Romanian-born and U.K.-born adoptees controls for the effects of some aspects of adoption, such as the experience of separation from birth parents (which all adoptees experience), while allowing a contrast between adoptees who experienced severe neglect in institutions versus those who did not.
The good news from the study is that those Romanian adoptees who spent less than 6 months institutionalized were generally indistinguishable from the U.K. adoptees across a range of measures of cognitive and emotional well-being. This implies that children have the resilience to rebound from severe deprivation when placed into stable and nurturing homes at a young age. However, children who endured more than 6 months of deprivation did not rebound quite so well. Across a range of measures, including autistic-like behavior, disinhibited social behavior, and hyperactivity, those who experienced longer durations of deprivation tended to show worse outcomes compared to the other groups. Although these results may not seem surprising – logically, it makes sense that longer deprivation would be more harmful – the results have direct implications for child welfare policy. In short, children are harmed when they are placed in institutions for longer than 6 months.
A more surprising finding of the study was that some negative consequences of neglect got better over the child’s life, whereas others got worse. Researchers assessed the participants at ages 6, 11, 15, and young adulthood (22-25 years old), and therefore could track the trajectory of developmental change over many years following adoption. One bright spot in the findings was that for the measures of cognitive ability (IQ), significant improvement over developmental time emerged. Romanian children deprived for more than 6 months showed cognitive impairments compared to the other two groups during childhood and adolescence, but not in adulthood. In other words, eventual catch-up in cognitive skills was evident even for the most severely-deprived group.
On the other hand, emotional well-being showed a pattern of worsening over developmental time among the severely-deprived group. Emotional problems were similarly low for all groups in childhood, but the severely-deprived group showed a significant increase in emotional problems in adulthood. That is, in young adulthood (but not at earlier ages), the group who had been severely deprived for more than 6 months as infants had higher rates of emotional problems, both as reported by themselves and as reported by their parents, compared to the other groups. For example, 43 percent of those in the most-deprived group reported using mental health services between the ages of 15 and 23, compared to 23 percent in the less-deprived Romanian group and 10 percent in the group of U.K. domestic adoptees. These findings demonstrate that some negative consequences of early neglect do not become fully evident until later during development. The transition from adolescence to young adulthood may raise new psychological challenges that are more difficult for those with a history of severe deprivation.
In sum, the results of this study offer reasons for both optimism and pessimism. Placement into nurturing homes led to developmental catch-up in cognitive abilities, even among those who experienced longer durations of institutionalization before placement. At the same time, the children who were institutionalized for a longer time during infancy tended to show greater emotional problems in young adulthood, compared to adoptees who were institutionalized for shorter periods or who did not experience institutionalization at all. Thus, while time (and nurturance) may heal wounds, it does not heal all of them completely.
Of course, these results should not be taken as deterministic for any individual child who experienced early neglect. The study focused on children exposed to some of the harshest orphanage conditions yet reported, and may not generalize to less severe experiences of neglect. Furthermore, the researchers reported that even among those children who lived in Romanian institutions for more than 6 months, a significant minority (about 20 percent) reported no problems at any of the time-points measured, raising interesting questions about the causes of individual differences in resilience. Yet, from a public policy standpoint, the implication is clear: children’s interests are best served by placement in stable family homes, rather than harmful institutional care, as early in life as possible.
Sonuga-Barke, E. J., Kennedy, M., Kumsta, R., Knights, N., Golm, D., Rutter, M., ... & Kreppner, J. (2017). Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study. The Lancet, 389(10078), 1539-1548.
By Rebecca Compton
18 July 2017
Potent antipsychotics given to children as young as two can lead to significant weight gain, according to new Canadian research into a class of drugs that one prominent American psychiatrist says are being used as tools of “social control.”
The number of children being started on second-generation antipsychotics, or SGAs, has grown exponentially, with prescriptions increasing 18-fold in B.C. alone between 1996 and 2011. Across Canada, between 2005 and 2009, antipsychotic drug recommendations for children and youth increased 114 per cent.
The new study was based on 147 children aged 10 to 16 treated at Hôtel-Dieu de Lévis hospital in Quebec between 2005 and 2013. The youth were part of a program created to track the metabolic effects of SGAs on children being treated with the mood-altering drugs for the first time.
