Childhood Mental Health Affects Adult Income

A recent study in Social Science and Medicine demonstrates for the first time that childhood psychological problems have long-lasting effects on adult income. Because the study compares siblings with and without psychological conditions, the authors were able to control for the effects of childhood family background and neighborhood on adult income. They also controlled for the effects of physical illness on mental health problems.

Researchers from the Rand Corporation analyzed data from the U.S. Panel Study of Income Dynamics which has followed 5000 families, and 35,000 individuals within those families, for over 40 years. It is considered the premier panel survey measuring key dimensions of adult socioeconomic status outcomes. The authors used various criteria to select 2,457 individuals between the ages of 25 and 53 to include in their study (see the original article for details). Participants were asked whether they experienced depression, substance or alcohol abuse, or other psychological conditions before age 17. Overall, 6% reported having one or more psychological problems as children: depression (4%), substance or alcohol abuse (2%), or other psychological conditions (2%). The prevalences found for these conditions are similar to those found in other retrospective studies.

Key Findings

Compared to their siblings, adults with childhood psychological problems on average:

• Had a 20% lower family income equaling $10,400 per year and $300,000 projected over their lifetimes.
• Worked seven weeks less per year. Most of the difference was due to a greater number not working at all. When comparing only siblings who worked one or more weeks, the difference was reduced to two weeks per year.
• Achieved six months less education (most common for those with substance or alcohol abuse).
• Were less likely to be married (by 11%). Of those that were, their spouses tended to have lower incomes.
• Were seven times more likely to have an adult psychological condition (35.8% vs. 5.4%). Those that reported childhood depression were the ones most likely to report psychological problems as adults.

Limitations

• The determination of childhood psychological conditions was based on retrospective reports by adults. This method is considered to be fairly reliable, but does not meet the same level of certainty as diagnostic interviews with children.
• The authors weren't able to test the effects of gender. Although there appeared to a trend for a greater impact on men's income, dividing the sample into half did not leave enough people in each group to determine statistical significance.
• They also couldn't test the effects of specific psychological disorders that were grouped together in the category of "Other Psychological Conditions" for the same reason.
• The participants weren't asked about receiving childhood treatment. Nonetheless, given the low rates of treatment for childhood mental illness, it is safe to assume that most of the participants did not receive help as children.

Implications

The lead author, economist James P. Smith, emphasizes the cost-effectiveness of early treatment. In an interview, he stated:

This study shows childhood psychological disorders can cause significant long-lasting harm and can have far-reaching impact on individuals over their lifetimes. Our findings illustrate what the enormous potential might be of identifying and treating these problems early in life.

Not all of the people who have psychological problems during childhood will carry these problems into adulthood. But they are 10 to 20 times more likely than others to have these shortfalls during adulthood. There clearly are large economic costs during adulthood caused by childhood psychological conditions.

I believe this study provides yet another reason to increase access to mental health services for children. We can now add lower income to the problems experienced by those struggling with mental illness. Not only does less income affect living circumstances, it also affects adults' ability to afford treatment for mental illness. It is much more effective and humane to treat mental illness early to prevent negative lifelong consequences.


Smith, J., & Smith, G. (2010). Long-term economic costs of psychological problems during childhood Social Science & Medicine, 71 (1), 110-115 DOI: 10.1016/j.socscimed.2010.02.046

You Asked: What Can We Do to Stop Rape?

A reader asks what we can do to stop rape. This question is very important to me having spent nearly 20 years treating child and adolescent victims of sexual assault and abuse.  It's also timely because April is Sexual Assault Awareness and Prevention Month. And awareness is the first step in preventing rape.

Let's start with some basic facts and then look at prevention. Sexual assault is any type of sexual activity (including rape) in which the victim is forced, threatened, doesn't consent, or is not capable of giving consent. Regardless of the victim's statements or actions, it is sexual assault if she or he is too young, drunk, drugged, or mentally impaired to legally consent to sex.

