A great deal of research over the years has focused on the devastating effects of bullying on the mental health of its victims. However, a recent study also suggests that children with mental disorders such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and depression are much more likely to engage in bullying behavior toward others.

Lead author Dr. Frances Turcotte-Benedict, a Brown University masters of public health student and a fellow at Hasbro Children’s Hospital in Providence, presented the findings at the American Academy of Pediatrics’ national conference in New Orleans on October 22. Turcotte-Benedict and her colleagues reviewed data provided by parents and guardians on mental health and bullying in the 2007 National Survey of Children’s Health, which included nearly 64,000 children ages 6 to 17 years.

In the survey, 15.2 percent of children were identified as a bully by their parent or guardian. Children with a diagnosis of depression or ADHD were three times as likely to be identified as bullies; children diagnosed with ODD were identified as bullies six times more often than children with no mental health disorders. The study found no noticeable differences between boys and girls—both were at increased risk for bullying when a mental health disorder was present.

Traits associated with ODD, such as aggression and revenge-seeking, appear to be clear risk factors for bullying. The connection between bullying and ADHD may be less obvious. “Even though, by definition, these children [with ADHD] aren’t angry or aggressive toward their peers, they do display traits that would increase the likelihood of having impaired social interactions,” explains Dr. Steven Myers, a professor of psychology at Roosevelt University in Chicago, in an October 22 interview with the Huffington Post. “If you’re not really thinking through the consequences of your actions on the playground, you might not have the self-monitoring or restraint to hold back from bullying.”

“These findings highlight the importance of providing psychological support not only to victims of bullying, but to bullies as well,” concludes Turcotte-Benedict. “In order to create successful anti-bullying prevention and intervention programs, there certainly is a need for more research to understand the relationship more thoroughly, and especially, the risk profile of childhood bullies.”

What do you think? Should bullying prevention programs do more to address the mental health problems of the bully? PAR wants to hear from you, so leave a comment and join the conversation!
It’s an age-old question, but now there’s science to give us an answer.

No, men and women cannot just be friends.

However, the reasons may be more complicated than you imagine. According to researchers at the University of Wisconsin-Eau Claire and published in the Journal of Social and Personal Relationships, attraction between members of cross-sex friendship is a common event. Furthermore, these “platonic” friendships have potential negative consequences for the individuals’ long-term romantic relationships.

Researchers surveyed more than 80 male-female pals and found that men were more attracted to their female friend than women were to their male friend. Men also tended to consistently (and mistakenly) believe that their female friend was more attracted to them than they actually were. Even if the woman in the pair was involved in a romantic relationship with another person, this did not deter most men – even if their gal pal was taken, this had no impact on their attraction.

Women, though, reported much less desire to date their male friends if they were already involved in a relationship. Younger females and middle-aged participants who reported more attraction to an opposite-sex friend also reported less satisfaction in their current romantic relationship.

In another survey conducted by the researchers, men reported that there was more to gain from attraction in friendships, while women felt that there was more to lose.

Do you have a successful cross-gender platonic friendship? Do you think that men and women can ever really just be friends?
New research has made the famous 1972 marshmallow test even more compelling. The original Stanford University study on delayed gratification, which promised children an extra marshmallow if they could resist the one in front of them for 15 minutes, analyzed whether a child’s ability to delay gratification had any correlation on future success. Today, researchers have taken that information a step farther – finding that a child’s ability to resist temptation isn’t innate, but highly influenced by environment.

Researchers from the University of Rochester gave five-year-olds used crayons and one sticker to decorate a piece of paper. One group of children was told they would receive a new set of art supplies, but never received it. For the second group, however, researchers made good on their promise and provided the children with new crayons and better stickers. Both groups were then given the marshmallow test.

The children who were promised the supplies and never received them waited an average of three minutes before eating their marshmallows. The children who had received the supplies promised resisted temptation for an average of 12 minutes, leading researchers to believe that experience plays into a child’s ability to delay gratification. Wait times reflected not just the child’s self-control abilities, but suggest a child’s reasoning of the stability of the world around them and their understanding of whether waiting to delay gratification would ultimately pay off. According to researcher Celeste Kidd, delaying gratification is only a rational choice if the child believes that the second marshmallow is likely to appear. Though children do not monitor every single action of the adults around them, they do have an overall sense of the reliability or unreliability of the people around them.

The group found that children may have more sophisticated decision-making abilities based on their environments than originally thought.
The CPT code numbers that mental health professionals use for billing psychotherapy services to insurance carriers will change on January 1, 2013. In addition to the code changes, Medicare reimbursement rates will also be revised. The AMA will publish the new codes and rates later this fall.