Once reserved for schizophrenia in adults, the drugs are being prescribed “off-label” – used in an unapproved way or for an unapproved age range or dosage – to adolescent boys, as well as girls and younger children, for attention deficit hyperactivity disorder (ADHD), aggression and behaviour problems.
Half a dozen second-generation antipsychotics are marketed in Canada, including clozapine, risperidone and quetiapine. None have been authorized for use in children under 18, with the exception of aripiprazole (sold under the brand name Abilify), which is approved for treating schizophrenia in 15-to-17-year-olds.
University of Montreal researchers collected height, weight and blood samples, looking at the side effects when one drug alone was used, or switched or combined with other antipsychotics.
Overall, after 24 months of antipsychotic treatment, the children’s mean weight increased by 12.8 kg, or 28 pounds. Twenty-three per cent of the youth in the study became overweight or obese, nearly 10 per cent developed impaired fasting glucose – a type of pre-diabetes – and one developed full-blown diabetes.
The most frequent diagnosis that led to the prescription of the antipsychotics was “disruptive behaviour disorder” in children with ADHD, surpassing actual psychotic or mood disorders – that despite national guidelines recommending against the use of antipsychotics for behaviour problems.
The increase in weight and BMI, seen regardless of the type of SGA treatment used, “remains of great concern given that childhood obesity can adversely affect nearly every organ system,” the researchers warn in the study, published by the Canadian Journal of Psychiatry. Serious complications include high blood pressure, fatty liver disease and an increased risk of heart disease and stroke “from childhood onwards.”
“Families tell me their kid went from drinking several litres of water to wanting to drink several litres of pop,” said Dr. Dina Panagiotopoulos, a pediatric endocrinologist at B.C. Children’s Hospital. One theory is the drugs affect brain chemicals that control hunger and satiety.
However, in a separate, yet-to-be published study, Panagiotopoulos’s team found children’s actual caloric intake doesn’t increase sufficiently to justify all the weight gain, and there is some suspicion the drugs affect a child’s resting energy expenditure – they burn fewer calories.
Panagiotopoulos has seen weight gains of as much as 50 lbs. (23 kg) in teenagers. Her own research shows antipsychotics are being prescribed to preschoolers as young as two.
“Some kids need these medications to function and to go to school and do well. I don’t want people to stop their children’s medication if they need it,” she stressed. “But there are things parents can do to live healthy lives and prevent some of these side effects, they just need to ask.”
She said children should be monitored every three months for the first year of treatment, and once a year, minimally, thereafter. “Often these kids will stay on these medications for years, and not be reviewed. We’ve had kids on them for over seven years.”
Dr. Allen Frances, professor emeritus at Duke University, said weight gains of “this enormous magnitude” can set children up for future diabetes and cardiovascular disease. “This is a terrifying study.”
Frances said antipsychotics are being “wildly and recklessly overused, very often by primary care doctors with little expertise, or time, under the influence of drug company aggressive marketing.”
He said the drugs are often prescribed to poor children and children in foster care. “It’s a form of social control. It’s medicalizing problems that are social problems.”
There may be rare instances where the behaviour problem is so extreme and resistant to any other form of treatment “that medication may be worth it, despite all the risks,” Frances added. “But this should be a very last resort, not a first reflex.”
By Sharon Kirkey
16 July 2017
At Graham Windham, a New York City-based child welfare agency, we have been developing a learning culture over time, an investment in improving our outcomes for children and families, while ensuring that we are able to adapt and innovate in the dynamic, evolving field of child welfare. One of Graham’s core pillars is that we grow: We are committed to continuous self-reflection and best practices, with opportunities to develop, practice and master skills with supports along the way.
Here’s what we’ve learned about what it takes to keep growing, as an organization and as individuals.
• A learning culture starts at the leadership level. Our commitment to learning begins at the board level, with board members who are focused on developing a rigorous performance culture in which strategy is driven by data. Several years ago, a careful examination of our results led us to establish a five-year vision with targeted outcomes for children and families. We then identified strategies for reaching these targets through literature reviews, surveys of other programs and internal roundtables with direct practice staff, youth and families. Adoption of these strategies set the priorities for the professional development of our staff, including training and coaching in specific evidence-supported models working with children and families (such as solution-based casework and motivational interviewing).