According to the most comprehensive, representative survey in the United States--the National Violence Against Women Survey:

• 1 of every 6 women (17.6%) and 1 of every 33 men (3%) have been raped at some time in their lives.
• The majority of the victims were younger than 18 years old when they were raped (females - 54%; males - 71%).
• Most disturbingly, many victims were less than 12 years old when they were raped (girls - 21.6%; boys - 48%).
• Girls under the age of 12 were most likely to be victimized by relatives. The girls ages 12 to 17 were more likely to be victimized by intimates and acquaintances. Women were more likely to be raped by intimates.
• Boys and men are more likely to be raped by acquaintances at all ages.

There are three basic approaches to preventing rape. The most common places the burden on potential victims to protect themselves. Some of the safety precautions are the same as for other violent crimes: Keep doors and windows locked (at home and in the car); don't open the door or go somewhere with strangers; and don't walk alone in isolated places (daytime or night). Although these actions can help prevent stranger rapes, most sexual assaults (80%) are committed by someone the victim knows--a boyfriend or girlfriend, relative, friend or acquaintance.

The following tips from the National Child Traumatic Stress Network's "Preventing Acquaintance Rape-A Safety Guide for Teens" apply also to young adults:

• Expect respect and keep away from people who don’t show you respect.
• Be clear about your limits: let the other person know what you want and don’t want to do. You have the right to change your mind, to say “no,” or to agree to some sexual activities and not to others.
• Don’t allow a person to touch you if it makes you uncomfortable. If your limits are reached or you sense danger, speak your mind and act immediately. Make a scene if necessary.
• Avoid excessive drinking or drugs. They reduce your ability to think and communicate clearly. Being drunk or high does not give anyone permission to assault you.
• Pour your own beverage and keep it in sight. Date rape drugs can be put into drinks and are often undetectable.
• Don’t hang out in places that keep you isolated from others. Although you may feel you can take care of yourself, it is always wise to be careful.
• Trust your instincts. If you feel that a person is not trustworthy or a situation is unsafe, leave.
• Have a back-up plan. For example, if you’re going out to a party in a different neighborhood, make sure someone you trust knows where you’re going. Have a person you can call to come and get you if you need to leave without your original ride.

A second prevention approach is to reach teen boys and young men before they commit rape. Men Can Stop Rape is one organization dedicated to this effort. Their program, Men of Strength (MOST) Club, is considered the premier primary prevention program for male youth in the country. It provides high school age and college age young men with a structured and supportive space to learn about healthy masculinity and redefine male strength.

The third approach is through law enforcement. Unfortunately, only 39% of rapes and sexual assaults are ever reported to the police. Partly due to the difficulty of investigating and prosecuting these crimes, only 16% of reports result in a perpetrator serving time in prison. Factoring in unreported rapes, only 6% of rapists end up in prison. The rest are free to repeat their crimes. One way to increase convictions is for more police and prosecutors to receive specialized training in sex crimes. Media attention and community pressure can help push local authorities into pursuing this training if they have not already done so.

So what can you do? Continue to educate yourself. Help raise awareness. Teach potential victims ways to protect themselves. Educate potential perpetrators through men's antiviolence programs. If you are a parent, talk to your children and teens about safety and healthy dating relationships. Encourage victims to report rape, and support them through the difficult process of investigation and prosecution. Donate time and money to your local rape crisis/sexual assault center--most are under-funded and under-staffed. (To find a center in your area, see RAINN's listing of state coalitions against sexual assault.) If you are a college student, get involved by supporting (or starting) a campus program to help victims and raise awareness among students.

To start raising awareness, watch the following video from RAINN and then e-mail it to everyone you know that could benefit. You can also link to it or embed it on your blog or website.

Child Abuse is the Primary Cause of Infant Homicides

Child abuse of any sort is difficult to understand, but the homicide of infants by caretakers is beyond most people's imagination. A new study sheds some light on who commits these acts.