The American Psychological Association’s Practice Central Web site outlines some of the anticipated changes, which include:

1.  Outpatient and inpatient psychotherapy codes will be replaced by a single set of codes that can be used in both settings.
2.  The new psychotherapy codes will have specified times rather than ranges:


  • 30 minutes, not 20-30 minutes

  • 45 minutes, not 45-50 minutes

  • 60 minutes, not 75-80 minutes


3.  The single psychiatric diagnostic evaluation code will be replaced by two codes: one for a diagnostic evaluation and the other for a diagnostic evaluation with medical services.


What practical steps do you need to take now in order to prepare for these changes? According to the American Psychiatric Association, the pharmacologic management code will no longer exist, so it is important for practitioners to start familiarizing themselves with the medical evaluation and management (E/M) codes for medication management. Practitioners should also review any contracts they have with insurers to make sure that the contracts don’t limit them to specific codes in the psychiatry section that may be replaced as of January 1. HIPPA requires that insurers use current CPT codes, so these companies should be updating contracts in the coming months.

For the latest information about these changes and how they may affect your practice, visit the American Psychological Association’s Practice Central Web site or call its Practitioner Helpline at 1.800.374.2723.
On October 15, PAR author Lisa Firestone, PhD, will be hosting a CE Webinar with violence expert Dr. James Gilligan on the topics of understanding and preventing violence. For more information on the Webinar, visit Dr. Firestone’s blog. To register for the Webinar, click here.
Adults with disabilities, particularly mental illness, have been found to be at an increased risk of being a victim of violence, according to a study funded by the World Health Organization’s Department of Violence and Injury Prevention and Disability. This finding, a meta-analysis of 21 studies, found that one in four people with a mental illness experience some type of violence in a given year – a much higher rate than that experienced by the general population.

The chance that a person with a mental illness will experience physical, sexual, or domestic violence was found to be 3.86-fold higher than the odds of an adult without any disabilities at all. However, violence against individuals with other disabilities was common – it was found that individuals reporting any disability were 50 percent more likely to experience physical, sexual, or intimate partner violence in the prior 12 months than those individuals without a disability, and 60 percent higher for people with intellectual impairments.

Researchers believe that their inclusion criteria probably underestimated the prevalence of violence against people with disabilities because many of the studies were based in high-income countries with lower reported rates of violence. Furthermore, there were no studies of violence against individuals with intellectual disabilities in institutional settings or studies of individuals with sensory impairments included in the analysis.

Approximately 15 percent of adults worldwide have a disability.
While every baby is different, the sleepless nights are something that most parents of infants can’t escape.

Sleepless nights don’t just equal tired parents, though. Sleep deprivation can double mom’s risk of suffering from depression and can lead to marital strife. But how should tired parents teach their babies to sleep?

While some parents believe letting their child “cry it out” will teach self-soothing behaviors, other parents believe that letting their child cry will cause their little one to feel insecure and abandoned. However, exhausted moms and dads have some new research on their side that can (hopefully) afford them a little shut eye.

A new study released in the journal Pediatrics followed 225 babies from seven months old until age 6 to compare the difference between parents who were trained in sleep intervention techniques and those who were not. The sleep intervention group was told to select either “controlled crying,” which had them respond to their infant’s cries at increasing time intervals, or  “camping out,” which asked them to sit with their child until he or she fell asleep, removing themselves earlier each night over a three-week period.

Families in the sleep training group reported improved sleep. Mothers were also less likely to experience depression and emotional problems. Furthermore, it was determined that those children in the sleep training group were not harmed by letting them cry it out. Researchers found no differences between these children and the children in the control group in matters of mental and behavioral health, sleep quality, stress, or relationship with their parents at age six. Allowing babies to cry for limited periods of time was found to help the entire family sleep better without causing psychological damage. Furthermore, an earlier study found that sleep training does work – babies learn to go to sleep easier and stay asleep longer than their counterparts.

No matter which method parents choose, they can feel better knowing that while it may seem that their infant is stressed when he or she is crying, researchers believe that it is good stress and it will have no lasting impact on the parent-child bond.
Heavy marijuana use during adolescence has now been linked to lower IQ scores later in life, according to a study published last month by the National Academy of Sciences.

The study, which tracked 1,037 subjects from birth to age 38 years, found that those who began smoking marijuana as teenagers and used it regularly throughout adulthood scored approximately 8 points lower on an IQ test than they had at age 13 years. In comparison, the IQ scores of non-users, as well as those who started using marijuana as adults, were stable. Small to medium declines in memory, processing speed, and executive function were also seen in regular users.

“We know that there are developmental changes occurring in the teen years and up through the early 20s, and the brain may be especially vulnerable during this time,” said Dr. Madeline Meier, a researcher at Duke University and lead author of the study, in an August 27 New York Times article.

The results of this study are in direct contrast with beliefs common among adolescents that marijuana use is harmless to health. “Adolescents are initiating cannabis use at younger ages, and more adolescents are using cannabis on a daily basis,” study authors said. “Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents.”