• Build in dedicated time and supports for learning. In order to ensure that staff are developing expertise in the approaches they needed to learn to be effective, we developed a training plan that includes two weeks of preservice training for new hires (including training in specific models as well as areas such as safety and risk, trauma stewardship and documentation); a three-month, six-month or one-year plan for continued learning (based on the position); and ongoing coaching and consultation in applying models to day-to-day work with children and families. We have found that supervision plays a critical role in staff members’ successful implementation of what they have learned. We must ensure that directors and supervisors have a solid understanding of the models staff are using, and that supervision sessions include time for teaching (e.g., role playing to demonstrate skills, going through hypothetical situations, etc.). We also carry out case unpackings and case practice reviews, in which staff can present cases to their supervisors and peers for input and support in working through the case. For example, in one case practice review, our Program Performance and Planning team identified that a case planner was focused on a specific issue that was impacting the family but not making progress. The team carried out a role play, which enabled the case planner to see how they might use motivational interviewing to identify the family’s motivation to make needed changes. Directors can also present leadership challenges to their peers at director meetings for feedback.
• Create feedback loops to drive continual improvement. As an organization, we continually track, analyze, review and discuss data at all levels to improve outcomes. That ranges from semiannual discussions on data with our board’s Program Performance Committee to daily monitoring and monthly performance reviews in specific programs, led by program leadership and staff with support from our Program Performance and Planning team. Case record reviews indicate areas in which individuals and teams need additional reinforcement in using specific models, so that we can provide targeted training and coaching in these areas. We have regular roundtable discussions for young people, parents, foster parents and direct practice staff to provide feedback, which then informs policy and practice. In listening to our data and teams, difficult issues surface that require us to take a hard look at our practices and where we have made mistakes. For example, we had to look at where we fell short in ensuring the stability of children in foster care. Addressing this issue required the intensive efforts of staff across all levels and programs to identify and focus on what was going wrong, put in place a plan and revise practices to prevent children from moving unnecessarily between foster homes.
To promote individual growth, supervisors work with staff to establish goals for the year as well as individual development plans, in which they outline skills they would like to develop or roles they would like to take on, as we are intentional in providing opportunities and support for internal advancement. The development plan may include stretch assignments for learning and demonstrating new skills needed in a desired role. Supervisors check in with staff on progress through regular supervision sessions as well as formal midyear and year-end evaluations, providing feedback and opportunities for improvement. In addition, staff can provide feedback to their supervisors to help them improve in how they support staff. For example, on one team in which staff are frequently at different sites, team members provided feedback that they needed more time for group discussions. The supervisor carried out the suggestion, which helped promote their learning and further their work.
Building a learning culture requires us to be intentional and proactive in how we allocate our time and resources, but we see the impact of it, with staff members better equipped to face the challenges of our work, more staff being promoted internally, and, most importantly, improved outcomes for the children and families we serve — the most powerful incentive to continue to grow.
By Nina Choudhary, Latavia Lee and Jill Lefkowitz
14 July 2017
Exposing children to social and emotional learning programmes at school may not only immediately improve their mental health, social skills, and learning outcomes but even lead to long-term positive outcomes, according to new research.
Social-emotional learning teaches children to recognise and understand their emotions, feel empathy, make decisions and build and maintain relationships.
"Social-emotional learning programmes teach the skills that children need to succeed and thrive in life," said Eva Oberle, Assistant Professor at the University of British Columbia (UBC) in Canada.
The researchers found that students who participated in such programmes graduated from college at a rate 11 percent higher than peers who did not. Their high school graduation rate was six percent higher.
Further, for participants drug use and behaviour problems were six percent lower, arrest rates were 19 percent lower, and diagnoses of mental health disorders were 13.5 percent lower.
All the children benefited from these programmes regardless of race, socio-economic background or school location, the researchers said.
"Teaching social-emotional learning in schools is a way to support individual children in their pathways to success, and it's also a way to promote better public health outcomes later in life," Oberle said.
For the study, published in the journal Child Development, the team analysed results from 82 different programmes involving more than 97,000 students from kindergarten to middle school in the US, Europe and the UK where the effects were assessed at least six months after the programs completed.
Schools are an ideal place to implement these interventions because they will reach almost all children, including those who are disadvantaged, the researchers noted.
"However, these skills need to be reinforced over time and we would like to see schools embed social-emotional learning systematically into the curriculum, rather than doing programmes as a 'one-off'," Oberle said.
