Studies show that parents who faced difficult situations in their childhood may pass on some of those risks to their children.

In a recent study funded by the NIMH, Jessica Uy, Ph.D., of the University of California Los Angeles, and colleagues analyzed the transmission of trauma from one generation to the next. They discovered that when mothers experience adversity in their childhood, it can negatively impact their mental health during and after pregnancy, which in turn, can affect their children’s mental health.

For the study, the researchers followed 541 mother-child pairs who participated in the Growing Up Singapore Toward Health Outcomes (GUSTO) study. Mothers in the study reported their levels of anxiety and depression at 26 weeks of pregnancy and at 3 months, 12 months, 24 months, 36 months, 4.5 years, and 6 years after the birth of their child. When their children were 4.5 years of age, mothers reported their recollections of childhood abuse or neglect.

The researchers asked the mothers and their children to fill out surveys when the children were between 7 and 8 years old to find out if the children were feeling anxious, depressed, or withdrawn. Additionally, the researchers collected functional magnetic resonance imaging (fMRI) data from a subset of 89 children in the study when they were 6 years old.

The study showed that maternal experiences of childhood neglect were associated with worse mental health (reflecting higher levels of anxiety and depression symptoms) both during pregnancy and after birth.

Worse maternal mental health, in turn, was linked to children having more feelings of anxiety and depression and being more socially withdrawn when they were 7.5 years old. Maternal experiences of childhood neglect were also associated with their children reporting more anxiety-related performance fears, physical symptoms, and restlessness.

Maternal experiences of childhood abuse were associated with worse mental health among mothers after birth, which in turn was linked to their children feeling more anxious, depressed, and withdrawn at 7.5 years of age.

The researchers also found a link between maternal mental health and their children’s brain activity. Children of mothers who experienced worse mental health after birth showed weaker connectivity between two parts of the brain (the amygdala and prefrontal cortex)—a connection critical for the regulation and processing of emotion.

The study had several limitations, the researchers said. The mothers who participated were from the general population, which meant most had lower levels of trauma, anxiety, and depression than would be found in a population in treatment. In addition, not all children had fMRI data, and having fMRI data from a larger sample of children would lend greater weight to the findings.

But the study results indicate that when a mother experiences difficult times during her own childhood, it can affect her mental health when she is an adult, during critical life stages such as during pregnancy and after giving birth. This, in turn, can increase the risk of mental health challenges in her children.

The authors suggest one way to break the transmission of risk may be to focus on providing intervention and support to women during these critical time periods.

You may be happy to chip in for everything from baby carriers, tricycles and rebounders to school tuition. But you may not have given as much thought to nutrition. The best gift you can give your grandchild is the gift of health. Your health and theirs. You’ll enjoy that investment for the rest of your life.

I was raised by a single mom. We lived with my grandparents, who I call my co-parents. (I think I turned out okay!) That was unusual 80 years ago, but not so much anymore.

Grandparents today have more meaningful roles in their grandkids’ lives. Many are taking on caregiving responsibilities. There are more extended families living under the same roof. Here in California, the trend is for young couples to build small homes for their parents in their backyards.

This is helpful for the grandkids and their parents. It’s also good for you, the grandparents. Becoming involved in your grandkids’ lives gives your own life more meaning. Studies show this can help you live longer and live better. he gift of health. Your health and theirs. You’ll enjoy that investment for the rest of your life.

I write a lot about how to get children, especially picky eaters, to consume more nutritious meals. A good diet is essential for their brain development as well as their muscles, bones and other parts of their growing bodies. As grandparents, you can have a huge influence on what they eat.

I’ve been a pediatrician for more than 50 years. Today, I see a lot more grandparents during office visits. The good news: They are generally more savvy about nutrition than parents. The bad news is that they waited too late. Some of my grandparents will say, “Dr. Bill, I’m 60. I’m frail. I have weak bones. I wish I’d started eating better when I was younger.”

It’s never too late, no matter what your age group. Not only can you generally make improvements in your own health, but sharing that information with your kids and grandchildren will be lessons learned by future generations. These can be full-circle moments.

As grandparents, we share stories. We pass down traditions. We should also be passing along nutritional wisdom. Here’s how I would approach this.

Explain to parents why it’s important to start young. If you preload grandkids with good nutrition when they are young, their minds and bodies will be ready to handle things that happen later on.

Be very diplomatic. Sometimes you just have to say to their parents: “I love our grandchild so much! I just want to prepare him/her to be strong in the future.”

Offer to handle some of the food costs. Parents will tell me, “But Dr. Bill, healthy foods cost more!” Enter you, the grandparents. You can say, “Honey, don’t let financial considerations impact your shopping list. We will make up the difference.”

