TIME Mental Health/Psychology

Children With Mental Health Problems Are Also at Risk as Adults

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A new study suggests that psychiatric problems in childhood are linked to several negative outcomes in adulthood

Having psychiatric problems in childhood is challenging enough, but new evidence suggests that these problems can lead to issues as an adult—even if the problems do not persist into adulthood.

A new study published in JAMA Psychiatry used data from a survey of 1,420 children from 11 counties in rural North Carolina. The children were followed over time and assessed annually between ages 9 and 16 for common psychiatric problems, like depression, anxiety and behavioral issues. The researchers found that 26% of children in the group suffered some form of behavioral or emotional disorder; another 31% displayed “subthreshold” psychiatric problems, or a few symptoms of psychiatric problems without being diagnosed with the condition.

“In terms of most types of health problems, kids are the healthiest,” says lead author Dr. William Copeland of Duke University Medical Center. Most chronic health diseases take hold during middle age, but “one exception is mental health problems, which occur at the onset of childhood and adolescence,” he says. These can include ADHD, behavioral or conduct problems, anxiety and depression.

Out of the initial survey group, 1,273 people were later re-evaluated three times at the outset of adulthood—ages 19, 21 and 25—to see how the now-young adults had fared in four areas: health, the legal system, personal finances and social functioning. These included negative life events like being incarcerated, dropping out of high school, having trouble keeping a job and having a serious health problem or addiction, Copeland says. “Nineteen and 21 are a peak period in terms of criminal behavior, substance problems, and transitioning from the home,” he says, and age 25 is when things typically start to stabilize.

Of the young adults who had suffered from a subthreshold psychiatric problem in childhood, 42% suffered an adverse outcome in adulthood. Of the kids who had behavioral or emotional issues as kids, 60% of them reported having trouble as adults. By comparison, just 20% of the young adults who had no psychiatric issues reported adult problems.

In other words, having a diagnosed psychiatric issue as a child made him or her six times more likely to experience at least one adverse effect as an adult and nine times more likely to suffer from two or more adverse outcomes. Children who had subthreshold symptoms without an official diagnosis faced three times the risk of having one adverse outcome and five times the risk of having two or more adverse outcomes.

Copeland thinks this is proof that mental health needs to be addressed early on and without stigma. “We need to focus on prevention and intervention,” he says. “If we want to reduce the cost and distress associated with many social problems, we really need to address them earlier.”

TIME Innovation

Buying Food in Bulk Is a Waste of Money

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These are today's best ideas

1. Stop buying food in bulk.

By Eric Holthaus in Slate

2. In rural India, delivering clean drinking water requires lots of power. Enter the solar desalinator.

By Julia Sklar at MIT News

3. Find out why we might be wrong about America’s stagnant wages.

By Josh Zumbrun in the Wall Street Journal

4. We’re overprescribing antipsychotic drugs for our kids.

By Nancy Shute at NPR

5. When robots make work obsolete, will humanities education make a comeback?

By Jonathan Malesic in the New Republic

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Research

This Is the Healthiest Month to Be Born In, According to Science

A new study identified 55 diseases associated with birth month

Read an interview with the study’s author.

Your birthday may be more important than you think when it comes your health.

Scientists at Columbia University used an algorithm to identify “significant associations” between the time a year a person is born and 55 diseases, including ADHD, asthma and heart disease. The new study, which was published in the Journal of American Medical Informatics Association, concludes that people born in May have the lowest overall risk for disease, while people born in October have the highest.

Though previous research had explored the connection between disease risk and birth season, this study confirmed 39 associations as well as laid out 16 new ones. Researchers looked at more than 1,600 diseases and 1.7 million patients treated in New York between 1985 and 2013 to identify the months most associated with asthma (October and July babies), ADHD (November babies, matching a Swedish study), and nine kinds of heart disease. They plan to replicate the study in other locations, to better identify the environmental factors contributing to such disparities.