13 July 2017
Literacy involves meaning-making with materials that humans use to communicate – be they visual, written, spoken, sung, and/or drawn. Definitions vary according to culture, personal values and theories.
We look to a broad definition of literacy as guided by UNESCO to be inclusive for all families. Children learn to be literate in a variety of ways in their homes, communities and places of formal education.
What research tells us
New research in three-to-five-year-old children’s homes and communities in Fiji, has revealed that children’s regular engagement in literacy across many different media has supported good literacy outcomes.
There were ten main ways of engaging in literacy-building activities. These included print and information, communication and entertainment technologies, arts and crafts, making marks on paper, screens and other surfaces like sand and concrete, reading and creating images, and talking, telling and acting out stories that were real or imagined.
Children also engaged with reading, recording and talking about the environment, reading signs in the environment, engaging in music, dance, song and, lastly, with texts and icons of religions and cultures.
These activities were enjoyed and valued by children and their families as part of their everyday lives, and were further bolstered by creating books with children in their home languages and English.
This research can be used to add to our discussions on how parents can help develop their children’s early literacy.
The Melbourne Institute of Applied Economic and Social Research found daily reading to young children improves schooling outcomes, regardless of family background and home environment.
The OECD Program for International Student Assessment (PISA) results also indicate a strong correlation between parents reading and storytelling with children in the early years and reading achievement at age 15, with those students performing one to two years above their peers.
However, it is not just being read to that matters. The adult-child interactions are also very important.
These interactions need to be lively and engage children with the text-in-hand. Alphabet toys and phonics programs alone offer little to develop literacy, as they focus on a code without contextual meaning. Words, and their letters and sounds, are best understood when seen and applied in everyday experiences, driven by children’s motivations.
How to be a talking, reading, writing, viewing, and listening family
There are several practical things parents can do to encourage broad literacy and learning in early childhood years.
1.Don’t wait. Read what you are reading aloud to your newborn. Children become attuned to the sound of your voice and the tones of the language you speak as their hearing develops.
2.Share stories at mealtime. Provide prompts like: “Tell us what your teddy did today”. Alternatively, randomly select from ideas for characters, problems, and settings, for example: “Tell us about an inquisitive mouse lost in a library”. Oral storytelling provides a bridge to written stories.
3.Record on your phone or write down your child’s stories. Turn them into a book, animation, or slide show (with an app). Children will see the transformation of their spoken words into written words. These stories can be revisited to reinforce learning of words, story structure and grammar.
4.Talk about their experiences. For example, prompt them to describe something they have done, seen, read or heard about. Research shows children’s oral language supports their literacy development, and vice-versa.
5.Guide literacy in your children’s play, following their lead. For example, help them follow instructions for making something, or use texts in pretend play, such as menus in play about a pizza place. Children will engage with various texts and the purposes they have in their lives.
6.Books, books, books. For babies and toddlers, start with durable board books of faces, animals and everyday things with few words that invite interactivity (e.g., “Where is baby?”). Progress to more complex picture books with rhyming language. Talk about personal links with the stories and ask questions (such as “I wonder what will happen next or where they went to”) as these will support comprehension. Look to the Children’s Book Council for awarded quality children’s literature.
7.Talk about words children notice. Be sure the words make sense to children. Talk about what words look like, what patterns, letters and sounds they make. This builds children’s word recognition and attack skills, and understanding of what words in context mean.
8.Involve your children in activities where you use literacy. For example, if you make shopping lists or send e-cards, your children could help create these with you. Explain what you are doing and invite children’s participation (e.g., “I’m looking at a map to see how to get to your friend’s house”). Children can meaningfully engage with and create texts and see the place these texts have in their lives.
9.Use community and state libraries. Most offer interactive family literacy programs. Early Years Counts and The Australian Literacy Educators Association has a range of resources for families.
Above all, be sure the experience is enjoyable, playful, and encourages children’s active involvement. Literacy should be engaging for your children, not a chore.
10 July 2017
A new research article proposes that more attention be given to what's right with children who grow up in high-stress environments so their unique strengths and abilities can be used to more effectively tailor education, jobs and interventions to fit them.
Stress-adapted children and youth possess traits – such as heightened vigilance, attention shifting and empathic accuracy – that aren't tapped in traditional learning and testing situations. In addition, these skills may actually allow at-risk children to perform better than their peers from low-risk backgrounds when faced with uncertainty and stress.