Restock the pantry for your grandchildren and yourselves. Ship healthy ingredients to the kids. Or, leave them behind after you’ve been watching the grandkids. One of my favorites ingredients is Healthy Heights Kidz Protein shake mixes, which are designed by pediatricians especially for kids. In addition to shakes, they are great to use as an ingredient to add important nutrients to other recipes. Not only do children need more protein, you do as well. The number-one health concern of grandparents is frailty. You need more protein for your own muscles and bones!

Involve your grandkids in food preparation. Our 4-year-old grandson loves to help me make smoothies with Grow Daily shake mixes. He adds a fistful of blueberries and kiwis, and he loves to scoop the shake powder from the bag. You want to do things with your grandchildren, not for your grandchildren. When they are involved, they are more likely to want to drink it or eat it.

Be proactive. Help grandchildren learn cooking skills. Encourage them to be active. Have conversations about food. Post healthy reminders around the house. We have tips you can download on our website. Search “healthy reminders” on AskDrSears.com. 

Be a healthy role model. Foods that are low fat or low carb are not good for children or adults. Serve smart fats and smart carbs. Smart fats are things like omega-3s from salmon that are good for the brain. Smart carbs are the ones that have fiber.

Teach your kids and grandkids about body composition. BMI went out of favor 10 years ago! Body composition — your muscle and bone mass, and your body fat distribution — are far more important than what the scale shows. If your grandchild is big boned and has big muscles, and the school tells parents their BMI is too high, you should say, “Don’t worry. This child is blessed with a body type that gives him/her large muscles and strong bones.” Waist size is the number-one scientifically studied parameter of health. If their waist isn’t potbellied, and you can’t grab a big piece of flab on their belly, their scale weight doesn’t matter. We use the term ‘lean’. That means the right body composition for your genetic body type.

What memories do you want your grandchildren to have of you? Many will be about food. I still fondly remember cooking with my grandpa. As important, what do you want to leave for your grandchildren? Teaching them healthy eating habits is an enduring investment that will carry them through their entire lives.

So your study found that screen use increases suicide risk?

The more time kids spend using screens from ages 9 to 11 years old, the higher their odds of suicidal behaviors two years later, at ages 11 to 13. Specifically, each additional hour of screen time increased the risk by 9%. The risk was highest with texting, followed by video chatting, watching videos, and playing video games. Social media didn’t show an effect, but that may be because, technically, kids aren’t allowed to be on social media platforms until they are 13 (though some still are), so we didn’t have as much data there.

What does “suicidal behavior” mean?

It means thinking about suicide, with or without a specific plan, as well as attempting suicide. We weren’t able to separate attempts versus types of thoughts in this study. I should also note that, overall, suicidal behavior was uncommon in these young kids, occurring in just 1.38% of the 11,633 kids we studied. The risk of suicidal behavior tends to increase with age, so this could be seen as an early warning sign.

Why does screen time increase suicidal behavior?

Time spent on screens often displaces time spent on in-person socializing, physical activity and sleep – all of which are good for mental health. Screen usage can lead to cyberbullying, poor eating habits, isolation and disrupted sleep – all of which can worsen mental health. It also increases exposure to potentially anxiety-provoking or otherwise distressing content.

Is all screen time bad for tweens?

Screens can be helpful in some cases, like for kids who, say, are LGBTQ and don’t have real-life access to support, and to stay in touch with friends and family who live far away. I’d say it’s about being thoughtful about how kids engage with screens and keeping an eye on what they consume.

What can parents do to help kids use screens safely?

It’s important for parents to do what’s developmentally appropriate. For older teens, it’s about giving advice. With younger children, preteens and young teens, it makes sense to have a more hands-on approach, like using parental controls and keeping them off social media until they are 13. This time, during early adolescence, is when you set the behaviors that will help kids develop healthy screen habits later on.

What healthy screen habits do you recommend for tweens?

• Avoid screens before bedtime. We know screen use interferes with sleep, and good sleep is so important for mental health.
• Avoid snacking while using screens, to make eating more intentional; and no use of screens during family meals. That helps keep family time about connection, and also helps parents monitor their kids’ eating, which is important because screen overuse is connected to disordered eating, a mental health issue.
• Parents can also establish screen-free zones, like bathrooms and bedrooms. Kids are less likely to get into violent or harmful content in public spaces in the home.
• Parents should try to model all these behaviors for their kids, which can be the hardest part.

What questions are you still trying to answer about screen time and suicide risk?

One is whether screen use causes suicidality, or whether the increased odds of suicide is because kids who are already depressed are more prone to using screens. With this paper, we see a little more evidence that it’s screens leading to suicidal behavior, because we adjusted for mental health at baseline and we looked at the kids two years later.Another question is, how can we identify the 1% of kids who might tip into suicidality? We need to learn more about the type of content they consume and how it might play a role.

]]> https://thirdage.com/racial-disparities-and-childbirth/ Thu, 09 Mar 2023 11:28:00 +0000 https://thirdage.com/?p=3076804 Read More→]]> Black women of childbearing age were twice as likely to have uncontrolled high blood pressure when compared with their white peers, increasing their risk of heart-related complications during pregnancy, according to new research published in February 2023 issue of the Journal of the American Heart Association, an open access, peer-reviewed journal.