Fujiwara, T., Barber, C., Schaechter, J., & Hemenway, D. (2009). Characteristics of Infant Homicides: Findings From a U.S. Multisite Reporting System PEDIATRICS, 124 (2) DOI: 10.1542/peds.2008-3675

The study reports on 72 cases drawn from the National Violent Injury Statistics System. The system was developed to provide detailed information from multiple sources--death certificates, coroner/medical examiner reports, police reports, and crime laboratories--to be used for public health research. The purpose of this study was to describe features of different types of infant homicide (under age 2) to inform prevention efforts.

Three-quarters of infant homicides were due to beating/shaking by a caretaker (Type 1). The perpetrator was most often the father (43%) or the mother's boyfriend (30%). In almost all cases, emergency medical treatment was sought by either the abuser or another household member. The authors conclude that Type 1 homicides are impulsive and largely unintentional in nature. However, in most cases there was evidence of prior physical abuse. Their recommendations for prevention are early identification of child abuse and education directed at male caretakers.

In contrast, most Type 2 homicides were committed by women (69%), were intentional, and no medical treatment was sought. The deaths were related to domestic violence, psychosis, other crime, or occurred within 24 hours of birth. There were too few cases of each kind to draw conclusions useful for prevention. A larger study would be needed.

Of note, nearly half of the Type 1 homicides were caused by shaking. Young adult males with little or no experience can find it difficult to care for a baby that continually cries. Some will shake a baby out of frustration and anger to stop it crying without realizing the damage shaking will cause. Not all shaken babies die, but survivors' injuries may include severe brain damage, blindness, learning disabilities, and physical impairments.

One hospital-based prevention education program directed at both parents has been successful in reducing the number of cases, and the program has been replicated elsewhere (Upstate New York Shaken Baby Syndrome Education Program). The basic elements of this and other prevention education are to raise awareness of injuries caused by shaking and teach caretakers how to soothe a crying baby and cope with their own frustration.

For more information: The National Center on Shaken Baby Syndrome

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This post was featured in Grand Rounds Vol. 5 No. 51, comes to Paramedicine! « Medic999

Keep Kids Safe This Summer

The National Center for Missing and Exploited Children has released Ten Safety Tips to Help Parents Keep Children Safe This Summer:

1. MAKE SURE children know their full names, address, telephone numbers and how to use the telephone.
2. BE SURE children know what to do in case of an emergency and how to reach you using cell phone or pager number. Children should have a neighbor or trusted adult they may call if they're scared or there's an emergency.
3. REVIEW the rules with your children about whose homes they may visit and discuss the boundaries of where they may and may not go in the neighborhood.
4. MAKE SURE children know to stay away from pools, creeks, or any body of water without adult supervision
5. CAUTION children to keep the door locked and not to open the door or talk to anyone who comes to the door when they are home alone.
6. DON'T drop your children off at malls, movies, video arcades or parks. These are not safe places for children to be alone. Make certain a responsible adult supervises your younger children at all times when they are outside and away from home.
7. TEACH your children in whose vehicle they may ride. Children should be cautioned to never approach any vehicle, occupied or not, unless accompanied by a parent or other trusted adult.
8. BE SURE your children know their curfew and check in with you if they are going to be late. If children are playing outside after dark, make sure they wear reflective clothing and stay close to home.
9. CHOOSE babysitters with care. Obtain references from family, friends, and neighbors. Many states now have registries for public access to check criminal history or sex-offender status. Observe the babysitter's interaction with your children, and ask your children how they feel about the babysitter.
10. CHECK out camp and other summer programs before enrolling your children. See if a background screening check is completed on the individuals working with the children. Make sure there will be adult supervision of your children at all times, and make sure you are made aware of all activities and field trips offered by the camp or program.

But what about teenagers?

