How Positive Parenting During Early Childhood May Prevent Obesity

By Stone Hearth News

How positive parenting during early childhood may prevent obesityPrograms that support parents during their child’s early years hold promise for obesity prevention, according to a new study in the online February 6 issue of Pediatrics.

Today, one out of five American children is obese. Young children who are overweight are five times more likely than their peers of normal weight to be obese by adolescence. Obese children and adolescents, especially low-income and minority youth, are at increased risk for a range of medical, social and academic problems.

The new study led by Laurie Miller Brotman, PhD, professor of Child and Adolescent Psychiatry and Director of the Center for Early Childhood Health and Development at the NYU Child Study Center investigated whether early family intervention that was effective for parents of children with behavior problems, resulted in lower rates of obesity. This innovative study took advantage of two long-term follow up studies of high-risk children who had participated in evaluations of either ParentCorps or another effective parenting intervention, the “Incredible Years,” during early childhood. The study involved 186 children from low-income, minority families at high risk for obesity who were randomly assigned to family intervention or a control group when the children were approximately four years old. Behavioral family intervention in early childhood included a series of weekly 2-hour parent and child groups over a 6-month period. The interventions did not address nutrition, activity, or weight.

“Children who enter school with behavior problems are at very high risk for academic underachievement and school dropout, antisocial behavior, delinquency, obesity and other health problems. ParentCorps engages parents of high-risk children, reduces harsh and ineffective parenting and prevents early behavior problems from escalating into more serious and intractable problems,” said Dr. Brotman.

For more than a decade, Dr. Brotman and her colleagues have developed and evaluated programs for parents and young children living in urban poverty. ParentCorps, a culturally-informed family program for young children, helps parents to be more responsive and nurturing as well as more effective in their approach to discipline. ParentCorps graduates are more attentive and attuned to their children, spend more time playing and reading with their children and praise positive behaviors such as sharing with peers. After participating in ParentCorps groups, parents replace physical punishment with more effective strategies such as time out. ParentCorps has benefits for ethnically and socioeconomically diverse families, and is especially helpful for parents of children with behavior problems.

In both follow-up studies, children who were assigned to the intervention and children in the control condition were evaluated from three to five years later. The evaluation of children as they approached adolescence included examination of body mass index, sedentary activity and physical activity. In one of the studies, blood pressure and nutritional intake were also measured.

Children who received family intervention during early childhood had significantly lower rates of obesity compared to children in the control group. In the larger study, without intervention, more than half of the children with early behavior problems were obese by second grade. In contrast, among children with behavior problems who received ParentCorps in early childhood, only 24% were obese. Similarly positive effects were found across the two studies on sedentary behavior and physical activity. The one study that examined blood pressure and diet showed lower rates of blood pressure and relatively lower consumption of carbohydrates in adolescents who received early childhood intervention.

ParentCorps and other programs that promote effective parenting and prevent behavior problems at a young age may contribute to a reduction of obesity among low-income, minority youth.

Dr. Brotman’s co-authors include Spring Dawson-McClure, PhD, Keng-Yen Huang, PhD, Rachelle Theise, PsyD, Dimitra Kamboukos, PhD, Jing Wang, MA, Eva Petkova, PhD, of the Department of Child and Adolescent Psychiatry and Gbenga Ogedegbe, MD, of the Department of Medicine, Division of General Internal Medicine, NYU School of Medicine.

This study of health outcomes was supported by the J. Ira and Nicki Harris Family Foundation. The original randomized controlled trials were supported by grants from the National Institute of Mental Health and the Institute for Education Sciences to Dr. Brotman.


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Depression in Later Life a Harbinger of Dementia

Late-life depression, occurring after age 50 years, is associated with a significantly increased risk for dementia, and in fact may be an early sign of cognitive decline, new research shows.

“Studies such as the Rotterdam [Scan] Study in the Netherlands have found that people who had early-life depression had a risk of Alzheimer disease in later life,” lead author Ge Li, MD, PhD, from the University of Washington, Seattle, told Medscape Medical News.

“But is depression causing dementia, or is it an early symptom of dementia? We wanted to explore the temporal relationship between the 2 conditions,” Dr. Li added.