The analysis of nearly 18 years of data found that food insecurity, or the lack of access to healthy foods, was experienced by one in four Black and one in three Hispanic women.

The study by Massachusetts researchers examined social factors influencing blood pressure control by race and ethnicity among U.S. women of childbearing age with high blood pressure.

“Although high blood pressure is a treatable, common chronic health condition, it is a leading cause of pregnancy-related deaths and severe disease,” said senior study author Lara C. Kovell, M.D., a cardiologist at the University of Massachusetts Chan Medical School in Worcester, Massachusetts. “The United States has much higher rates of pregnancy-related deaths than economically similar countries, and Black women are disproportionately affected.”

Previous research has indicated that Black, Hispanic, and Asian women face a higher risk of complications and stroke during childbirth, and Black and Hispanic women who develop pregnancy-induced high blood pressure are at least six times more likely to die than white women.

“A better understanding of racial and ethnic differences in hypertension control may help advance health equity in the United States,” the authors wrote.

In this study, researchers reviewed data from the National Health and Nutrition Examination Survey from 2001 to 2018, which included 1,293 women of child-bearing age, average age 36 years, who had a diagnosis of hypertension with a blood pressure above 140/90 mm Hg or a self-reported history of antihypertensive medication use. About 59% of the participants were white women, 23% were Black women, about 16% were Hispanic women and 1.7% were Asian women. About 20% of the participants had never been pregnant.

Uncontrolled high blood pressure was defined as a systolic blood pressure of 140 mm Hg or higher (the top number in a blood pressure reading) and a diastolic blood pressure of 90 mm Hg or higher (the bottom number). Three consecutive blood pressure measurements were taken after five minutes of seated rest, with one minute in between measures, and the average was calculated. Women answered questions about their lifestyle, such as diet, exercise, smoking and alcohol intake, and access to health care, education and blood pressure medication use.

Social determinants of health factors examined in this study were based on the American Heart Association’s Scientific Statement on Social Determinants of Risk and Outcomes for Cardiovascular Disease. These included education, income, food security, home ownership, language and access to health insurance and medical care.

“Food insecurity is important when thinking about high blood pressure since sodium levels are higher in many lower-cost food options such as canned, ultra-processed and fast foods,” Kovell said. “Moreover, food insecurity and a lack of access to healthy foods have been shown in other studies to increase the risk of high blood pressure.”

Among the researchers’ findings:

Black women of childbearing age with high blood pressure were more than twice as likely to have uncontrolled high blood pressure than white women, and among those who were aware of their diagnosis, Black women were three times more likely to have uncontrolled blood pressure.

The risk factors for high blood pressure persisted among Black women after considering social determinants of health.

Black and Asian women had a higher average blood pressure and were more likely to have uncontrolled high blood pressure than white women; 38% and 36%, respectively, versus 25%.

Food insecurity was higher among Hispanic and Black women compared with white women, 32% and 25%, respectively, versus 13% among white women.

Asian women were more often unaware of their high blood pressure and were more likely to have uncontrolled blood pressure compared with white women.

1 in 4 Black women and one in three Hispanic women reported food insecurity.

Researchers say more study is needed, including examination of structural racism and discrimination, to better understand why Black women of childbearing age face challenges in both food security and heart health.

“Questions about food insecurity and health care access should be included in the standard screening questions at hospital or clinic visits, especially among pregnant women or women planning to become pregnant,” Kovell said. “We still have a lot of work to do to understand and reverse the disparities in maternal mortality between white and Black women in the U.S.”

Grief may not be obvious, but the suffering is real. Imagine yourself at age 6 or 10 or 16 – or a child you love – losing a parent. Look around your community and realize that many young people are grieving. It’s a critical issue because the effects of a death permeate their entire life and can interfere with their development if unaddressed. 

Children grieve according to their age, but loss at any stage of growing up is an earthquake that irrevocably shifts the young person’s inner and outer terrain. Volunteering at a children’s grief center, I witness such struggles firsthand, evoking my own early mother loss that I wrote about in my memoir, The Art of Reassembly. 

In Their Hearts and Minds

The enormity of loss can be difficult for children to absorb, so their reactions may not look like what adults expect. Young children often go in and out of grief, crying one minute and then running outside to play the next, while older children may have lots of questions at times and withdraw at others. 

Grieving children of all ages often feel alone, the only one of their peers to have experienced a loss, and therefore different from all their friends and classmates. Whether they reveal it or not, fear is a significant aspect of grief for children and teens. They often worry about losing someone else. Who will take care of me now? What if someone else dies? Such anxieties may show up in trouble sleeping, separation anxiety, or new sensitivities to places or situations. 