Most research to date has focused on detrimental effects of growing up under stressful conditions and the deficits in cognitive development that can result, said Bruce J. Ellis, lead author.
"We're not arguing that's wrong, but that it is only part of the picture," said Ellis, a University of Utah psychology professor. "The other part is that children fine-tune their abilities to match the world that they grow up in, which can result in enhanced stress-adapted skills. We're trying to challenge a world view and give consideration to an alternative adaptation-based approach to resilience."
The study "Beyond Risk and Protective Factors: An Adaptation-based Approach to Resilience" is forthcoming in the July issue of Perspectives on Psychological Science.
Co-authors include JeanMarie Bianchi, University of Arizona; Vladas Griskevicius, University of Minnesota; and Willem E. Frankenhuis, Radboud University Nijmegen.
The prevailing view is that children who experience high-stress environments are at risk for impairments in learning and behavior and that interventions are needed to prevent, reduce or repair the damage that has been done to them.
These high-stress environments include neighborhood danger; exposure to environmental chemicals; bad housing conditions; neglectful and abusive parenting; low-quality childcare; and peer and school violence. Research has shown that the more stressors children are exposed to, the more their performances in traditional learning and testing situations is compromised.
Most interventions are aimed at countering these deficits and getting "children and youth from high-risk backgrounds to act, think, and feel more like children and youth from low-risk backgrounds," the authors say.
In other words, the dominant approach assumes at-risk youth are somehow broken and need to be fixed.
Virtually no research attention has been paid to what strengths and abilities youth possess as a result of growing up in high-risk environments, Ellis said.
Although there is a rich body of literature examining adaptive responses in birds and rodents to stressful environments, the first theoretical work related to humans was published in 2013 by co-author Frankenhuis, followed by the first experiments in 2015 by co-author Griskevicius, Ellis said.
That research showed repeated or chronic stress does not exclusively impair cognition and can improve forms of attention, perception, learning, memory and problem-solving.
"Our argument is that stress does not so much impair development as direct or regulate it toward these strategies that are adaptive under stressful conditions," Ellis said. "Stress-adapted children and youth may perform better on tasks that involve situations and relationships that are relevant to them, such as social dominance. They also may perform better in settings that do not attempt to minimize the reality of daily stressors and uncertainties."
These stress-adapted skills should be understood, appreciated and seen as building blocks for success, Ellis said. A first, essential step is that researchers catalog the strengths and abilities of people who grow up in high-stress environments and focus on how to leverage those abilities to enhance learning, intervention and developmental outcomes.
6 July 2017
Escaping from brutal conditions in many nations of Africa, Asia, and Europe, the world's refugee children need specific kinds of support. While they are diverse in terms of their languages, religions, personalities and family structure, they almost universally share a history of trauma and disruption.
Many refugee children have had their attachments violently disrupted as they watched loved ones die of disease or malnutrition or killed in front of them. Few families remain intact as they make their way from battle zones to refugee camps and – eventually – relative safety in the countries that receive them.
Refugee children have had their communities disrupted – both those communities in their original home areas and the communities that form in the refugee camps where some families live for years and even decades, waiting for resettlement.
Refugee children have lost roots, role models, and neighbors. They have had to leave behind friends, grandparents, parents and siblings. All too often they were deprived of the opportunity to say “goodbye,” as people vanished from one day to the next, removed by warring factions, authorities, wild beasts, or natural disasters.
Hugo Kamya, Ph.D., a clinical psychologist and social work professor at Simmons College who grew up in Uganda spoke about the plight of refugee children at the conference of the American Professional Society on the Abuse of Children (APSAC) in Portland, Maine, on June 22 2017.
He described the multiple losses of refugee children, some of which are present for all immigrant children such as the loss of the familiar and the loss of friendships. But he also described the special losses of refugee children. These include, for instance, children who have lost some physical function if they had fingers or arms cut off by their captors, or if they have been so violently sexually assaulted that they have lost their reproductive functions or are unable to control their urine. Some children were permanently physically injured during their escape, as they bounded off cars and trains or were mauled by animals. Refugee children have also lost the normal childhood sense of safety, and this can prove extremely difficult to rebuild.