The study is published in the September issue of the Archives of General Psychiatry.

Early Manifestation of Dementia?

The investigators used data from the Adult Changes in Thought study, a large, community-based, prospective study of people aged 65 years and older who were free of dementia at baseline, and who were followed-up every 2 years for up to 15 years.

Participants in the study were Seattle-area members of the Group Health Cooperative health maintenance organization. The study had 3 phases of enrolment.

The first cohort of 2581 participants was recruited in 1994 to1996, 811 participants were enrolled in 2000 to 2002, and another 709 participants were enrolled in 2004 to maintain a cohort of more than 2000 participants at risk for dementia in each calendar year.

Baseline depression was assessed with the Center for Epidemiologic Studies Depression Scale, and participants who scored 11 or greater were deemed to have significant depressive symptoms. The participants were also asked whether they had suffered from depression in the past.

The study showed that during a mean of 7.1 years of follow-up, 658 participants (19.3%) developed dementia.

At baseline, 321 participants (9.4%) had significant symptoms of depression, and 21.2% reported a history of depression.

After adjusting for age, sex, wave of enrolment, and educational level, the researchers found that participants who had a depression score higher than 11 had a 71% higher risk for dementia (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.37 – 2.13).

In addition, the study showed that late-life depression, occurring after the age of 50 years, was associated with an increased risk for all-cause dementia (adjusted HR, 1.46; 95% CI, 1.16 – 1.84). However, early-life depression, occurring before the age of 50 years, was not associated with dementia risk (adjusted HR, 1.10; 95% CI, 0.83 – 1.47).

“We think that depression in later life might be an early manifestation of dementia. Our results confirm that late-life depression is linked to an increased risk of dementia, so if you have a long history of depression, that is probably not causing the dementia. It is more due to something happening in later life,” said Dr. Li.

Intervention Studies the “Next Step”

By the time someone meets the criteria for dementia, the disease is in its late stages. Early diagnosis, therefore, is very important, Dr. Li added.

“If depressive symptoms could be an early sign of dementia, this raises the possibility that we might be able to intervene at an earlier stage, where we might have some impact on the outcome,” she said.

Anton P. Porteinsson, MD, William B. and Sylvia Konar professor of psychiatry at the University of Rochester School of Medicine and Dentistry, New York, agreed that treating late-life depression might be a way of slowing the progression to dementia.

“We need to do observational clinical trials, but it seems to make sense. It’s pretty clear that depression and dementia, the most common neuropsychiatric disorders in the elderly, often co-occur, and this co-occurrence exceeds chance,” he told Medscape Medical News. “Depression clearly signals a higher risk of developing both mild cognitive impairment and dementia.”

Dr. Porteinsson pointed out that in the Alzheimer’s Disease Neuroimaging Initiative study, the presence of depressive symptoms correlated with brain atrophy and white matter damage in the brain.

“We don’t know the mechanism and the causative factors, but the correlation is there,” he said.

Also not yet known is whether treating the depression will mitigate the risk of progressing to dementia.

“That’s going to be the next thing for us to discover. Certainly there are short-term benefits in terms of quality of life, but are there also going to be long-term benefits in terms of better disease load and dementia risk? This is what we need to discover.”

Dr. Li and Dr. Porteinsson have disclosed no relevant financial relationships.

From Medscape Medical News > Psychiatry

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Risk Management

Risk Management: Quick Tips I

Risk Management: Quick Tips I

Click on image to view course webpage

This new online continuing education course addresses a variety of risk management topics in the form of seven archived articles from The National Psychologist.