Unfortunately, many young people are alone with their emotions. Adults around them may be too grief-stricken themselves or simply unaware that avoiding painful conversations only compounds the grief. For example, although telling a child the truth about how someone died may be very hard, honest information creates trust between child and adult. Children often perceive more than adults realize, so incomplete or vague explanations leave them more afraid or confused and sometimes feeling needlessly guilty. 

At Home

As a grieving young person grapples internally with big emotions, the parent’s death can necessitate outward changes in daily life, removing familiar stability. Besides their loss of a primary relationship, these changes create a cascade of loss in so many other areas of life that the parent touched. These secondary losses are especially painful for children, who usually have little control over such decisions.   

For example, when a parent who was the primary breadwinner dies, the other parent may have to resume working, which marks a big change. A new caregiver may come into the picture. Perhaps the house is no longer affordable, so a move becomes necessary, which might require a change of schools and loss of friends. Children who lose their only parent face even greater disruption, while even small changes that affect a once reliable routine can cause distress in a grieving child. 

Older children may suddenly be thrust into roles of responsibility for siblings or the household or even as emotional support for the surviving parent in the wake of the death. Constantly being stretched beyond their capacities – “parentified” – creates stress and anxiety. Children learn to ignore their own feelings in deference to others’ needs, and taking on adult concerns so young inhibits their ability to connect with peers so they miss out on normal activities. To have healthy adult relationships, these patterns often must be unlearned.

At School 

With so much churning within themselves and in their home life, it’s unsurprising that bereaved children may have difficulties with concentration, which leads to a decline in academic performance. Previously accomplished students can become discouraged if their grades fall. Students who struggled before the death are at further disadvantage. Either way, it’s school stress compounding grief. 

A study by the University of Pittsburgh found that children who lost a parent were more than twice as likely than nonbereaved kids to show impaired functioning at school and at home, even seven years later. This result held even after researchers adjusted for risk factors such as pre-existing mental health conditions. A 2019 review of population data found that children with parent loss were more likely to be expelled from school or repeat a grade, while they were less likely to be in a gifted program. 

Support Matters

Nothing can erase the pain of children’s grief, but having support makes a difference. It can take varied forms, and all of them are needed. Formal grief programs, where kids can interact with peers who also had a loss can be life changing. They dispel the isolation that young grievers feel. Informally, anyone who is in relationship to a grieving child can support them, by listening when they wish to talk and respecting their wishes when they don’t, also by sharing their own feelings and recollections of the person who died. 

Schools are well-positioned to support grieving young people, because that’s where they spend so much of their time. Caring adults like teachers and coaches can check in with the student and give then space to talk when they want to. They can also provide practical assistance in managing the demands of school while grieving. Administrators can proactively provide grief education to the whole school community and create supportive policies. Fortunately, grief awareness is growing in schools and  resources are available. 

Beyond Spare: A Role for Prince Harry

In the UK, Prince Harry is known for caring gestures toward grieving children, writing letters to kids who lost a parent in the military and offering comfort to young grievers he meets. In Spare, he shares the impact of losing his mother at 12 years old. In this next chapter of his life, it’s time for Prince Harry to step into the role of public spokesman for children’s grief support. 5.6 million children are counting on him. 

About 

Peg Conway writes and practices Healing Touch energy therapy in Cincinnati, OH, where she also volunteers at a children’s grief center. Her essays about early mother loss and long-term grieving have appeared at The Manifest-Station, the Cincinnati Enquirer, and The Mighty. After earning a master’s in journalism, she worked in corporate communications. Later, she became a certified childbirth educator and doula. Peg and her husband have three grown children and one grandchild. The Art of Reassembly: A Memoir of Early Mother Loss and Aftergrief is her first book.

You may be happy to chip in for everything from baby carriers, tricycles and rebounders to school tuition. But you may not have given as much thought to nutrition. The best gift you can give your grandchild is the gift of health. Your health and theirs. You’ll enjoy that investment for the rest of your life.

The new age of grandparenting    

I was raised by a single mom. We lived with my grandparents, who I call my co-parents. (I think I turned out okay!) That was unusual 80 years ago, but not so much anymore.Grandparents today have more meaningful roles in their grandkids’ lives. Many are taking on caregiving responsibilities. There are more extended families living under the same roof. Here in California, the trend is for young couples to build small homes for their parents in their backyards.This is helpful for the grandkids and their parents. It’s also good for you, the grandparents. Becoming involved in your grandkids’ lives gives your own life more meaning. Studies show this can help you live longer and live better.

The nutrition opportunity 

I write a lot about how to get children, especially picky eaters, to consume more nutritious meals. A good diet is essential for their brain development as well as their muscles, bones and other parts of their growing bodies. As grandparents, you can have a huge influence on what they eat.I’ve been a pediatrician for more than 50 years. Today, I see a lot more grandparents during office visits. The good news: They are generally more savvy about nutrition than parents. The bad news is that they waited too late. Some of my grandparents will say, “Dr. Bill, I’m 60. I’m frail. I have weak bones. I wish I’d started eating better when I was younger.”It’s never too late, no matter what your age group. Not only can you generally make improvements in your own health, but sharing that information with your kids and grandchildren will be lessons learned by future generations. These can be full-circle moments.