“It’s important not to get overly nervous about these results because even though we found significant associations the overall disease risk is not that great,” said Nicholas Tatonetti, the study’s senior author and an assistant professor at Columbia University Medical Center. “The risk related to birth month is relatively minor when compared to more influential variables like diet and exercise.”

For more on the study, read an interview with Columbia’s Tatonetti here.

TIME Developmental Disorders

The Kids Most Likely to Have ADHD In the U.S.

The latest report on attention deficit hyperactivity disorder shows higher risk by gender, race and family income

Using data collected from parent reports of the developmental disorder attention deficit hyperactivity disorder (ADHD), the Centers for Disease Control and Prevention says that boys, white children and kids living in poverty have the highest rates of the condition in the U.S.

The information on ADHD, collected from a representative sample of U.S. families between 2011 and 2013 as part of the National Health Interview Survey, shows that 9.5% of children ages four to 17 were diagnosed with ADHD. The diagnosis was more common among older children than in younger ones.

Twice as many boys as girls were diagnosed, and more white children than any other race were told they had ADHD.

Family income also seemed to contribute in some way; children on public insurance had the highest rates of ADHD at 11.7%, compared to those with private insurance (8.6%) and children without insurance (5.7%). More children from families with incomes less than 200% of the federal poverty line were diagnosed with the condition than those from families living at about that threshold.

While the survey only showed a snapshot of the rates of ADHD broken down by gender, race and family income, the information could help public health officials better understand who is being diagnosed with the condition and potentially find better ways of providing support to those families, both in school and at home. “In view of the economic and social costs associated with ADHD and the potential benefits of treatment, the continue surveillance of diagnosed ADHD is warranted,” the report authors from the CDC’s National Center for Health Statistics write.

TIME neuroscience

How Air Pollution Affects Babies in the Womb

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A new study finds evidence that prenatal exposure to common pollutants can contribute to hyperactivity, aggression and more in kids

It makes sense that an expectant mom’s exposure to pollutants in the air can affect her still-growing baby’s lungs and respiratory system. But there’s increasing evidence that such compounds can also harm brain development and contribute to behavioral and cognitive problems later in childhood.

In the latest study on the subject, published in JAMA Psychiatry, researchers for the first time pinpointed exactly which areas of the brain are affected if a baby is exposed to car exhaust and the byproducts of burning home heating oil. These polycyclic aromatic hydrocarbons (PAHs) have previously been linked to developmental delays, lower verbal IQ. signs of anxiety depression and problems with attention. But researchers haven’t been able to identify which areas of the brain are most vulnerable.

MORE: Children Exposed to More Brain-Harming Chemicals Than Ever Before

In this study, they recruited 40 mothers and their children living in the inner city who were participating in an ongoing study of pollution’s effect on development. They were selected because they had low exposure to environmental factors other than PAHs that could affect development, such as tobacco smoke, lead, insecticides and other chemicals. Based on measurements of PAH in their surroundings, about half of the mothers had PAH exposures below the median of those in the larger group, and half had PAH exposures higher than the median.

“The effects were extraordinarily powerful,” says Dr. Bradley Peterson, director of the Institute for the Developing Mind at Children’s Hospital Los Angeles and lead author of the study. “The more prenatal exposure to PAH, the bigger the white matter problems the kids had. And the bigger the white matter problems, the more severe symptoms of ADHD, aggression and slow processing they had on cognitive tasks.”

MORE: Mom’s Exposure to Air Pollution Can Increase Kids’ Behavior Problems

White matter is made up of the fibrous connections between nerve cells and is critical to helping neurons from one part of the brain communicate with their counterparts in other regions, and the babies with the highest exposure to PAH in the womb showed a dramatically lower volume of white matter in the left side of their brains. The entire left hemisphere, from the front to the back, was affected. “You would assume that an environmental exposure brought in by the blood and circulating to the brain would affect both sides of the brain,” says Peterson. “But the adverse effects of PAHs is located on one side; that’s surprising.”