I always recommend that parents pay close attention to the whereabouts of younger teenagers. Middle-schoolers in particular are more likely than younger children to be home alone during the summer. Ages of 12 to 15 are riskier due to lack of experience, immature decision-making, and an overwhelming desire to spend time with peers. They are more likely to have friends over while parents are at work, go somewhere without permission, and be enticed into forbidden activities by older teens they meet at the mall or other teen hang-outs. Because younger teens can't anticipate negative consequences that may arise in social situations, they are more likely than older teenagers to end up in unsafe circumstances beyond their control.

Some common-sense tips:

Contact friends' parents to confirm plans and adult supervision. Don't trust the older siblings of your child's friends to be good supervisors. Chaperone or discreetly shadow your teenager at the mall, movies, and other public venues.

Don't rely only on cell phone contact from your teen. It's too easy for them to disguise their location. Call home numbers to confirm your teen's whereabouts.

Don't make it too easy for teens to predict your schedule. Come home early once in awhile, drop by unexpectedly, and call at unpredictable times. This prevents them being able to count on leaving and getting back before you come home from work.

Assume you have to double-check all plans. At the same time, avoid giving your teen the impression that you don't trust him. Let her think that you are an anxious and over-protective parent. This will decrease power struggles and help your teen save face when he has to decline an invitation that breaks your rules.

The National Center for Missing and Exploited Children also has a summer safety tip sheet for kids. Although written for children, the tips can still apply to young teens.

Please share any other parent tips you might have for child and teen safety and have a safe summer!

Child Sexual Abuse Fact Sheet

The National Child Traumatic Stress Network recently updated their Child Sexual Abuse Fact Sheet - For Parents, Teachers, and Other Caregivers. It provides an overview of symptoms, disclosure, myths and facts, and safety education.

Myths and Facts

Myth: Child sexual abuse is a rare experience.

Fact: Child sexual abuse is not rare. Retrospective research indicates that as many as 1 out of 4 girls and 1 out of 6 boys will experience some form of sexual abuse before the age of 18. However, because child sexual abuse is by its very nature secretive, many of these cases are never reported.

Myth: A child is most likely to be sexually abused by a stranger.

Fact: Children are most often sexually abused by someone they know and trust. Approximately three quarters of reported cases of child sexual abuse are committed by family members or other individuals who are considered part of the victim’s “circle of trust.”

Prevention Tips for Parents

• Teach children accurate names of private body parts.

• Avoid focusing exclusively on “stranger danger.” Keep in mind that most children are abused by someone they know and trust.

• Teach children about body safety and the difference between “okay” and “not okay” touches.

• Let children know that they have the right to make decisions about their bodies. Empower them to say no when they do not want to be touched, even in non-sexual ways (e.g., politely refusing hugs) and to say no to touching others.

• Make sure children know that adults and older children never need help with their private body parts (e.g., bathing or going to the bathroom).

• Teach children to take care of their own private parts (i.e., bathing, wiping after bathroom use) so they don’t have to rely on adults or older children for help.

• Educate children about the difference between good secrets (like surprise parties—which are okay because they are not kept secret for long) and bad secrets (those that the child is supposed to keep secret forever, which are not okay).

• Trust your instincts! If you feel uneasy about leaving a child with someone, don’t do it. If you’re concerned about possible sexual abuse, ask questions.

Protecting Your Child From Sexual Abuse

There are a multitude of resources for parents on preventing child sexual abuse. Unfortunately, many focus on teaching children about "stranger danger" when in actuality, most abusers are known to children and their families. Many are family members themselves--parents, step-parents, older siblings, cousins, uncles, aunts, and grandparents. Others are trusted adults who take care of children (daycare providers, babysitters) and those who work with children (teachers, coaches, youth ministers, and private music, dance or martial arts instructors).

Most parents assume that professionals who work with children pass background checks. Unfortunately, background checks only pick-up convicted sex offenders or those proven to be abusers by child protective services. Abusers who move from state to state may be missed. Religious institutions, sports leagues, and other private organizations often don't require background checks, and no one monitors private instructors.

Here are two general resources that I particularly like from the National Center for Missing & Exploited Children to help parents protect their children from sexual abuse and exploitation.