How to get started 

As grandparents, we share stories. We pass down traditions. We should also be passing along nutritional wisdom. Here’s how I would approach this.

• Explain to parents why it’s important to start young. If you preload grandkids with good nutrition when they are young, their minds and bodies will be ready to handle things that happen later on.
• Be very diplomatic. Sometimes you just have to say to their parents: “I love our grandchild so much! I just want to prepare him/her to be strong in the future.”
• Offer to handle some of the food costs. Parents will tell me, “But Dr. Bill, healthy foods cost more!” Enter you, the grandparents. You can say, “Honey, don’t let financial considerations impact your shopping list. We will make up the difference.”
• Restock the pantry for your grandchildren and yourselves. Ship healthy ingredients to the kids. Or, leave them behind after you’ve been watching the grandkids. One of my favorites ingredients is Healthy Heights Kidz Protein shake mixes, which are designed by pediatricians especially for kids. In addition to shakes, they are great to use as an ingredient to add important nutrients to other recipes. Not only do children need more protein, you do as well. The number-one health concern of grandparents is frailty. You need more protein for your own muscles and bones!
• Involve your grandkids in food preparation. Our 4-year-old grandson loves to help me make smoothies with Grow Daily shake mixes. He adds a fistfull of blueberries and kiwis, and he loves to scoop the shake powder from the bag. You want to do things with your grandchildren, not for your grandchildren. When they are involved, they are more likely to want to drink it or eat it.
• Be proactive. Help grandchildren learn cooking skills. Encourage them to be active. Have conversations about food. Post healthy reminders around the house. We have tips you can download on our website. Search “healthy reminders” on AskDrSears.com.
• Be a healthy role model. Foods that are low fat or low carb are not good for children or adults. Serve smart fats and smart carbs. Smart fats are things like omega-3s from salmon that are good for the brain. Smart carbs are the ones that have fiber.
• Teach your kids and grandkids about body composition. BMI went out of favor 10 years ago! Body composition — your muscle and bone mass, and your body fat distribution — are far more important than what the scale shows. If your grandchild is big boned and has big muscles, and the school tells parents their BMI is too high, you should say, “Don’t worry. This child is blessed with a body type that gives him/her large muscles and strong bones.” Waist size is the number-one scientifically studied parameter of health. If their waist isn’t potbellied, and you can’t grab a big piece of flab on their belly, their scale weight doesn’t matter. We use the term ‘lean’. That means the right body composition for your genetic body type.

What memories do you want your grandchildren to have of you? Many will be about food. I still fondly remember cooking with my grandpa. As important, what do you want to leave for your grandchildren? Teaching them healthy eating habits is an enduring investment that will carry them through their entire lives.

Dr. Sears, or Dr. Bill as his “little patients” call him, has been advising busy parents on how to raise healthier families for over 50 years. The father of 8 children, he and his wife Martha have written more than 45 books including “The Healthiest Kid in the Neighborhood,” and hundreds of articles on parenting, childcare, nutrition, and healthy aging. He is the co-founder of the Dr. Sears Wellness Institute for training health coaches, and he runs the health and parenting website AskDrSears.com.

In 2016, the task force recommended screening for depression in children and adolescents.

In a news release announcing its final recommendation for anxiety screening, the task force said, “Too many children and teens in the United States experience mental health conditions, including anxiety, depression, and suicidal thoughts or behaviors. There are several forms of anxiety, including generalized anxiety disorder and social anxiety, but all forms are characterized by excessive fear or worry. Depression, or major depressive disorder, is a condition that negatively affects how people feel, think, and act.”

For older children and teens, screening and follow-up care can reduce symptoms of depression and can improve, and potentially resolve, anxiety, the USPSTF said. However, there is very limited evidence on the benefits and harms of screening children younger than 8 for anxiety and younger than 12 for depression. And while suicide is tragically a leading cause of death for older children and teens, there continues to be limited evidence across all ages about screening for suicide risk in those who do not show signs or symptoms. This is an area where more research is critical.

“The Task Force cares deeply about the mental health of all children and adolescents. Unfortunately, there are key evidence gaps related to screening for anxiety and depression in younger children and screening for suicide risk in all youth,” Task Force member Lori Pbert, Ph.D., said in the task force news release. “We are calling for more research in these critical areas so we can provide healthcare professionals with evidence-based ways to keep their young patients healthy.”

Start Early

Over the summer, most families take their cues from the sun and stay up later. While it may be tempting to keep the late-night fun going up until the end, starting your school routine a few weeks early can help ease the transition back to school. Starting two to three weeks before the advent of school, begin going to bed and getting up close to when you need to for school, and try to eat on a more regular schedule as well. This advice isn’t just for little kids — teens and adults need quality sleep for proper functioning, and getting your plan straight now will help ensure that you all start the school year off more prepared and don’t feel as much anxiety over the advent of that first day. 