The asymmetrical effect speaks volumes about how PAHs target brain tissue. Like other neurotoxins, they may preferentially seek out actively developing tissue. During gestation, the left side of the brain, which houses language capabilities, may be undergoing more intense structural changes in preparation for birth. This was supported by the fact that in the larger group of children in the study, those who were exposed to PAHs around age five didn’t show the same left-sided bias; in the older children, the pollutants affected both sides equally because the right hemisphere of the brain is undergoing active development at that time as well.

MORE: ADHD Linked to the Air Pregnant Women Breathe

Peterson suspects that the connection between PAHs and later behavioral and cognitive symptoms such as inattention, hyperactivity and slow processing speed may be due to how PAHs disrupt the normal communication between nerves in the left side of the brain and elsewhere.

The problem, he admits, is that moms-to-be can’t easily change where they live or work. And most people aren’t aware of how many PAHs they absorb on a daily basis. There are ways to minimize the risk of exposure, however. Expectant mothers can avoid secondhand smoke, a major source of the compounds. Not directly inhaling exhaust from cars on busy streets or smoke from fireplaces can also help, as can spending as much time as possible in parks or other areas free of burning fuels. It won’t eliminate the risk from living in an inner city and being surrounded by car emissions, but it can help, Peterson says. “Even if you can reduce your exposure from moderately high to moderate levels, it’s going to have a beneficial effect on the developing fetus,” he says.

TIME

There’s a Promising Pill For Binge Eating Disorder

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Correction appended, Jan. 15, 2015

A drug typically used to treat ADHD in adults and kids may also be an effective treatment for binge eating disorder, a new study shows.

In the study, published in the journal JAMA Psychiatry, researchers tested the safety and effectiveness of the drug lisdexamfetamine dimesylate on people with binge eating disorder—those who repeatedly eat an excessive amount of food, accompanied by a sense of having no control. When people took the drug every day for 11 weeks, half of them stopped binge eating entirely, which was more than the placebo group.

A drug that can treat both ADHD and an eating disorder may seem like an odd pairing, but lisdexamfetamine dimesylate works by acting on the dopamine and norepinephrine systems in the brain, which are two pathways that help control rewards and control. People with binge eating disorder can experience reward dysfunction and be very impulsive, similar to symptoms in people with ADHD. Norepinephrine helps with focus and concentration, while the dopamine helps recalibrate the rewards system—so the drug may help binge eaters feel more in control and able to avoid mindless eating.

“This study adds to our toolbox in that we have another treatment to potentially offer to people suffering binge eating disorder,” says study author and eating disorders and obesity expert Denise E. Wilfley of Washington University School of Medicine in St. Louis. “What we really want is a comprehensive treatment plan. There is a lot of loneliness and isolation needs to be met.” (Pharmaceutical company Shire, which has a version of lisdexamfetamine dimesylate, funded the trial and has supported prior research performed by Wilfley as well).

Another drug called topiramate has been used similarly to treat eating disorders, but has been shown to have some serious side effects, including cognitive problems. But in the new study, lisdexamfetamine dimesylate caused side effects similar to those in people with ADHD who take the drug, none of them serious, the results showed. One patient in the new study died, but the cause of death was determined to be methamphetamine overdose. The study authors do not believe it was related to the study.

Other treatments like cognitive behavioral therapy and interpersonal psychotherapy have already proven to be successful at treating binge eating disorder—which was only formally recognized as a disorder in 2013—but this study didn’t compare the effectiveness of the drug to the other treatments. Another question researchers want to explore is whether the drug wears off at night, a common time for people to binge, so more research is needed.

Even so, the fact that the drug succeeded because it was able to give a person more cognitive control opens the door to other non-pharmacological treatments, some of which show impressive results. Meditation, for instance, has been shown to help enhance executive function, as has exercise. Given how recently binge eating disorder was formally recognized as a problem, researchers hope there will soon be a variety of ways to treat it.

Correction: The original version of this story misstated the relationship between the pharmaceutical company Shire and the trial’s research. The company funded the study.

