Poverty itself can be harmful to health, education

At the height of the recession in 2012, nearly one in four American children were living in poverty.

Today, five years after America went through the worst economic crisis since the Great Depression, children are still more likely to live in poverty than adults. In fact, while the national poverty rate sits at 14 percent, for children, it’s 18 percent.

Learn about the brain, stress, and health in easy-to-read language.

The problem is particularly acute for children of color. While white children experience poverty at a rate of 11 percent, around 27 percent of Hispanic children, 31 percent of black children and 34 percent of Native American children in America today are growing up poor.

There are the obvious side-effects of growing up in poverty: deprivation, worry, and sometimes hunger and the risk of homelessness.

But just as troubling, experts say, is that growing up in a poor household is linked with long-term consequences in educational outcomes, physical health and brain development that can follow a child well into adulthood. Here are just a few ways how:

Children who grow up poor are more likely to be poor as adults

According to a study, around five percent of adults who never experienced poverty as children were poor at ages 20 and 25. If they were poor anywhere from one to seven years as a kid, that number went up to approximately 13 percent. For those who spent eight to 14 years in poverty as children, 46 percent were poor at age 20, and 40 percent were poor at age 25.

The longer you grow up in poverty, the harder it is to graduate

One factor at play for why poor children go on to struggle as adults is education. Whether it’s because they didn’t have access to good schools, or their parents didn’t have the time or resources to help them, children who grow up in poverty often start at a disadvantage that can make it harder to achieve later in life.

In a 2017 report from the Urban Institute, researchers found that 62 percent of children who spent at least half their childhoods in poverty went on to attain a high school diploma by age 20. By comparison, that number was 90 percent for those who never experienced poverty.

The gaps only widen when it comes to college. 

Overall, the Urban Institute found that only 16 percent of kids who spent half their childhoods poor were either consistently working or in school and mostly out of poverty by their late 20s.

Growing up poor can carry long-term health implications

Poverty itself can be dangerous. Children growing up poor are more likely to be injured in accidents, and five times more likely to die due to accidents, according to the American Academy of Pediatrics.

Children in poor neighborhoods are at increased risk of cycling accidents, pedestrian injuries, falls, burns, poisonings and chemical burns.

But the risks go deeper than that. Research shows that children who grow up in poverty are also more likely to develop chronic illnesses such as asthma or obesity — the latter can lead to further health problems, including diabetes and heart disease. Poor children are also more likely to be sedentary and exposed to tobacco, which in turn may increase the risk of heart and lung problems when they grow up.

Poverty can also harm a child’s brain development and lifelong mental health

“There are definite impacts [of poverty] on physical health,” said Benard Dreyer, former president of the American Academy of Pediatrics, in an interview with FRONTLINE. “But in addition, and perhaps more importantly, there’s an impact on brain development and the ability to succeed in life.”

Dreyer was referring to a growing body of research that shows exposure to “toxic” stress can actually impact a child’s brain development.

All children experience stress, and caring adults or support networks can help them cope and figure out how to respond. However, the constant stresses of living in an impoverished household — and in some cases, dealing with abuse or neglect — can create a toxic stress response.

Such levels of stress “impact children’s brain development in the first couple of years of life,” said Dreyer, and can result in permanent changes to brain structure and function. These changes can manifest as increased anxiety, impaired memory and mood control – making it harder to learn, solve problems, follow rules and control impulses. The release of stress hormones can also create a “wear and tear” effect on the child’s organs, including the brain.

Source: PBS/Frontline

Autism's Puzzles

Learn brain basics in easy-to-read language.

What is autism spectrum disorder?

Autism spectrum disorder (ASD) refers to a group of complex neurodevelopment disorders characterized by repetitive and characteristic patterns of behavior and difficulties with social communication and interaction. The symptoms are present from early childhood and affect daily functioning.

The term “spectrum” refers to the wide range of symptoms, skills, and levels of disability in functioning that can occur in people with ASD. Some children and adults with ASD are fully able to perform all activities of daily living while others require substantial support to perform basic activities. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5, published in 2013) includes Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorders not otherwise specified (PDD-NOS) as part of ASD rather than as separate disorders. A diagnosis of ASD includes an assessment of intellectual disability and language impairment.

ASD occurs in every racial and ethnic group, and across all socioeconomic levels. However, boys are significantly more likely to develop ASD than girls. The latest analysis from the Centers for Disease Control and Prevention estimates that 1 in 68 children has ASD.

What are some common signs of ASD?

Even as infants, children with ASD may seem different, especially when compared to other children their own age. They may become overly focused on certain objects, rarely make eye contact, and fail to engage in typical babbling with their parents. In other cases, children may develop normally until the second or even third year of life, but then start to withdraw and become indifferent to social engagement.

