Anxious Parents Can Transmit Anxiety to Children, Twin Study Shows

The association between parental and offspring anxiety and neuroticism appears to be environmental rather than genetic—that is, children and adolescents learn anxious behaviors from their parents rather than inheriting anxiety genetically.

That’s the conclusion of a remarkable study titled "The Intergenerational Transmission of Anxiety: A Children-of-Twins Study" by Thalia C. Eley, Ph.D., of Kings College London and colleagues at institutions in the United States and Sweden. The study was published in AJP in Advance.

Researchers used data from the Twin and Offspring Study of Sweden comprising information on 387 monozygotic twin families and 489 dizygotic twin families. Parental anxious personality was self-reported by twins using 20 items from the Karolinska Scales of Personality. Offspring anxiety symptoms were measured using items from the Child Behavior Checklist (30). Twins, their spouses, and offspring all reported on offspring behavior over the previous six months. A method of statistical analysis called Structural Equation Modeling allowed the researchers to quantify the effects of additive genetic, common environmental—that is, nongenetic effects that make members of a nuclear family similar to one another—and nonshared environmental effects (which make members of a family different from one another) of parental anxiety.

For both anxiety and neuroticism, the models provide support for significant direct environmental transmission from parents to their adolescent offspring. In contrast, there was no evidence of significant genetic transmission, according to the report.

Robert Freedman, M.D., editor of the American Journal of Psychiatry, told Psychiatric News, “This study is a landmark, because it is the first to clearly establish the early transmission of anxiety symptoms from parents to children, not through their shared genetic background, but rather from the way in which anxious parents raise their children. Parents who are anxious can now be counseled and educated on ways to minimize the impact of their anxiety on the child's development.”

For related information, see the Psychiatric News article “CBT for Child Anxiety May Confer Long-Term Protection From Suicidality.”

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Youth in Various Ethnic Groups Give Different Reasons for Receiving MH Treatment, Study Finds

Racial and ethnic minorities were more likely than whites to endorse externalizing or interpersonal problems and less likely to endorse internalizing problems as reasons for mental health treatment, according to a report online in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers at Emory University and colleagues analyzed data from the 2005-2008 editions of the National Survey on Drug Use and Health on nearly 2,800 adolescent participants who experienced a major depressive disorder and received mental health treatment in the prior year. Racial/ethnic differences in endorsing each of 11 possible reasons for receiving treatment were examined and adjusted for sociodemographic characteristics, health and mental health status, treatment setting, and survey year.

The researchers found that despite similar depressive symptom profiles, Hispanic adolescents were more likely than whites to endorse “breaking the rules or physical fighting” as reasons for mental health treatment. Black adolescents were more likely than whites to endorse “problems at school,” but less likely to endorse “feeling afraid/anxious” or “trouble eating” as reasons for treatment. Asian adolescents were more likely to endorse “interpersonal problems” but less likely than whites to endorse “suicidal thoughts/attempt” and “feeling depressed” as reasons for treatment.

“These findings are not surprising," said Annelle Primm, M.D., APA deputy medical director and director of APA's Division of Diversity and Health Equity, who reviewed the study. "They illustrate that culture counts with respect to a group’s conceptualization of mental illness. Giving reasons of externalizing or interpersonal problems may represent a person's preference for embracing explanations that fit within the realms of cultural norms versus accepting pathological labels, which can be severely stigmatizing and humiliating in some cultural groups.”

For related information, see the Psychiatric News articles, "For Better Mental Health Care for Latinos, Look at Neighborhoods" and "How Americans' View of Black Men Affects Mental Health Care."

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Resting the Brain Appears to Help Concussion Victims Recover, Study Finds

Too much thinking may hinder recovery from concussion, suggests a study of the effects of cognitive activity on the duration of postconcussion symptoms. Physical and cognitive rest are considered central to recovery from concussion but prior research on the importance of cognitive activity was unclear.