TIME Parenting

The 5 Trends Driving the Surge in ADHD

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Researcher says it's less to do with brain chemistry and more to do with money

Until recently, 90% of all Ritalin takers lived in the U.S. Now, America is home to only 75% of Ritalin users. But that’s not because Americans are using less of the drug, says a Brandeis professor. That’s because ADHD diagnoses, and treatment via pharmaceuticals are growing in other parts of the world.

In a recent paper in the journal Social Science and Medicine, sociologists Peter Conrad and Meredith Bergey looked at the growth of ADHD in the United Kingdom, Germany, France, Italy and Brazil and found that prescriptions for Ritalin-like drugs have risen sharply, particularly in the U.K. and Germany.

Attention Deficit Hyperactivity Disorder, or ADHD, is a controversial subject among many parents, educators and medical professionals. Some doctors insist it’s a genuine neurological condition, if occasionally over-diagnosed and not treated properly. Others believe parents are giving their children drugs unnecessarily. (For a look at what it’s like to be, or parent, an ADHD child, read TIME’s special report, Growing Up with ADHD).

Conrad and Bergey, while not doctors, fall into the second camp. They list five possible reasons for the jump in ADHD diagnoses that have little do with medicine.

1) Pharmaceutical companies are well-resourced and determined lobbyists, and have coaxed some countries to allow stimulants, such as Ritalin and Adderall to be marketed more directly.

2) Treating patients with counseling and non medical therapies is becoming less popular than treating them with medicine. (Many insurers, including Medicaid, will pay for drugs but not for psychotherapy, for example.)

3) The Diagnostic and Statistical Manual (DSM), the bible of mental disorders, is gaining more traction in Europe and South America. The DSM has slightly broader standards for diagnosing ADHD than the system used by many other countries, the International Statistical Classification of Diseases and Related Health Problems (ICD), hence more folks are falling within the standard.

4) ADHD advocacy groups are raising awareness of the condition.

5) Because everybody is occasionally fidgety and distracted and nearly everybody despairs of not getting enough done, people turn to the internet for answers and find checklists put up by drug companies, with overly general questions like: “Are you disorganized at work and home?” and “Do you start projects and then abandon them?” and encourage people to ask their doctors about medication.


According to the study, fewer than 1% of kids in the U.K. had been diagnosed with ADHD in the 1990s, but about 5% are today. In Germany, prescriptions for ADHD drugs rose 500% over 10 years, from 10 million daily doses in 1998 to 53 million in 2008. Conrad, author of The Medicalization of Society, worries that we may be addressing a sociological problem with a chemical solution.

“There is no pharmacological magic bullet,” says Conrad, who suggests that the one-size-fits-all compulsory education system might be more to blame for kids who can’t sit still rather than a flaw in brain chemistry.

“I think we may look back on this time in 50 years,” writes Conrad, “and ask, what did we do to these kids?”

TIME Developmental Disorders

ADHD Linked to the Air Pregnant Women Breathe

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Alan Hicks—Getty Images Heavy traffic can pollute the air with compounds that can contribute to ADHD

Everything an expectant mother does can have an impact on her baby’s development—including the air she breathes

Research has long connected what a mom-to-be eats and drinks to the health of her baby, and recent studies have even linked behavioral experiences such as stress, sleep and mood to the growing fetus’s development.

Now, scientists reporting in the journal PLOS ONE have pinpointed one exposure that could contribute to a baby’s higher risk of developing attention deficit hyperactivity disorders (ADHD), which the latest data from the Centers for Disease Control show affects around 11% of children aged four to 17 years.

MORE: Early Exposure to Air Pollution Tied to Higher Risk of Hyperactivity in Children

Frederica Perera, director of the center for environmental health sciences at the Mailman School of Public Health at Columbia University, and her colleagues focused in on how the pollutants in the air that pregnant women breathe can affect their babies’ cognitive development. Perera previously found a correlation between polycyclic aromatic hydrocarbons (PAHs) emitted by burning fossil fuels (such as in car exhaust and some forms of residential heating) to developmental delays by age three, reduced IQ in kindergartners and attentional problems by age six. So the team looked specifically at symptoms associated with concentration and evaluated how these effects connected to PAHs might be contributing to ADHD.