Kamya described the foreshortened sense of future that characterizes many refugee children. They have seen altogether too much death and destruction first-hand. This leads some to assume they will also die young, while others feel indestructible. Some will engage in daredevil practices, unsafe sex, or substance abuse, as if to tempt death to try again to catch them. And they may simply have lost their ability to assess danger.
Kamya provided concrete suggestions for psychotherapists and other caring adults who work with refugees:
• Help them discover a sense of purpose: They may feel guilty for having survived when so many did not. They may welcome death. Our job, then, is to help them discover a sense of purpose. For some, this might include telling their story publicly or working to save family members. For others, a sense of purpose might have no direct link to their refugee journey but rather might consist of tending a piece of land, caring for a child, or practicing their religion faithfully.
• Help them identify their strengths: Kamya described a young adult who – when asked his skills on a job application – wrote “no skills.” Kamya asked if he woke up, made his bed each morning, cared for his siblings, and prepared his materials for high school. “Write ‘organizational skills’ on your application, then,” Kamya urged. He then reminded the young man that he had outswum a crocodile, walked miles through dangerous territory, and evaded capture. “Write ‘crisis management skills’ on the form,” Kamya further urged him. Recognizing their strengths helps refugees with more than job applications, of course; it improves their self-confidence and sense of hope. So often people who may be considered wise and educated in their home countries are considered ignorant in their new countries because they don’t speak the language well or arrive penniless. Therapists and other caring adults may need to help them remember and feel pride in those strengths that have survived despite extreme challenges.
• Help clients anticipate problems: Refugees may arrive in their new countries expecting a warm welcome and streets lined with gold. Depending on where they settle, after an initial honeymoon period many refugees instead encounter anti-immigrant hostility and streets covered in snow. It is important to remind refugees that certain problems and obstacles are inevitable, but many can be overcome. They may need to be reminded that their circumstances will look quite different in a year or a decade. They may need to anticipate being flooded with feelings during holidays, ceremonies such as weddings, and in reunions with people they have not seen for a long time. They have already survived worse; they will survive this, too.
• Help clients with language issues: Depending on their age and whether they immigrated alone or accompanied by family members, some refugee children have lost their first language. They may have endured trauma in one language, which they no longer speak. What has happened to these memories? Recent trauma theory suggests that they are engraved in the body and may appear somatically as disease, pain, phobias, depression or panic. Perhaps these trauma symptoms can best be handled through psychotherapies that rely less on verbal channels, such as EMDR, as well as bodily healing practices such as yoga, drumming, and walking.
• Help clients make meaning: As a narrative therapist, Kamya emphasized the importance of helping clients make meaning of their traumatic experiences. Refugees who may see themselves as weak for having passively endured humiliations rather than fighting back, for example, may be helped to see the strength and wisdom in choosing not to put themselves and others at risk by fighting when they could not have “won.” Refugees who engaged in sex in exchange for food or were sexually assaulted may be helped to move from feeling shame to thinking of themselves as brave survivors.
Refugee children need adults who are aware of their current and former struggles and are willing to listen to them, support them, and believe in them. Let’s be those people.
Fontes, L. (2008). Interviewing clients across cultures. New York: Guilford.
Kamya, H. (2009). The impact of war on children: How children make meaning from war experiences. Journal of Immigrant and refugee Studies, 7, 2, 211-216
Kamya, H. (2008). Healing from Refugee Trauma: The Significance of Spiritual Beliefs, Faith Community, and Faith-based Services. In Froma Walsh (Ed.). Spiritual resources in family therapy (286-300). 2rd edition. New York: Guilford Press
By Lisa Aronson Fontes
29 June 2017
On any given night in Toronto, there are 1,000 to 2,000 homeless youth sleeping on streets or in shelters. Across Canada about 40,000 young people experience homelessness. Among them, approximately 25 to 40 percent self-identify as lesbian, gay, bisexual, and queer.
These are dangerously high numbers since it is estimated that only five to 10 percent of the population identify as LGBTQ. That’s why across Canada local and provincial governments are being pressured to step up and enact change. By the fall of 2015, the city of Toronto agreed to update its shelter standards, setting aside funds to open two transitional housing shelters specifically for LGBTQ youth. A few months prior, the province of Alberta drew up an official action plan to tackle the issue, outlining the current data (0.8 percent of the homeless population in Alberta identify as transgender) and offering up ways to support these youth, from gender-inclusive washroom signage to intervention methods. Around the same time the Boys and Girls Club of Calgary began the Aura Host Homes project – producing another first-of-its-kind moment– that pairs LGBTQ youth with local families in a safe and supported environment.