Child Protection

Know The Rules...General Tips for Parents and Guardians

Both publications are also available in Spanish. Hard copies can be ordered at 10 cents a piece with the first 50 copies free.

Parenting Tips to Prevent Child Abuse - Your Tax Dollars at Work

If you are still working on your income taxes, and getting frustrated as a result, it might help to consider what your federal and state tax dollars support. One worthwhile endeavor is the efforts of child protective services to investigate and intervene on the behalf of abused and neglected children across the nation. Although we might have different opinions about paying taxes, I don't believe any of us can really argue against the need to fund these services.

In honor of National Child Abuse Prevention Month, let's review the extent and costs of child abuse and neglect in the United States.

(Warning! Statistics ahead, but only a few.)

Extent

In 2006 (the year the most recent statistics are available), 3.3 million reports were made to child protective services of suspected child abuse or neglect on behalf of 6 million children in the United States. As a result of these reports, 905,000 children were determined to have been abused or neglected. Approximately 64% were neglected, 16% were physically abused, 9% were sexually abused, and 7% were emotionally abused or neglected. An estimated 1,530 children died due to abuse or neglect. Child Maltreatment, 2006, Washington,DC: U.S. Department of Health and Human Services, Administration on Children, Youth, and Families, 2008.

Cost

The direct cost of child abuse and neglect in the United States totals more than $33 billion annually. (This figure includes law enforcement, judicial system, child welfare, and health care costs.) After adding in the indirect costs (special education, mental health care, juvenile delinquency, lost productivity, and adult criminality), the amount is more than $103 billion annually. Ching-Tung Wang and John Holton, Total Estimated Cost of Child Abuse and Neglect in the United States, Washington, DC: Prevent Child Abuse America, 2007.

(End of statistics. That wasn't so bad, now was it?)

It's in all our interests to do what we can to prevent child abuse and neglect. The Children's Bureau of the U.S. Dept. of Health and Human Services provides some resources to do so via it's Child Welfare Information Gateway (along with many more statistics for those inclined).

One set of resources for National Child Abuse Prevention Month is a series of tip sheets for parents and caregivers. All six are available in pdf format individually or as a set. They are also available in Spanish. Titles and descriptions follow.

Bonding With Your Baby

Strong bonds between babies and caregivers help babies' bodies and brains grow. This tip sheet helps parents understand normal infant behavior, the importance of nurturing and attachment, and what parents can do to develop strong bonds with their babies.

Dealing With Temper Tantrums

A young child's tantrums can be stressful for parents. This tip sheet helps parents understand why toddlers have tantrums, what they can do to help prevent tantrums, and how to handle them calmly when they occur.

Connecting With Your Teen

Teens are becoming more independent, but they still need their parents' love, support, and guidance. This tip sheet helps parents understand typical teen behavior. It offers suggestions for how parents can use simple, everyday activities to reinforce their connection with their teens and show they care.

Teen Parents ... You're Not Alone!

Being a teen parent is a 24-hour-a-day job and can feel overwhelming at times. This tip sheet reassures teen parents that these feelings are normal. It offers suggestions for reducing stress, improving parenting skills, and finding help when needed.

Ten Ways to Be a Better Dad

Fathers who spend time with their children increase the chances that their children will succeed in school, have fewer behavior problems, and experience better self-esteem. This tip sheet lists 10 concrete ways that fathers can enhance their involvement in their children's lives.

Raising Your Grandchildren

When children can't be with their parents, a grandparent's home can provide stability and comfort. This tip sheet helps grandparent caregivers understand how their grandchildren may be feeling, how to help children feel safe and secure in their home, and where to find support in their community if needed.

These tip sheets are an example of what's known as universal prevention. They are aimed at everyone, not just parents who are at risk to abuse or neglect their children. The idea is to give all parents and caregivers helpful tips to strengthen their parenting skills and their families. Take a look. You may find you already know most of this, but I'll bet there are some you'd like to practice more often with your own children.