The scientists measured the level of PAHs in both the cord blood retrieved when the mothers gave birth and the mothers’ blood following delivery. They also collected urine samples from the children at age three or five years and analyzed them for PAH levels. The children born to mothers with higher levels of PAH during pregnancy had five-fold increased odds of showing symptoms of ADHD than those who were born to mothers with lower levels. The effect remained strong even after the researchers adjusted for the babies’ exposure to air pollution and smoking after birth.

“This is a new finding, and if the PAHs are identified as a contributor to ADHD, that opens up new avenues for preventing ADHD,” says Perera.

MORE: Study Links Exposure to Pollution with Lower IQ

PAHs, says Perera, circulate in the body for a long time, so even brief exposures could contribute to changes in the body. And each person processes the chemicals differently. Some may be more prone to breaking down the compounds into their potentially toxic elements, while others are less affected by the exposure.

While mothers may not be able to control some exposures, such as those from traffic and heating sources, there are some ways that expectant women can reduce their risk. Pushing local legislators to adopt clean air laws is one way to improve air quality, and on a more personal level, families can make sure that cooking areas have proper ventilation, avoid burning candles and incense and other sources of PAHs, and most importantly, ensure that they aren’t exposed to tobacco smoke. “Air quality is a policy problem, but individuals can be empowered to take steps,” Perera says.

MORE: Mom’s Exposure to Air Pollution Can Increase Kids’ Behavior Problems

Women who are pregnant can also eat more antioxidants from sources like fresh fruits and vegetables, since these can counteract some of the oxidative damage that PAHs wreak on fetal cells.

Perera stresses that limiting exposure to PAHs isn’t the only answer to reducing the increasing rate of ADHD in the country. Genetic and other environmental factors all contribute to the disorder, but identifying as many potential factors as possible could start to reduce the effect that the chemicals have not just on mothers, but on their developing babies as well.

TIME Mental Health/Psychology

Why Schools Should Screen Their Students’ Mental Health

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Two new reports argue for in-school mental health screenings

Schools should be a first line of defense for catching young people at risk for mental health issues from depression to ADHD, a pair of new reports says.

Kids and adolescents spend a significant amount of their time in school, yet providing mental health screenings and care is not an overarching requirement for many schools. “We need to think about how to embed mental health services so they become part of the culture in schools,” says study author Dr. Mina Fazel, a child psychiatrist at the University of Oxford. “It will take a commitment from health and education.”

The reports, published in The Lancet Psychiatry, looked at programs already implemented in both high-income schools and middle- and low-income schools. The authors made suggestions for both education systems. For instance, schools could conduct school-wide screenings by asking teachers to identify at-risk kids for further evaluation, or health counselors could be trained to spot both physical and mental issues by looking for visible signs like weight fluctuation or bullying. If treatments like cognitive behavioral therapy were included in a school’s health offerings, Fazel believes mental health problems could be caught early and treated.

“If we made mental health part of the usual health system of a school, then it becomes more normal…and hopefully it will then be easier to access it,” says Fazel. According to data presented in the reports (which is UK-specific but also looks at U.S. programming), about 75% of adults who access mental health treatment had a diagnosable disorder when they were under age 18, but in high-income countries, only 25% of kids with mental health problems get treatment.

Stigma is largely to blame for a lack of participation in mental health care. “[Mental health] is the service that people seem to know least about, seem to fear accessing most, and think they will be negatively viewed by their peers or their teachers or their families if they access those services,” says Fazel.

Some schools in the U.S. and abroad have had success with mental health screenings and programs, but implementation still hasn’t been made a standard, which Fazel thinks is a lost opportunity. By prioritizing mental health in a child’s early years, more people will get the treatment they need early on.

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