But a year and a half later, attention on the problem seems to have come to a halt. While research on the issue has improved, Alberta remains the only province to write up an official action plan. Meanwhile, LGBTQ youth are still overrepresented in shelters across the country. “We started doing the work which is really great, but we have to continue doing the work because obviously queer and trans youth homelessness is still a problem,” says the Centre of Addiction and Mental Health’s Alex Abramovich, who has played a main role in working to end LGBTQ youth homelessness.
Abramovich – particularly through his University of Toronto doctoral thesis “No Safe Place to Go,” which provided the first comprehensive overview of the unique needs of the population – added fuel to a fire that had been growing for years. Advocates on solving youth homelessness had been noticing the trend, but it wasn’t until Abramovich’s work was published in 2012 that the issue made its way into the public sphere. After years of campaigning with numerous community agencies, stakeholders, and political leaders, Abramovich’s comprehensive research and hunger for change began to make waves across the country. Shelters began prioritizing queer and trans youth while provincial and municipal governments felt the pressure to make policy changes. The Alberta government, in fact, personally requested that Abramovich help prepare the province’s focused response to end LGBTQ youth homelessness.
While many communities and municipal governments have made similar moves to address the problem in their districts, no other province has produced a specific action plan, despite the pressing need. In Ottawa alone, close to half of the city’s homeless youth identify as LGBTQ with little to no official supports available for them. “I think Ontario could really learn from the Alberta strategy,” says Abramovich, who hopes the trend will continue to spread across the country. “There needs to be more collaboration across sectors and looking at the different successful models.” Quebec and the Maritimes in particular, where there are no specific programs for LGBTQ homeless youth, could benefit from this. A 2016 plan to end youth homelessness in Saint John’s referenced Abramovich’s work and the Host Homes project as possible solutions, but provided nothing concrete.
Despite his research, Abramovich says gathering data on the matter remains difficult. Actual numbers of LGBTQ youth who experience homelessness remain elusive because many young people slip under the radar. It is reasonable, Abramovich says, to believe the figures are much higher. Youth who identify as LGBTQ frequently experience discrimination in the home and shelter system, and many are forced to leave their homes after coming out to their families. Once on the street they may avoid shelters where they are forced to submit to gender norms and can experience transphobia and homophobia by staff and other youth. This not only puts them at a higher risk of being chronically homeless, but forces them to rely on couch-surfing or adapt to life on the streets, which can lead to drug abuse and survival sex.
Many small-scale programs and projects are making headway across Canada’s cities. In late 2015 Vancouver’s RainCity Housing emerged as one of the first LGBTQ youth-specific projects to tackle the problem of homelessness. It was followed closely by the opening of YMCA’s Sprott House in Toronto in February 2016, which is Canada’s first transitional housing program for LGBTQ youth.
The trick is finding the right programs that work for a variety of cases. RainCity Housing has taken a housing-first approach, prioritizing getting youth off the street and building a support network where they feel safe. The staff work with every young person to figure out what living situation will suit them best, giving them choice and offering supports and referrals to deal with any mental health or substance abuse problems at their own pace. “We develop a model around each youth instead of fitting each youth into a model,” says RainCity Housing associate director Aaron Munro. “What we’re offering is permanent housing.” This approach differs from Sprott House, which acts as a youth shelter, and much more from the Egale Centre, Toronto’s second LGBTQ youth-exclusive shelter that is due to open in fall 2017 and will prioritize counselling.
There is still much work to be done. Most of these projects and programs are still in their early stages, and agencies are only able to serve handfuls of youth, who must go through competitive application processes to be considered. Sprott House, for example, only accepts youth ages 16 to 24 and offers 25 beds for a stay of up to one year. Many services are only structured toward aiding a particular subgroup within LGBTQ youth, such as those who are chronically and episodically homeless. This often excludes the possibility of helping those who may be in need of emergency shelter or who find themselves in dangerous situations because of a lack of alternative housing options.
