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Hilber Psychological Services

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The Effects of Screen Time on Kids

The recent question of concern considers how all that screen time impacts the physical structure of your kids' brains, as well as their emotional development and mental health. The National Institutes of Health hopes to answer this question by studying the adolescent brain development. Anderson Cooper, correspondent of CBS 60 Minutes, interviewed different researchers to get a better understanding the research we are looking for.

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 The first wave of data found significant differences in the brains of nine and ten-year-olds who spend more than seven hours a day of screen time, compared to those who don’t. These brains showed premature thinning of the cortex, the part of the brain that processes information from the five senses. The study also revealed that kids who spend more than two hours a day on screens got lower scores on thinking and language tests. While this research may take a significant amount of time to complete, researchers hope to answer not only how much time are they spending, how they perceive it impacting them, but also what are some of the outcomes. And that will get at the question of whether there's addiction or not.

 Dr. Dimitri Chrisrakis at Seattle Children's Hospital, speaks on the recommendation for parents to, "avoid digital media use, except video chatting, in children younger than 18 to 24 months." In his 60 Minutes talk, “Toddlers need laps more than apps”, Dr. Chrisrakis warns that babies playing with iPads do not transfer what they learn from the iPad to the real world. This is a critical period for human brain development. Apps on iPads with lights, colors, and sounds are more stimulating to an infant than an original toy. His research proves that kids are less likely to put down an iPad while playing with it, than they are to put down a toy. Tristan Harris, former Google manager, explains that phones and apps are being designed to capture and keep kids' attention. Apps use specific techniques to get people to use the product for as long as possible.

 Until recently, it was impossible to see what happens inside a young brain when a person is focused on a mobile device. Dr. Bagot is among scientists who believe screen time stimulates the release of the brain chemical dopamine, which has a pivotal role in cravings and desire. The idea is that people are more likely to continue checking their devices in order to keep the good feelings. Teenagers now spend on average four and a half hours a day on their phones. All that time has resulted in a fundamental shift in how a generation of American kids acts and thinks. Jean Twenge, a psychology professor at San Diego State University has spent years combining surveys of people since the 1960s. She discovered sudden changes in the behavior and mental health of teens born in 1995 and later, the first generation to spend their entire adolescences with smartphones. Twenge found that the percentage of teens who reported drinking or having sex fell. But the percentage who said they were lonely or depressed spiked. It's possible other factors may have played a role, but Twenge says she wasn't able to identify any that correlated as closely as the growing popularity of the smartphone and social media.

 It is difficult to say whether it's the specific things that teens are doing on their phones that's the problem. Or whether it’s just the amount of time that they're spending on their phones that is the problem. With new technological shifts, people become excited and amused without realizing the consequences until years later when it’s too late. Tech companies have created ways to monitor screen time or set time restrictions on apps, but most parents aren’t aware of these tools. Twenge believes smartphones, as well as most devices, are great when they are used for the right purpose. It is the excessive use of apps and social media that cause harm. She states, “it should be a tool that you use. Not a tool that uses you.”

 The purpose of this article is not to frighten parents, but to educate them on the effects screen time can have on kids. This is not to say remove electronics completely but beware of what part of technology is actually benefiting you, and what part is harming you. If your child is using an excessive amount of screen time, learn more about the tools that can help prevent this future addiction.

If you have questions about children development and the effect of screen time please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services. 

~Written by Allison Parker and Tanya L. Hilber, PsyD 

Reference: Cooper, Anderson. “Groundbreaking Study Examines Effects of Screen Time on Kids.” CBS News, CBS Interactive, 9 Dec. 2018, www.cbsnews.com/news/groundbreaking-study-examines-effects-of-screen-time-on-kids-60-minutes/

Consistent Use of ADHD Medication May Stunt Growth by 2 Inches

According to the article, "Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds", written by Dr. David Rabiner, "although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists". The Multimodal Treatment Study of ADHD (MTA Study) tested 600 7–9-year-old children with ADHD. These children were randomly assigned into one of these four groups: 
1. Carefully monitored medication treatment
2. Intensive behavior therapy
3. Medication treatment combined with behavior therapy
4. Community care (parents obtained whatever treatment they want)

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After 14 months, the study showed that those children who received carefully monitored medication treatment or medication treatment combined with behavior therapy had lower levels of overall ADHD symptoms and better overall adjustment compared to those children who received intensive behavior therapy or community care. The results stayed the same after an evaluation 10 months later. However, evaluation after 1 year and again after several groups showed no group differences based on the initial group treatment assignments. Therefore, the initial benefits of the medication had disappeared. The study continued annually through age 18 and then reduced visits to age 25. Within this group, individuals were categorized based on their medication usage:
a. Consistent, i.e,. those who had met the minimum threshold during each year;
b. Inconsistent, i.e., those meeting the minimum threshold in some but not all years; and
c. Negligible, i.e., below the minimum threshold in all years. 