The severity of ASD can vary greatly and is based on the degree to which social communication, insistence of sameness of activities and surroundings, and repetitive patterns of behavior affect the daily functioning of the individual.

Social impairment and communication difficulties
Many people with ASD find social interactions difficult. The mutual give-and-take nature of typical communication and interaction is often particularly challenging. Children with ASD may fail to respond to their names, avoid eye contact with other people, and only interact with others to achieve specific goals. Often children with ASD do not understand how to play or engage with other children and may prefer to be alone. People with ASD may find it difficult to understand other people’s feelings or talk about their own feelings.

People with ASD may have very different verbal abilities ranging from no speech at all to speech that is fluent, but awkward and inappropriate. Some children with ASD may have delayed speech and language skills, may repeat phrases, and give unrelated answers to questions. In addition, people with ASD can have a hard time using and understanding non-verbal cues such as gestures, body language, or tone of voice. For example, young children with ASD might not understand what it means to wave goodbye. People with ASD may also speak in flat, robot-like or a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Repetitive and characteristic behaviors
Many children with ASD engage in repetitive movements or unusual behaviors such as flapping their arms, rocking from side to side, or twirling. They may become preoccupied with parts of objects like the wheels on a toy truck. Children may also become obsessively interested in a particular topic such as airplanes or memorizing train schedules. Many people with ASD seem to thrive so much on routine that changes to the daily patterns of life — like an unexpected stop on the way home from school — can be very challenging. Some children may even get angry or have emotional outbursts, especially when placed in a new or overly stimulating environment.

What disorders are related to ASD?

Certain known genetic disorders are associated with an increased risk for autism, including Fragile X syndrome (which causes intellectual disability) and tuberous sclerosis (which causes benign tumors to grow in the brain and other vital organs) — each of which results from a mutation in a single, but different, gene. Recently, researchers have discovered other genetic mutations in children diagnosed with autism, including some that have not yet been designated as named syndromes. While each of these disorders is rare, in aggregate, they may account for 20 percent or more of all autism cases.

People with ASD also have a higher than average risk of having epilepsy. Children whose language skills regress early in life — before age 3 — appear to have a risk of developing epilepsy or seizure-like brain activity. About 20 to 30 percent of children with ASD develop epilepsy by the time they reach adulthood. Additionally, people with both ASD and intellectual disability have the greatest risk of developing seizure disorder.

How is ASD diagnosed?

ASD symptoms can vary greatly from person to person depending on the severity of the disorder. Symptoms may even go unrecognized for young children who have mild ASD or less debilitating handicaps. Very early indicators that require evaluation by an expert include:

• no babbling or pointing by age 1
• no single words by age 16 months or two-word phrases by age 2
• no response to name
• loss of language or social skills previously acquired
• poor eye contact
• excessive lining up of toys or objects
• no smiling or social responsiveness

Later indicators include:

• impaired ability to make friends with peers
• impaired ability to initiate or sustain a conversation with others
• absence or impairment of imaginative and social play
• repetitive or unusual use of language
• abnormally intense or focused interest
• preoccupation with certain objects or subjects
• inflexible adherence to specific routines or rituals

Health care providers will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior. Some screening instruments rely solely on parent observations, while others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of ASD, a more comprehensive evaluation is usually indicated.

A comprehensive evaluation requires a multidisciplinary team, including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose and treat children with ASD. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for ASD, children with delayed speech development should also have their hearing tested.

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What causes ASD?

Scientists believe that both genetics and environment likely play a role in ASD. There is great concern that rates of autism have been increasing in recent decades without full explanation as to why. Researchers have identified a number of genes associated with the disorder. Imaging studies of people with ASD have found differences in the development of several regions of the brain. Studies suggest that ASD could be a result of disruptions in normal brain growth very early in development. These disruptions may be the result of defects in genes that control brain development and regulate how brain cells communicate with each other. Autism is more common in children born prematurely. Environmental factors may also play a role in gene function and development, but no specific environmental causes have yet been identified. The theory that parental practices are responsible for ASD has long been disproved. Multiple studies have shown that vaccination to prevent childhood infectious diseases does not increase the risk of autism in the population.

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What role do genes play?

Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, then the other will be affected between 36 to 95 percent of the time. There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD. In families with one child with ASD, the risk of having a second child with the disorder also increases. Many of the genes found to be associated with autism are involved in the function of the chemical connections between brain neurons (synapses). Researchers are looking for clues about which genes contribute to increased susceptibility. In some cases, parents and other relatives of a child with ASD show mild impairments in social communication skills or engage in repetitive behaviors. Evidence also suggests that emotional disorders such as bipolar disorder and schizophrenia occur more frequently than average in the families of people with ASD.