Give your child a preview 

Talk to your child about what they will be doing in the upcoming school year. If your child is starting school for the first time, see if there’s a kindergarten orientation or a way to meet their teacher before school begins. Whether they’re starting a new elementary school or going back to the same one, go explore it with your child. Review where their class will be, visit the cafeteria, the library or the art room. Take them to the playground (with a friend who’ll be going to their school, if possible) to help them adjust and feel comfortable at the school. Give your child a “preview” of the new faces and places they’ll be seeing. This can help to “right size” the school in your child’s mind and remove the fear and mystery. 

Shopping together for school supplies 

Shopping together for school supplies, and using the shopping trip as a time to talk about what to expect at school, can be a healthy way to keep a child talking. Parents should also try to connect their child with future classmates. “f a child knows someone who is going to be in the same classroom, that can greatly reduce their apprehension and fear of the unknown. 

Facilitate friendships.

Help prepare kids for school-year socializing by arranging a couple of playdates with classmates and reminding them that they’ll be seeing their familiar school friends again soon. 

Promote the positives

Field trips, old friends, new classes, sporting events, after-school activities. There’s plenty to get fired up about! Remind your child and the enthusiasm will be contagious. 

Sick of School — Literally 

Nervousness over heading back to class can make kids feel sick. They may complain of stomachaches, headaches, nausea and dizziness, especially on Sunday evenings after feeling well all weekend. If you observe potential symptoms of stress as the start of school approaches, I suggest having a candid conversation with your child. Don’t just accept “fine” if you ask your child, “How are you?” or, “How was your day?” Ask questions that can’t be answered “yes” or “no,” like, “How do you feel about returning to school?” Then, let them talk, and don’t try to fix what they say. 

When anxiety about school “masks” something else

Kids of any age who don’t want to go to school, or who want to avoid it, may be doing so because of a specific issue beyond general anxiety, worry or depression. Children who are bullied or teased often become anxious about going to school, and if the problem is not addressed, the anxiety will continue along with a host of other problems. Similarly, children who are avoiding school may be doing so because school is hard for them.School anxiety often emerges just before a child is diagnosed with a learning difficulty.”

Sanam Hafeez Psy.D

New York State Licensed Neuropsychologist and Director of Comprehend The Mind

www.comprehendthemind.com

Sanam Hafeez Psy.D is a New York City based Neuropsychologist and School Psychologist.  She is also the founder and director of Comprehensive Consultation Psychological Services, P.C. She is currently a teaching faculty member at Columbia University. Click here to see Dr. Hafeez on Dr.Oz: http://www.doctoroz.com/episode/do-smart-drugs-work-we-test-them-so-you-don-t-have?video_id=4518086514001

Dr. Hafeez graduated from Queens College, CUNY with a BA in psychology. She then went on to earn her Master of Science in Psychology at Hofstra University. Following that she stayed at Hofstra to receive her Doctor of Psychology (Psy.D.) She later completed her post-doctoral training in Neuropsychology and Developmental Pediatrics at Coney Island Hospital.

Dr. Hafeez’s provides neuropsychological educational and developmental evaluations in her practice. She also works with children and adults who suffer from post traumatic stress disorder (PTSD), learning disabilities, autism, attention and memory problems, trauma and brain injury, abuse, childhood development and psychopathology (bipolar, schizophrenia, depression, anxiety, etc…) In addition, Dr. Hafeez serves as a medical expert and expert witness by providing full evaluations and witness testimony to law firms and courts.

Dr. Hafeez immigrated to the United States from Pakistan when she was twelve years old. She is fluent in English, Urdu, Hindi and Punjabi (Pakistani and Indian languages.) She resides in Queens, New York with her husband and twin boys.

Honors and Publications:

–       April 2013 Main Speaker at Learning Disabilities Awareness Conference, New York City at Baruch College, CUNY

“Evaluating and Accommodating Students with Disabilities”

–       June 2008 Appointment to the New York City 18-B panel Assigned Counsel Plan

Appointed as a preferred and approved Neuropsychologist and Clinical Psychologist in the New York City Court System for low cost or pro bono criminal, civil and family law cases

–       January 2008 CUNY Proficiency Exam Waiver Position Paper

                                                Hafeez, S. (2008)

Commissioned by CUNY to advocate for the Learning Disabled population and the bias of the CUNY Assessment. 

Research based paper presented to the Board of CUNY Student Disabilities to waive requirement. 