At the last evaluation, age 25, participants self- and parent-reported, and doctors measured the patient's height compared to other individuals around the area that had not been diagnosed with ADHD in their childhood. Based off of the medication categorized above, only 14.3% of participants consistently used medication through age 18. After comparing the other participants, participants with ADHD maintained substantially higher ADHD symptoms over time regardless of their initial treatment. It was clear that ADHD symptoms in young adulthood are not related to patterns of medication use through adolescence. 

There was thus no indication that consistent medication treatment over a number of years had any persistent impact. However, there was a relationship found between persistent medication use and adult height. According to Dr. Rabiner, "Students in the Consistent and Inconsistent medication treatment groups had average heights — combined across these groups — that were about an inch shorter than those in the Negligible treatment group. And, participants in the Consistent Group were nearly an inch shorter on average than those in the Inconsistent group, i.e., nearly 2 inches shorter than those in the Negligible group". 

Overall, the study concluded there was substantial persistence of ADHD symptoms into adulthood and although the benefits of medication treatment on ADHD symptoms dissipate, the impact on adult stature persists. However, it is possible that some other factor that contributed to some participants taking medication more consistently, e.g., more severe symptoms, also explains the reduced height attainment in this group.

There are many take home messages:
1. Relatively few youth with ADHD use medication consistently over their development.
2. Many individuals with ADHD will continue to struggle with ADHD symptoms into adulthood. 
3. Although medication helps control symptoms in the short-term, it is not a cure.
4. It is unknown whether optimal medication treatment maintained over many years would have a greater impact.
5. Parents and clinicians need to balance the need for persistent treatment in some children with the likely consequences of reduced adult height. 

Due to the symptoms that may occur from using persistent medication, an optimal solution would be to find the lowest effective dose of medication, or combine medication treatment with other behavior therapy and/or other approaches.

If you have questions about ADHD and how it can affect you or your child or would like to schedule an appointment, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services

~Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Rabiner, David. “Consistent Use of ADHD Medication May Stunt Growth by 2 Inches, Large Study Finds.” SharpBrains, SharpBrains, 28 Mar. 2018.

Top 7 things anxiety sufferers want those without it to know
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Sometimes suffering from anxiety can be hard to understand if you don't suffer from it yourself. People without anxiety often think "Just breathe and you'll be fine" or "What's the big deal?". But to people with anxiety, it's a really big deal. Here are the top 7 things anxiety sufferers want those without it to know. 

1. People with anxiety obsess over the little things. 
Things that seem like little things to you, are actually really big things to people who suffer with anxiety. Something as "small" as being looked at wrong or ignored can be very daunting. Situations like these stick with them throughout the day causing even more problems. So the next time something "small" happens, recognize it can be big to them. 

2. People with anxiety have every intention of going to an outing, but at last minute cancel. 
As these daunting ideas continue through out the day, our decision to go out to the movies or dinner becomes the worst idea in the world. Although people with anxiety want to go out, their thoughts often get the best of them and lead to only one decision, canceling. 

3. We are exhausted. 
The constant thinking and question can take a toll on a person who suffers from anxiety. Distracting thoughts throughout the day lead to staying up late at night constantly thinking. This leads to a lack of sleep and struggle to wake up in the morning. Waking up is a struggle for everyone, but imagine what it's like for someone with anxiety. 

4. Anxiety sufferers replay conversations in our head.
When your mind is constantly thinking and running through every possible scenario, you often start to explain a topic faster than possible. All of a sudden, what you're saying isn't making sense. This can be embarrassing for someone who suffers from anxiety. With that feeling of embarrassment, they often shut down. This doesn't mean they're in a mood, they're just struggling with that moment. 

5. Anxiety sufferers compare themselves to others. 
It's hard for someone with anxiety to understand how easy it is for people to get over things. When they see in person or on social media everything that is going on in other people's lives, they often question why it's so much harder for them. This causing even more of an issue when they begin worrying about why they're so worried all the time. 

6. Anxiety sufferers obsess over mistakes and beat ourselves up over it:
When something goes wrong, they often blame themselves. Therefore, when they make a mistake, they obsess over it. Doing things wrong and believing they're not good enough can lead to bigger problems. It's no surprise they're perfectionists. 

7. Finally: please, please don’t give up on us.
Sometimes, when a person with anxiety has no other option than to give up on themselves, they really need YOU to not give up on them. Although it can be frustrating and hard to understand, don't give up on them. 

People who suffer with anxiety are aware of how irrational they may sound. They know what they are going through and they're trying their hardest. Before giving up on them, try to understand them. 