In addition to genetic variations that are inherited and are present in nearly all of a person’s cells, recent research has also shown that de novo, or spontaneous, gene mutations can influence the risk of developing autism spectrum disorder. De novo mutations are changes in sequences of deoxyribonucleic acid or DNA, the hereditary material in humans, which can occur spontaneously in a parent’s sperm or egg cell or during fertilization. The mutation then occurs in each cell as the fertilized egg divides. These mutations may affect single genes or they may be changes called copy number variations, in which stretches of DNA containing multiple genes are deleted or duplicated.  Recent studies have shown that people with ASD tend to have more copy number de novo gene mutations than those without the disorder, suggesting that for some the risk of developing ASD is not the result of mutations in individual genes but rather spontaneous coding mutations across many genes.  De novo mutations may explain genetic disorders in which an affected child has the mutation in each cell but the parents do not and there is no family pattern to the disorder. Autism risk also increases in children born to older parents. There is still much research to be done to determine the potential role of environmental factors on spontaneous mutations and how that influences ASD risk.

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Do symptoms of autism change over time?

For many children, symptoms improve with age and behavioral treatment. During adolescence, some children with ASD may become depressed or experience behavioral problems, and their treatment may need some modification as they transition to adulthood. People with ASD usually continue to need services and supports as they get older, but depending on severity of the disorder, people with ASD may be able to work successfully and live independently or within a supportive environment.

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How is autism treated?

There is no cure for ASD. Therapies and behavioral interventions are designed to remedy specific symptoms and can substantially improve those symptoms. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of the individual. Most health care professionals agree that the earlier the intervention, the better.

Educational/behavioral interventions: Early behavioral/educational interventions have been very successful in many children with ASD. In these interventions therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as applied behavioral analysis, which encourages positive behaviors and discourages negative ones. In addition, family counseling for the parents and siblings of children with ASD often helps families cope with the particular challenges of living with a child with ASD.

Medications: While medication can’t cure ASD or even treat its main symptoms, there are some that can help with related symptoms such as anxiety, depression, and obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity in people with ASD. Parents, caregivers, and people with autism should use caution before adopting any unproven treatments.

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What research is being done?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.  NINDS and several other NIH Institutes and Centers support research on autism spectrum disorder. 

Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424
http://ninds.nih.gov

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Depressed post-Trump? Know the signs.

Depressed after the recent election? Many Americans are. When does just having the "blues" turn into something serious, worthy of medical attention? Read this excerpt from our new book, Healing the Brain.

Scientists have long acknowledged the brain’s circuitry and biochemical processes as integral aspects of depression, specifically as these processes control neurotransmitters that control mood. Beginning in the 1970s, neuroimaging technologies rapidly advanced the study of how brains function – or fail to function. Functional magnetic resonance imaging (fMRI), which became available to researchers over the past 20 years, gives cognitive neuroscientists a 3-D view of neural activity within the brain.

Studies using this technology demonstrate the role of neurotransmitters serotonin, norepinephrine, and dopamine as they regulate mood in the human body. Scientists still aren’t exactly sure why individuals with depression have low amounts of these neurotransmitters, yet they do know that for some, antidepressants that specifically target how the brain balances these these neurotransmitters are an effective therapeutic intervention.

Studies show the benefits of combining medication and psychotherapy.

Yet much controversy surrounds the issue of prescribing antidepressants, with some claiming that too often an individual is prescribed a pill without receiving the benefits of psychotherapy or talk therapy. Leigh Matthews, psychologist and director of Urban Psychology in Brisbane, Australia, treats adult clients for depression. There is an abundance of studies evidencing the efficacy of the combination of medication and psychotherapy.

But psychology, Matthews said, tries to first focus on treatment without medication, so it’s not always respected by other disciplines, such as general practice physicians or psychiatrists. But the process of psychotherapy and its outcomes last far longer than simply prescribing medication. Yet there are times when medication is absolutely essential, according to Matthews, who also supervises psychologists-in-training at the University of QLD, and those completing their internships through the Australian College of Applied Psychology.

She said when clients are so depressed that they can’t get out of bed, think rationally, or use any of the strategies proposed in session, then it’s time for medication. Or when clients verbalize suicidal ideation and intent indicating severe depression, then medication is absolutely required.

Also if an individual has a long history of depression, or a strong family history suggesting a genetic basis, then “perhaps they, like a diabetic requiring insulin, need long-term pharmacotherapy to rectify neurochemical imbalances.”

Read the Book!