The study assessed 335 athletes (average age 15) seen in a sports concussion clinic at Children’s Hospital Boston. Ice hockey, football, basketball, and soccer players accounted for most of the patients. The researchers found that total symptom burden at the first visit and cognitive activity were associated with the duration of concussion symptoms, said William Meehan, M.D., and colleagues online January 6 in Pediatrics. Meehan is with the Brain Injury Center and Division of Sports Medicine at Children's Hospital Boston.

“[C]ognitive rest entails limiting activities that require attention and concentration, such as reading, text messaging, video game playing, working online, and performing schoolwork,” the researchers noted.

They hypothesize that adenosine triphosphate (ATP) might help explain how cognitive rest affects recovery. ATP is needed in brain cells to restore homeostasis, but decreased cerebral blood flow following concussion causes an imbalance between increased need for ATP and a decreased supply, which prolongs concussion symptoms. “One of the reasons for instituting cognitive rest is to conserve the limited ATP supplies for injury recovery, as opposed to using ATP for intellectual tasks,” they said. Complete abstinence from those cognitive tasks is not necessary, they said, but they recommend academic accommodations until the concussion symptoms disappear.

To read more about the effects of concussion, see the Psychiatric News article, "New Effort Begins to Prevent, Intervene on Concussions." Also see the study, "Outcomes of Sport-Related Concussion Among College Athletes" in the Journal of Neuropsychiatry and Clinical Neurosciences.

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ADHD Diagnoses Rise 66 Percent Over 10-Year Period

In 2010, 10.4 million children and adolescents were diagnosed with attention-deficit/hyperactivity disorder (ADHD) during an outpatient visit, a substantial jump from the 6.2 million ADHD diagnoses made in 2000. These data come from a new study published in the March/April Academic Pediatrics. For the study, Craig Garfield, M.D., of Northwestern University led a team of researchers in reviewing ADHD diagnosis and treatment data from the IMS Health National Disease and Therapeutic Index. The rise in ADHD diagnoses has been accompanied by an increase in the treatment of these patients by specialists, such as child psychiatrists, rather than primary care physicians, the researchers found. Garfield noted in an interview with HealthDay that the surge in ADHD diagnoses may be attributable to increased public awareness and media coverage of the disorder and to pharmaceutical companies advertising products to treat ADHD. Read more about the increasing number of ADHD diagnoses in Psychiatric News.

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Bullying Hard to Define, but Still Must Be Tackled

A recent blog in the Washington Post looked at how society has a hard times defining bullying among young people, especially in schools. “Though we can all agree that bullying is wrong, we can’t agree on exactly what it is,” wrote Janice D’Arcy. But stopping bullying doesn’t involve identifying and punishing mean kids, wrote psychiatrist Stuart Twemlow, M.D., in Psychiatric News.

 Bullying is a social process, not a personal one, said Twemlow, a professor of psychiatry at Baylor College of Medicine and co-author with Frank Sacco, Ph.D., of Preventing Bullying and School Violence (American Psychiatric Publishing). “Shaping the child's behavior with social-skills training won’t effect change in the system until group dynamics, often unconscious, are discussed and resolved,” he said. “All schools need to take steps to mold a set of ideas or an approach to prevent bullying, adapt it to their cultural context, and get very high buy-in from staff and parents. Then a school can truly become a creative social, emotional, and intellectual learning environment.”

For purchasing and additional information see Preventing Bullying and School Violence.

Stuart Twemlow’s comments on bullying are published in Psychiatric News.

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New Data on Effect of "Black Box" Warning for Children Using Antidepressants

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How did the 2003 FDA advisory warning on suicidality among children using SSRI antidepressants affect the recognition and treatment of depression in children? A new analysis appearing in Psychiatric Services (July 2011) indicates that the so-called “black box” warning may have diminished the likelihood of making an outpatient visit for depression but not the prescription of an antidepressant in the case of a diagnosis of depression. “National Trends in Prescribing an Antidepressant Before and After an FDA Advisory on Suicidality Risk in Youths” is posted at  http://psychservices.psychiatryonline.org/cgi/content/full/62/7/727. For further coverage of the findings, see the next issue of Psychiatric News, and for information on the “black box” warning, see http://pn.psychiatryonline.org/content/42/19/1.1.full.