–       1998-2000 Doctoral Fellowship, Hofstra University

*Awarded a stipend in exchange for a research assistant position with core faculty member

Clinical Experience:

Director and Founder February 2003-Present

Comprehensive Consultation Psychological Services                                

• Provide quality monolingual and bilingual psychological, educational, neuropsychological and speech and language evaluations

• Early Intervention, Pre-School and School Age Special Education Services

• Awarded a competitive contract through bidding with the New York City Department of Education (NYC DOE)

• Awarded an assessment and interpreting contract with Putnam-Westchester BOCES

• Provide evaluations and services to college level students with educational disabilities

• Also provide occupational and physical therapy evaluations as well as therapeutic services in all areas. 

• Contract with school district and various agencies to provide evaluations and related services

• Provide neuropsychological, psychological and forensic evaluations for legal purposes to individuals, law firms, agencies and courts

Teaching Experience:

Faculty Appointment September 2011-Present

Columbia University, Teacher’s College, New York, NY

PhD program in Psychology

• Instruction of neuropsychological and cognitive testing measures (SB-5, WJ-III, WISC-IV, etc)

• Supervision and training of graduate students for clinical testing at university clinic

The report was published on June 8 in  Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Previous research has shown that due to their exposure to chemotherapy and/or radiation, childhood cancer survivors may face up to a five-fold increased risk of cardiovascular disease and death, compared to the general population. Multiple studies have shown that most adult childhood cancer survivors report receiving only general medical care, not specific to their experience with cancer. Previous research also suggests that cancer survivors are not receiving recommended cardiovascular screenings in a timely manner due to limited awareness of future health complications by survivors and health care professionals.

“These findings make underdiagnosis and undertreatment significant concerns for the estimated half a million childhood cancer survivors living in the United States,” said lead study author Eric J. Chow, M.D., M.P.H., an associate professor in clinical research and public health sciences at the Fred Hutchinson Cancer Center in Seattle.

In this study, cardiovascular risk factor undertreatment was defined as being diagnosed with high blood pressure, high cholesterol or diabetes and having higher-than-recommended levels of “bad” cholesterol, triglycerides or blood glucose. (No detail were available about Type 1 or Type 2 diabetes diagnosis.)

Participants were recruited from the Childhood Cancer Survivor Study (CCSS), a large study that includes people who were diagnosed with cancer before age 21 between 1970 and 1999 at health care centers in the U.S. and Canada, and who survived at least five years. Between September 2017 and April 2020, researchers recruited from the pool of U.S.-based CCSS participants childhood cancer survivors who were at least 18 years old, free of heart disease or heart failure, living within 50 miles of nine major U.S. metropolitan areas (Atlanta, Boston, Denver, Houston, Minneapolis, Philadelphia, Pittsburgh, Seattle and Columbus, Ohio). Those recruited were also taking part in a separate clinical trial testing the potential of a telehealth-care plan to improve cardiovascular outcomes among long-term survivors of childhood cancer. Among this group, which was 85% white adults and 57% women, the most common types of cancer were leukemia, lymphoma and bone cancer.

Researchers measured blood pressure, lipids, glucose and hemoglobin A1c levels in nearly 600 adults (median age 37 years) an average of 28 years after cancer diagnosis and obtained similar data on a comparison group of nearly 350 same-age adults without a history of cancer. The analysis found:

Cancer survivors were more likely than those without a history of cancer to have hypertension (18% vs. 11%, respectively), abnormal lipid levels (14% vs. 4.9%, respectively) and diabetes (6.5% vs. 3.2%, respectively).

Participants in both groups had similar rates of underdiagnosed hypertension, high cholesterol and diabetes: 27.1% among cancer survivors and 26.1% among the comparison group. However, cancer survivors were 80% more likely to be undertreated for these conditions compared to their study counterparts.

“Serious heart disease is uncommon in young adults in the general population, which includes childhood cancer survivors, therefore, greater awareness of the significantly higher cardiovascular disease risk when there is a history of cancer is important,” Chow said. “Raising awareness among primary care professionals as well as improving survivors’ ability to self-manage their health may mitigate the increased risks. There are specialized heart disease risk calculators designed for cancer survivors, and those may be more accurate in predicting future cardiovascular disease risk than risk calculators designed for the general population.”

The analysis also included the results of a self-reported questionnaire assessing medical history, such as cardiovascular health and treatment; diet, exercise and other lifestyle habits; and people’s belief in the ability to manage their own health.

Information on the comparison group of peers who had no history of childhood cancer came from the 2015-2016 National Health and Nutrition Examination Survey, in which participants had standardized health examinations and in-home interviews, comparable to the questionnaire taken by the cancer survivors.

The most underdiagnosed and undertreated cardiovascular disease risk factors among the cancer survivors were hypertension at 18.9% and lipid disorders at 16.3%.

Among the cancer survivors, men were twice as likely to be underdiagnosed and undertreated for the cardiovascular disease risk factors; while survivors who were overweight or obese were 2-3 times more likely to be underdiagnosed and undertreated.

Cancer survivors who had two or more unhealthy lifestyle factors, such as physical inactivity and low consumption of fruits and vegetables, were twice as likely to be undertreated than the comparison group.