Topics include:

  • Social Networking: How Should Psychologists Respond to Online ‘Friending’ Requests?
    Many who read this article are likely to have a knee-jerk response of, “No way can a therapist accept a friend request from a client under any circumstance!” As with most ethical dilemmas, the avoidance response of “don’t” is not always applicable, as it is not always the correct or most helpful response.
  • Some Additional Thoughts on Social Networking
    Therapists who choose to use social networking and other electronic means as a way to exchange information with clients must deal with the multitude of confidentiality issues and other risk management questions created by doing so. This article reviews the confidentiality, legal and ethical issues involved.
  • Malpractice Insurance 101: Claims-made vs. Occurrence Coverage
    The purpose of this article is to acquaint early career psychologists and those who may be confused about insurance with an important issue to consider when shopping for professional liability coverage: What type of insurance should you buy?
  • Progress Notes: What Not to Write Down
    This article provides suggestions and considerations for what to (and not to) write in your progress notes.
  • Triple Jeopardy: Dangers of an APA Ethics Complaint
    For most psychologists, professional licensure is a prerequisite for their livelihood and professional identity. Most of us know psychologists are in “double jeopardy” when it comes to practice vulnerability. Malpractice lawsuits and complaints before state licensing boards can drastically restrict a psychologist’s ability to practice. This articles reviews the issues and offers suggestions.
  • When Marital Therapy Isn’t & When Marital Therapy Is
    These articles discuss the use of creative billing, to include creative diagnostics, in order to provide marital therapy under an insurance plan.

This course is intended to provide psychotherapists of all specialties with a set of brief, practical tips for dealing with risk management challenges that present themselves in everyday practice. Course #10-42 | 2011 | 13 pages | 8 posttest questions | 1 Hour CE

Ethics in Therapy: Quick Tips I

Ethics in Therapy

Click on image to view course webpage

This new online CE course addresses a variety of ethics topics in the form of seven archived articles from The National Psychologist and is intended to provide psychotherapists of all specialties with a set of brief, practical tips for dealing with ethical dilemmas that present themselves in everyday practice.

Topics Include:

Office ‘Bookstore’ Should Not be for Profit
By Jeffrey E. Barnett, PsyD, ABPP

Psychologists frequently make recommendations to clients for books to read, workbooks and CDs to use, and even movies or television shows to view. In fact, bibliotherapy, the integration of such media into ongoing psychotherapy is a widely used and often highly effective addition to psychotherapy. Learn the issues involved to avoid crossing any boundaries.

Ethical, Effective Marketing for Your Private Practice
By Susan Giurleo, PhD

Many psychologists are cautious, confused and unsure of how to market their work. Many worry that marketing is unethical and something that we should not consider as we pursue a private practice career. Learn effective, ethical marketing techniques you can use to market your practice.

Law Impacts Psychology
By Richard Lawlor, PhD, JD

Over the past several years many articles have appeared in this newspaper for practitioners dealing with various aspects of psychology and the law. Some dealt with a substantive area of psychology and its impact on the law, for example research on children’s memories and the implications for interviewing children and using them as witnesses. Discover the areas of law that psychologists need to be aware of, and understand.

Duty to Warn is Now Duty to Protect
Review by Milton F. Shore, PhD, ABPP

Book review of: The Duty to Protect: Ethical, Legal and Professional Considerations for Mental Health Professionals by Werth, J.L., Welfel, E. and Benjamin, G.A.H. (Eds.) 2009. Washington, D.C. American Psychological Association.

Test Givers Must be Qualified
By Jeffrey E. Barnett, PsyD, ABPP

As a busy professional, it makes great sense to utilize others when it is appropriate to do so. This can be a much more efficient way to work than doing everything yourself. But, the situation is more complex when clinical activities are involved. Learn the ethical issues, laws and regulations for use of non-licensed subordinates in the provision of clinical services.

To Collect or Not to Collect?
By Ofer Zur, PhD

In today’s economy and financial difficulties the questions regarding fees and debt collection from clients seem to be more frequent and more relevant. In times of economic crisis, many people who have lost their homes or jobs understandably seek psychotherapy to better cope with stress due to mounting debt and loss. Explore the relevant professional, relational, clinical, ethical, legal and unintentional consequences aspects of this issue.

Duty to Warn, Protect Differs in HIV Cases
By Jeffrey E. Barnett, PsyD, ABPP

The situation where a client who is HIV-positive or who has AIDS reports having unprotected sex with another person or having done so in the past raises a number of ethical challenges. Explore the relevant issues of informed consent, confidentiality and exceptions to confidentiality, laws concerning the duty to warn and protect when threats of dangerous behavior are made and case law that may impact these areas.

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