Which approaches are working best for specific cases will become clearer over time, laying the groundwork for more and better programs to emerge, funds willing. Abramovich, for his part, isn’t done. “I think as a next step we have to look at how we can prevent this problem from happening in the first place and find ways of working within the school system and working with families,” he says. “We can’t just end homelessness, we have to be strategic about it.”
By Amy van den Berg
4 July 2017
Scientists and psychologists in the Netherlands are calling for kids in youth care to be examined for post traumatic stress disorder (PTSD) as a new standard. It is becoming increasingly clear that trauma plays an important part in behavioral problems, and this can be prevented by PTSD screening and treatment, they said to the Volkskrant. Treatments of less than four hours were shown to have a significant impact, meaning the brief periods of consultation could also be especially cost effective.
"We see children who have been living with severe PTSD for years", researcher and clinical psychologist Carlijn de Roos of the University of Amsterdam said to the newspaper. "While these complaints can be resolved within a few weeks. We think that waiting lists can be significantly shortened by briefly screening for PTSD. If they don't suffer from traumatic experiences, you will know within five minutes. This saves healthcare millions a year."
On Thursday De Roos is publishing a study showing that the treatment method Eye Movement Desensitization and Reprocessing (EMDR) is effective in treating children with PTSD, as it is also used for treating adults. In this treatment patients are asked to recall a traumatic memory while moving their eyes backwards and forward and following a hand. It forces the brain to complete an external task while the memory is in use, allowing a patient to confront and manage a difficult memory to reduce the anxiety that memory causes.
De Roos' study, concluded as part of her PhD research, involved 103 kids between the ages of 8 and 18 who lived through a single traumatic event – rape, accident, abuse, death of a parent. All of them lived with PTSD for an average of a year and half, with outliers of 10 years. After 45 minutes of EDMR treatment, only 7 percent of them still had full-blown PTSD, 20 percent still showed some symptoms, according to the study.
The University of Amsterdam participated in the study along with the Trauma Center for Children and Youth at the GGZ Rivierduinen. Along with EMDR, they also looked into the effect of Cognitive Behavioral Writing Therapy, or WRITEjunior. "In writing therapy, the child writes a story on a computer, together with the therapist, about the event and the consequences, including all the horrid aspects of the memory. In the last session, the child shares the story of what happened to him or her with important others," the university revealed in a statement.
The EMDR treatment demonstrated positive effects after an average of 2 hours and 20 minutes, the study determined. Completing WRITEjunior therapy took an average of 3 hours and 47 minutes. "The most important thing, of course, was that the results were lasting, as shown during a follow-up measurement one year later," De Roos said in a statement sent to the NL Times.
PTSD symptoms are seen in some 16 percent of kids who experience a single traumatic incident, like the loss of a loved one, a sexual assault, physical abuse, or a traffic accident. "Children who do not get the right treatment suffer unnecessarily and are at risk of developing further problems and being re-traumatized", De Roos advocates. "The challenge for health professionals is to identify symptoms of PTSD as quickly as possible and immediately refer for trauma treatment."
Colleagues Saskia van der Oord, Bonne Zijlstra, Sascha Lucassen, Sean Perrin, Paul Emmelkamp and Ad de Jongh are all credited as authors on the study, released Thursday in the Journal of Child Psychology and Psychiatry. All authors have a position at the University of Amsterdam, except for Sean Perrin who is listed as working with the Psychology Department at Lund University in Sweden.
Clinical psychologist Iva Bicanic, head of the National Psychological Trauma Center, also advocates for PTSD screening. "Youth care knows so many children who were sexually assaulted, abused and experienced domestic violence", she said to the Volkskrant. "But often children are found so complex and instable that the choice is made not to screen or treat them. That argument has no scientific justification. In practice a family is often supported in raising the child, due to the child's behavioral problems, but the source is not acknowledged and not addressed."
According to professor Agnes van Minnen of Radboud University, a shocking number of kids have been in youth care for years without getting trauma treatment. "Aid workers often don't dare to ask about trauma because they are afraid of making it worse. Another mistake is that care workers think that children will tell them themselves if something bad happened. But if you do not ask about it, they won't come out with it."
Rafaele Huntjens, associate professor at RUG, thinks that PTSD screening is a good idea, but warns that it must be done carefully. "There is a risk that therapists will see certain signals and think there should be trauma, while those complaints may also have another cause. So you must have trained interviewers do this, and according to a reliable method."
By Janene Pieters
29 June 2017