Wednesday, October 01, 2014

Early Puberty, Again.

Plenty of adolescent fare popped up in media this week including perennial favorites early puberty and the perils of screen time (in addition to smoking pot, depression and anorexia). I might have let these media darlings go but they kept re-appearing on my homepage and radio. I have two middle-schoolers, I could not not comment.

I especially couldn’t ignore the early puberty banter considering it came from a name I knew quite well - Laurence Steinberg, a foremost adolescence expert and professor of psychology at Temple University - who penned an opinion piece published at CNN entitled Obesity, early puberty and why we should be concerned:

The high obesity rate among very young children is worrisome for many reasons. One is that obesity causes children to go through puberty earlier. American children have been maturing at an increasingly younger age, and one of the reasons is that more youngsters are overweight.

His central argument rests on the assumption that girls and boys are entering puberty at increasingly younger ages:

Just how much has the age of puberty fallen? At the beginning of the 20th century, the average American girl got her first period sometime between the ages of 14 and 15. Today, it is closer to 12. The first signs of puberty -- like "breast budding" -- are visible even earlier. In 1960, the average age of breast budding was 13. By the mid-1990s, it had fallen below 10.

It sounds so plausible. Unfortunately, the evidence is limited and far from conclusive. Granted, there is better evidence for earlier breast development though this research only started in the past few decades, mostly in the US. It’s anyone’s guess how early colonial girls needed training bras. Cotton Mather didn’t mention it.

As for age at first period, the jury is still out. Those “average American girls” Steinberg refers to? They’re a very small “sample” of northern Europeans living in the rural US around the early 1900s. There is some evidence suggesting no historical shifts occurred and yes, even some suggesting increasing age of first menarche. Also note, the Tanner Scales, the current reigning medical benchmark of pubertal development (still in use today!) comes from observations of British youth living in orphanages in the 1950s and 60s, war orphans. Enough said. I’ve written about the evidence related to increasing earlier puberty before and won’t get into it here.

Even news-ish sources like WebMD, the fine purveyor of medical knowledge, don't pretend obesity is the single, overwhelmingly most important factor of early puberty. Fortunately someone there decided to list at least a few other potential risk factors like ethnicity and international adoption.

Oh Steinberg does mention a few others:

The high rate of childhood obesity over the past 40 years is not the only reason our children are maturing earlier sexually. Children's exposure to chemicals called "endocrine disruptors" -- substances found in foods and in many consumer products, from plastics to cosmetics that throw off normal hormonal functioning -- is probably playing a role.

There is also speculation that increased exposure to light—including artificial light emitted by computers, tablets, and smartphones—may be a contributor. CNN

So the esteemed psychologist mentions not the familial or socio-cultural factors linked to earlier puberty, the ones studied for decades and decades, but targets plastics and electronics. Does anyone else find this slightly odd? 

He ignores hereditary factors, family discord, absence of a father and other chronic social stressors linked to earlier puberty. So light from tv might cause girls to sprout breasts but not living with chronic stress. Light bad, elevated cortisol levels, okay? For love of PMS, he edited the first volume of The Handbook of Social Psychology published in 2009. The chapter on puberty addresses the issue of earlier onset of puberty including many risk factors.

To speak of obesity as if it is definitely driving youth into puberty earlier than ever does not fit the facts. To speak of it as a done deal is not accurate. So of course I was curious why Steinberg latched on to obesity and earlier puberty. Frankly I'm still not clear but he took to the media (including NPR) to promote his new book:
In Age of Opportunity, Steinberg leads readers through a host of new findings — including groundbreaking original research — that reveal what the new timetable of adolescence means for parenting 13-year-olds (who may look more mature than they really are) versus 20-somethings (who may not be floundering even when it looks like they are). He also explains how the plasticity of the adolescent brain, rivaling that of years 0 through 3, suggests new strategies for instilling self-control during the teenage years. Packed with useful knowledge, Age of Opportunity is a sweeping book in the tradition of Reviving Ophelia, and an essential guide for parents and educators of teenagers. Amazon.