The study also found that childhood cancer survivors who reported higher self-efficacy – a stronger belief in their ability to manage their own health – had 50% lower odds of undertreatment for the cardiovascular disease risk factors studied. “That perhaps is not surprising, yet it suggests that efforts to help survivors learn how to take greater ownership of their health conditions may help to improve longer term outcomes,” Chow said. “This has been shown in patients with other chronic health conditions outside of cancer as well.”

Among the study’s limitations are the potential for measurement error and misclassification among the cancer survivors and comparison group because of one-time health assessments.

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Although cardiovascular disease, which includes heart disease and stroke, is more common among older people, the risks often begin much earlier in life. Previous research confirms physical and psychological abuse and other adverse experiences in childhood increase the risk of developing obesity, Type 2 diabetes, high blood pressure and high cholesterol, which, in turn, increase the risk for cardiovascular diseases.

Conversely, healthy childhood experiences — nurturing, loving relationships in a well-managed household, including having family members who are involved and engaged in the child’s life — may increase the likelihood of heart-healthy behaviors that may decrease the cardiovascular disease risks. In this study, researchers explored whether nurturing relationships and well-managed households may offset the likelihood of higher cardiovascular risk factors.

“Our findings demonstrate how the negative and positive experiences we have in childhood can have long-term cardiovascular consequences in adulthood and define key heart disease risk disparities by race and sex,” said study lead author Liliana Aguayo, Ph.D., M.P.H., social epidemiologist and research assistant professor at Emory University’s Rollins School of Public Health in Atlanta.

According to an AHA news release, researchers examined information from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, an ongoing, long-term study among 5,115 Black and white adults enrolled from 1985-1986 to 2015-2016. Study enrollment occurred in four U.S. cities: Birmingham, Alabama; Chicago; Minneapolis; and Oakland, California. More than half of the study participants were women, and nearly half were Black adults. At the start of the study, participants were 25 years old, on average. All participants received initial clinical examinations and eight additional examinations every few years to assess cardiovascular risks over 30 years.

At ages 33 to 45, participants completed a survey of questions to assess areas of their family life during childhood. For this analysis, three areas were examined:

Abuse: how often a parent or adult in their home pushed, grabbed, shoved or hit them so hard that they were injured; and how often a parent or adult in their home swore at them, insulted them or made them feel threatened.

Nurturing: how often a parent or adult made them feel loved, supported or cared for; and how often a parent or adult in the family expressed gestures of warmth and affection.

Household organization: did they feel the household was well-managed, and did their family know where they were and what they were doing most of the time. (No definitions or criteria were provided for the term “well-managed;” study participants were instructed to determine if the term described their childhood family experience.)

Participants were categorized based on their responses to the survey questions:

Roughly 30% of participants reported experiencing “occasional/frequent abuse,” which included those who responded, “occasionally or moderate amount of time” or “most or all of the time” to questions related to abuse.

About 20% of participants reported they experienced abuse “some or little of the time,” which was categorized as “low abuse.”

About half of the participants reported no childhood abuse and described their family life during childhood as nurturing and well-managed.

Among the adults who reported experiencing abuse during childhood, the risk of Type 2 diabetes and high cholesterol — but not obesity and high blood pressure — was higher, compared to the adults who reported no abuse in childhood. The increase in risk, however, appeared to vary depending on gender and race.

Researchers noted:

The risk of high cholesterol was 26% higher among white women and 35% higher among white men who reported low levels of abuse in childhood, compared to same sex and race adults who reported no abuse in childhood.

The risk of Type 2 diabetes was 81% higher among white men who reported occasional/frequent abuse during childhood, compared to adults who reported no abuse in childhood.

Black men and white women who said they experienced abuse and grew up in a dysfunctional household were more than 3.5 times as likely to develop high cholesterol as those who reported no abuse during childhood. In contrast, among people who reported growing up in a well-managed household, the risk of high cholesterol decreased by more than 34%.

An unexpected finding: The risk for cardiovascular disease risk factors was not higher among Black women who reported experiencing abuse in childhood.

Several limitations may have affected the study’s results. This study was a retrospective analysis of data collected in the CARDIA study in 2015-2016; no new surveys were conducted with the CARDIA study participants. The questionnaires about childhood family experiences were completed when the participants were adults, relying on memories, which may include some inaccuracies or incomplete recollections. In addition, participants’ BMI (body mass index), which is a measurement of weight according to height, was recorded only in adulthood, with no data on BMI during childhood for comparison.

“Further research is needed to better understand the potential mechanisms linking childhood abuse and family environment to higher heart disease risk factors, as well as the impact of structural racism and social determinants of health, which likely influenced the differences we found by race and sex,” Aguayo said. “This information is critical to strengthening cardiovascular disease prevention interventions and policies, particularly those that focus on people who experienced abuse or other trauma during childhood.”