Although the authors ruled out several alternative explanations for the neuropsychological effects (such as hard drug use, alcohol dependence, and schizophrenia), they acknowledge that their results must be interpreted within the context of the study’s limitations. “There may be some ‘third’ variable that could account for the findings,” they said. “The data cannot reveal the mechanism underlying the associations between persistent cannabis dependence and neuropsychological decline.”

What do you think? Is there a disconnect between common beliefs about marijuana use and the reality of its long-term effects on health? PAR wants to hear from you, so leave a comment and join the conversation!
One of the world’s most popular and trusted assessments of cognitive impairment is now available as a convenient app for smartphones and tablets. Like the paper-and-pencil version, the app can be used to screen for cognitive impairment, to select patients for clinical trials research in dementia treatment, or to track patients’ progress over time.

The MMSE/MMSE-2 app includes a brief instructional video that walks users through the features of the app. In addition to the original MMSE, both standard and brief versions of the MMSE-2 are available, enabling health care providers to choose the version that will suit each client. Scoring is done automatically, and patient records can be uploaded directly to an electronic medical records (EMR) system or e-mailed to appropriate personnel. Equivalent, alternate forms of the MMSE-2 decrease the possibility of practice effects that can occur over serial examinations. The app also includes norms for the MMSE and the MMSE-2, by age and education level.

The MMSE/MMSE-2 app is available to qualified health care professionals from the Apple® App StoreSM (for the iPhone® or iPad®) and from Google Play (for Android™ devices). The app is free—users pay only for administrations, which start at $1.25 each.

 
Editor’s Note: Last week, we blogged about non-medical prescription drug use (NMPDU) and a study that linked it to depression in college students. This week, we follow up with one of the study’s coauthors, Dr. Amanda Divin, from Western Illinois University. In the study, Dr. Divin found that young women were more likely to abuse painkillers than young men. We wanted to learn more.

PAR: Why might females be more likely than males to use painkillers if they were feeling hopeless, sad, depressed, or suicidal?

Dr. Divin: Well, there are lots of reasons. First, the properties of opioid painkillers are that they block pain reception in the brain but also increase release of dopamine in the brain which results in euphoria. So the pharmacological properties of painkillers make them attractive to people who may be feeling the blahs of depression or other depressive symptoms.

Second, research indicates that females have greater exposure to prescription drugs with addictive potential (e.g., opioid painkillers and anti-anxiety drugs) and are more likely to be prescribed a drug than males. If you look at the literature, and even empirical evidence, it's very common for a woman to go to a doctor complaining of symptoms, and she is given a prescription for a painkiller or sedative, whereas a male may be given different advice or treatment.

Third, women are more likely to suffer from depression. Their physiology also makes them more likely to become addicted to painkillers (females actually need a lower dose of opioids than males do to experience the same amount of painkilling effects).

If you put all those things together, it almost seems like common sense that females are more likely to self-medicate. I do want to point out, however, there have been other studies which have found the opposite—that it’s males [who are more likely to self-medicate]. There is still a lot of research and replication that needs to be done.

PAR: Why did you decide to conduct this study? How did it affect you personally?

Dr. Divin: I'm a professor, so I work with college students every day. It’s not at all uncommon that a student will come talk to me about their problems. It’s very common that prescription drug use or depression/suicidal thoughts are among those problems. In talking with my colleague Keith Zullig [from West Virginia University], who has done a lot of research on prescription drugs, we decided this was an area that really needed to be investigated. This study personally affected me in a couple of ways: I read just about every single article that had ever been printed regarding prescription drug use—and wow, did this open my eyes to what a commonplace, everyday sort of thing NMPDU is, how easy it is to acquire prescription drugs, and just how socially acceptable it has become. Both the NMPDU and suicide literature also opened my eyes to the stress college students are under nowadays and how stress, depression, and NMPDU are all connected. I will say some of the scariest things I learned from doing this research are about the very dangerous side effects and risks that prescription drugs carry.

PAR: What advice would you give to college students using non-medical prescription drugs?

Dr. Divin: My best advice would include a few things:

(1) If you're feeling depressed, the solution isn’t going to be found in a pill bottle. NMPDU only offers a temporary solution to a very real and pervasive problem. The best thing to do is go see a professional. On most college campuses, seeing a doctor or mental health professional is free! In the final analysis, you are just temporally postponing the problem and possibly creating others in the process.

(2) Prescription drugs carry very real and dangerous side effects. Just because they were approved by the FDA doesn't mean you’re not going to have an adverse or deadly reaction.

(3) If you are currently taking several different prescription drugs non-medically, be very careful of the possible drug interactions.

(4) There is no shame in admitting you have a problem and need help.

 

This interview was conducted by Grace Gardner, a recent graduate from the University of South Florida and an editorial assistant in the Production Department at PAR.