That small paragraph is remarkable.

New timetable of adolescence

Plasticity of the adolescent brain...

…rivaling that of years 0 to 3

Reviving Ophelia

Translation: Parents, don’t relax now. You have one more chance in adolescence to mess up your child for good.

But I still don’t see why all the fuss about obesity and puberty. Maybe nutrition is Steinberg’s side project? Maybe he is fixated on childhood obesity. Maybe he and Michelle Obama are tight? 

Does he need to convince parents that kids are developing earlier so they (we) have more time to worry? 

In any event it doesn’t justify the use of shoddy historical data or misrepresenting the so-called “causes” of early puberty. 

This mess certainly doesn't help this parent of two adolescents who is trying to navigate the complexities of screen time, homework-related screen usage, the screen-related social demands of adolescence or the new school requirement that each middle schooler bring a very expensive, fragile, highly addicting laptop to school every day. 

Next up: Save some of your screen time for adolescence and screen time/media use.

Wednesday, September 24, 2014

Artificial Sweeteners Are Bad For You?

A clutch of new studies published in Nature suggest artificial sweeteners might contribute to obesity and diabetes or as the Wall Street Journal so elegantly phrased it "trigger unwanted changes." At least some people appear more at risk but who can tell with news coverage like this:
The scientists performed a multitude of experiments, mostly on mice, to back up their assertion that the sweeteners alter the microbiome, the population of bacteria that is in the digestive system. New York Times
Multitude of experiments? (i.e...... 4).

Mostly on mice. 

Scientists doing studies to back  up their assertions. (As opposed to studies that don't back up their assertions.)

Microbiome (i.e. instant credibility, instant anxiety for you and me). 

The experts must have some grand theory if not evidence as to why fake sugar wrecks havoc with gut bacteria:
Researchers aren't sure about the exact mechanisms causing the imbalance in the gut bacteria populations. Wall Street Journal
At present, the scientists cannot explain how the sweeteners affect the bacteria or why the three different molecules of saccharin, aspartame and sucralose result in similar changes in the glucose metabolism. New York Times 
NBC News wrote about bacterias Bacteroides and Clostridiales, as if you or I care, but proceeded to dispense with all science and reason in the headline: 
How Can Diet Sodas Make You Fat? Study May Explain It. 
Some study indeed might explain it but not this one.   

I should cut the media a break because even Nature, the organization that published the study, forgot what the study really studied:
Sugar substitutes linked to obesity. Nature 
They forgot the study assessed gut bacteria, not obesity. Thank goodness they didn't drag out diet soda too. 

USA Today didn't stop at obesity, diabetes or even artificial sweeteners. They couldn't resist giving an expert the chance to haul out other public health nuisances:
In trying to understand why certain diseases like food allergies and diabetes have been increasing, Nagler said she looks to things that change gut microbes, such as the introduction of antibiotics, changes in diet, Cesarean-section births, the introduction of formula and the elimination of infectious diseases. Cathryn Nagler, University of Chicago
Girlfriend got cut off before mentioning screen time, cyber-bulling and early puberty. In any event there seems to be a growing consensus among experts that artificial sweeteners should be taken off the shelf:
“I think the validity of the human study is questionable.” - Dr. Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health.  New York Times
An unbiased expert? 

Reuters had to go all the way to Glasgow to dig up an expert who wasn't very impressed: 
"Animal data for many experiments do not show the same effect in humans, which can sometimes be quite the opposite," and "current epidemiological data in humans do not support a meaningful link between diet drinks and risk for diabetes, whereas sugar rich beverages do appear to be associated with higher diabetes risk." - Naveed Sattar, University of Glasgow
Favorite new public health term: unsupervised use of artificial sweeteners.