While this information is geared towards individuals who suffer with anxiety, this same information about empathy and understanding emotions can be used to all individuals with disasbilties. 

 Contact us for more information on individuals who suffer with anxiety, learning and expressing emotions, or for help with children who are struggling.

~Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Mazza, Laura. “Top 7 Things Anxiety Sufferers Want Those without It to Know.”Love What Matters. 

The Cognitive Triad and Cognitive Distortion Part 1: by Dr. Ben Alpert

During the first therapy session, I like to teach patients about the different styles of therapy that might help them depending on their specific problem or issue. Cognitive Behavior Therapy (CBT) is an orientation based on the Cognitive Triad, the connection between Thoughts, Feelings and Behaviors. Patients usually nod their heads at this psychology jargon stating that they grasp the basic concepts but in order to help connect it to their real lives, I introduce the following scenario:

Imagine you’re in high school and sitting in the front row of math class. There is one empty seat next to you and the minute before the bell rings for class to start, your best friend sits down next to you. You say “Hey, what’s up!” and your friend doesn’t respond and doesn’t even look at you. Class begins and the teacher is standing right in front of you so you can’t talk, text or pass notes until class is over. Why didn’t your friend respond? What are you thinking? What emotions are you feeling? What physical reactions occur in your body? How are you behaving in the moment? How will you act after class?

Your answer to all of these questions will depend on your specific personality characteristics, life experiences and perhaps on the psychological issues (anxiety, depression, PTSD, low self-esteem, relationship conflict) you may be struggling with. Your brain starts moving at a mile a minute to figure it all out.

Let’s break this math class situation down because it’s sometimes hard to differentiate between thoughts, feelings and behaviors.

Thoughts: Why didn’t my friend talk to me? What did I do wrong? Are they angry at me? Did I say or do something that made them angry or upset? Let’s replay every conversation I have had with them over the past week or month or year or decade. This may take a while. Was it that joke I told? Maybe they took it the wrong way? Did I forget their birthday or to call them back? Did they think I was trying to hit on someone they liked? Did I not wear pink on pink day last week? Are they still angry that I borrowed their favorite stuffed animal when we were 5 and I never gave it back? I always do these things, nobody will ever like me. Wait, maybe something terrible happened to my friend, maybe someone died, who could it be, oh this is terrible. Your mind will continue to jump from place to place struggling to figure out what might be occurring.

Wow, all of those intense thoughts have now led to a whirlwind of emotions.

Moods/Emotions/Feelings: I am so anxious about all of the things I might have done or might have happened. I feel super depressed because my friendship may be over. I am so angry at them for feeling this way about me.

These emotions are so strong, I can feel them physically.

Physical Reactions: I may throw up, my heart is racing, my lungs feel heavy, I am sweating, I am shaking.

Now that I am experiencing all of these physical changes, I can’t just let it go, I am going to do or say something at the end of class.

Behaviors/Actions: In the moment: Lack of focus on math. After class: I am too scared to talk to my friend, maybe I’ll just walk out of class without talking to them (this may lead to a rift in your relationship). I am going to yell at my friend or say the meanest things I can to them for not talking to me because I am certain that they are angry at me so I am going to attack first. Let me come up with that list of meanest things now so I will be ready. Perhaps you bad mouth your friend behind their back or tell others that you are angry or upset with this friend for what they did which could lead to the destruction of your friendship or their friendships with others. Some of these may seem like extreme reactions but they happen all the time.

Gosh, that’s a lot of stuff going on in terms of possible thoughts, feelings, physical reactions and behaviors! Now what if I told you that your friend was just super tired because they stayed up late watching a movie, they barely got any sleep and they didn’t even hear you say hello. You have just spent the last 45 minutes creating countless scenarios of what you may have done wrong, you are possibly highly anxious, super depressed or incredibly angry, you made yourself physically ill, you may hurt or destroy your friendship with your behaviors afterwards by separating or retaliating, oh and you didn’t learn any math so you might fail the next test all because you created a false reality in your head. Learning how to stop this spiral is crucial in learning how to better our relationships and also manage stress, anxiety and depression.

In part two we will discuss why this happens and what to do to stop ourselves from getting caught in negative thought spirals. Check it out here: Part Two

Be well,

Dr. Ben Alpert :-)

To discuss this and other issues or behaviors in detail, contact us at Hilber Psychological Services. To read more about cognitive distortion, feel free to click on this additional blog post.

Burns, D. D. (1999). The feeling good handbook. New York, N.Y., U.S.A: Plume.

Greenberger, D., & Padesky, C. A. (2016). Mind over mood: change how you feel by changing the way you think. Second edition. New York, NY: The Guilford Press.