FNPHT: Courtesy of lead author, Eran Elinav, a physician-immunologist at Israel's Weizmann Institute of Science, via Wall Street Journal. 

Wednesday, September 17, 2014

Quack Child Psychology: The experts are not fooled by pseudoscience

A recent study polled child mental health experts on the credibility of questionable psychological practices. The experts, mainly child psychologists, rated assessments and treatments on a scale ranging from "not at all discredited" to "certainly discredited" or in lay terms, "not too bad" to "utter b.s." 

Many finely honed psychological instruments such as Enneagrams, biorhythms, handwriting analysis and the Fairy Tale Test did not pass muster with the professionals. The Rorschach, in comparison, received mixed reviews. Treatments that got the skeptical side-eye include but are not limited to past life regression therapy, crystal healing, and withholding food or water. I can only hope, since I’ve yet to read the entire study, that Conversion Therapy got skewered in the hot mess of harmful and hateful cures.

Anti-Pseudoscience SuperHero and Certified Quack-Busting Therapist, Gerald Koocher (photo credit: DePaul University)
No one here is surprised the research team could piece together over 100 questionable mental health protocols. I am slightly surprised however and disappointed the media ignored this story. A quick Google search revealed no mainstream or really much of any media save those content-gobbling curators picked this one up. Not even Natural News.

It is fabulous starting with lead author, Gerald Koocher, dean of the College of Science and Health at DePaul University, past president of the American Psychological Association and author of the not-published-soon-enough book, Psychoquakery. He should step out into the media spotlight more often and not just because he rocks nerd better than Bill Gates or any Brooklyn hipster.

The Huffington Post and others should heed his advice:

There are several signs that a psychological assessment or therapy is “quack,” said Koocher. First, it addresses a challenging or hard-to-treat problem by proposing an overly simple solution. Psychoquackery also is usually in sync with the spirit of the times and is often promoted by a charismatic expert. Science Daily

Be still my heart.

Charismatic expert. Psychoquackery. Spirit of the times.

...paging Dr. All-Natural, Organic, Neuro-Imaging, Lactating, Brain-Training, Endocrine-Disrupting, You’ve Already Messed Up Your Kid So You Must Be Vigilant In The Small Remaining Time You Have Left…

Fortunately Koocher got to the other clues you should forget recovered memories and other psychobabble that give psychologists a bad rep:

“Parents must be able to ask the right questions. ‘What studies have been done to show the effectiveness of this?’ And if someone says to you, ‘Medical science is keeping a lid on this because it’s too powerful and will put them all out of business,’ that’s a strong sign that a treatment is too good to be true,” Koocher said.

It might also be a sign someone is either sociopathic or delusional. No, I'm not a licensed clinical psychologist so I can't accept third party payments or charge you for that totally accurate diagnostic assessment-atizing. I can however keep this on my website because of that disclaimer below.  

Now if you’ll excuse me I need to go delete "Certified on the Fairy Tale Test" from my LinkedIn profile.

UPDATE: My third-grader came home from school and reported he was an Orange. Naturally he took this as confirmation he should play as many sports as possible. Rest assured, the True Color Personality Test is somehow based on the Meyers-Briggs and as I am clearly a Green l will spare you any links to the no doubt highly valid and reliable online proliferations of the test.

Gerald P. Koocher, Madeline R. McMann, Annika O. Stout, John C. Norcross. Discredited Assessment and Treatment Methods Used with Children and Adolescents: A Delphi Poll. Journal of Clinical Child & Adolescent Psychology, 2014; 1 DOI: 10.1080/15374416.2014.895941

Thursday, September 11, 2014

Early Intervention for Austim: A miracle cure the media cannot resist

A new pilot study suggests intervention as early as 6 months could reduce or eliminate autism symptoms in children at high risk. Published on Tuesday in the Journal of Autism and Developmental Disorders, media quickly jumped all over the very small study despite its highly speculative findings:

 Pilot Intervention Eliminates Autism Symptoms In Babies Huffington Post

Autism Therapy in 6-Month-Old Babies Eliminates Symptoms in Limited Study Newsweek

Treating Infants for Autism May Eliminate Symptoms NBC News

Study finds early treatment for infants may remove signs of autism Fox News

Taking Action Early May Protect Against Autism WebMD

Could early intervention erase signs of autism? CNN

Could early intervention reverse autism? CBS News

Earlier Help for Children at Risk for Autism Wall Street Journal

The Wall Street Journal hedged its bets and didn’t say much of anything. Not so for Huff Po and Newsweek who declared this latest children’s health discovery a sure thing. The rest of the lot had the good sense to throw in a question mark or otherwise acknowledge that the early intervention, however successful it might prove in the future, is not yet the second coming. 

Did I mention this study intervention involved a mere 7 children 6-15 months old? That's how many kids I could sit in my dearly departed minivan, I couldn't possibly call it a sample.

Despite the tentative nature of the study, Huff Po ran with the results delivering no hint of caution in its opening lines:  

A small new pilot study has found that parents can help significantly reduce symptoms of autism in babies who haven't even reached their first birthdays simply by changing how they play and interact with them.

Oh my. Get on it parents, right now! Huff Po didn’t bother highlighting the fact this was indeed a tiny study. They didn’t stress the exceptionally few number of youngsters involved or the lack of randomized design and thus difficulty establishing cause and effect. It’s absurd, no impossible, to do significance tests on such a limited pile of data. 

The only nod to caution in the entire article gets quickly buried from an outside autism professional gushing about the results: 

While the new research is a pilot study and as such is highly preliminary, Gerard Costa, director of the Center for Autism and Early Childhood Mental Health at Montclair State University, called the outcomes for this small group of children and their parents "wonderful" and "very encouraging."…"The findings are clearly saying what we've always felt to be the case, which is that early intervention can make an enormous difference," he said.

Enormous difference. We got the cure for autism right here folks.

Even news sources that did highlight the small number of participants and speculative nature of the results went to lengths to tell why we should be impressed by the results.

NBC News did the classic bait and switch in a mere 2-3 sentences:

“With only seven infants in the treatment group, no conclusions can be drawn,” the [study co-authors] wrote.
However, the effects were striking. Six out of the seven children in the study had normal learning and language skills by the time they were 2 to 3.

(To their credit, the authors did remind everybody that the study is a tiny first and should not be taken as definitive evidence.) 

Finally, CBS News found an expert who wasn’t at all impressed by the results:  

"This study is groundbreaking in certain regards," said [Dr. Lisa Shulman, director of infant and toddler services at the Children's Evaluation and Rehabilitation Center at the Albert Einstein College of Medicine Shulman]. "It pulls together various streams of current research in a meaningful way.

Groundbreaking? The CBS intern tasked with getting a good quote deserved the night off for this one.  

WSJ showed a bit more nuanced than most but just like its fellow media, reported on the great rise in autism cases over the past decade or so:

The number of children identified with autism has risen sharply since 2002, and the latest figures from a 2014 CDC report estimate 1 in 68 U.S. children are affected by autism or a related disorder. That climb could result from a combination of more children affected with the condition, plus greater awareness of it, experts say.

And like everyone else, WSJ failed to mention that other factor, the expanded DSM criteria back in the 1990s. Apparently the experts who attribute the rise of autism in part to the DSM changes didn’t “say” anything this week. 

Nor did the articles bother explaining the results could be due to factors other than the intervention itself. The families in the study were involved with the institute performing the intervention, namely because they had older children diagnosed with autism. Some families agreed to participate in the intervention (essentially  coaching parents how to better interact with their babies). Some families did not. Something different between these two groups could account for the seemingly miraculous results. It's just not clear at this point. I know the results seem encouraging but having done quite a few pilots I know sure results don't always pan out regardless of their potential value.