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Rita Crisafi

Letting a baby play on an iPad might lead to speech delays, study says

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(CNN) Anyone raising a child today has likely fretted about screen time and wondered about the impact of devices on our kids. Does the technology affect their brains? Does it limit their social development? Could it harm them emotionally? Could it delay when they start talking?

I had never thought about that last question until a new study, released Thursday and being presented at the 2017 Pediatric Academic Societies Meeting, revealed some striking findings.

The study found that the more time children between the ages of six months and two years spent using handheld screens such as smartphones, tablets and electronic games, the more likely they were to experience speech delays.

“I believe it’s the first study to examine mobile media device and communication delay in children,” said Dr. Catherine Birken, the study’s senior investigator and a pediatrician and scientist at the Hospital for Sick Children in Toronto, Ontario. “It’s the first time that we’ve sort of shone a light on this potential issue, but I think the results need to be tempered (because) it’s really a first look.”

In the study, which involved nearly 900 children, parents reported the amount of time their children spent using screens in minutes per day at age 18 months. Researchers then used an infant toddler checklist, a validated screening tool, to assess the children’s language development also at 18 months. They looked at a range of things, including whether the child uses sounds or words to get attention or help and puts words together, and how many words the child uses.

Twenty percent of the children spent an average of 28 minutes a day using screens, the study found. Every 30-minute increase in daily screen time was linked to a 49% increased risk of what the researchers call expressive speech delay, which is using sounds and words. The study did not find any link between use of a handheld device and other areas of communication, such as gestures, body language and, social interaction.

‘We need more definitive research’

Birken, who is also an associate professor of pediatrics at the University of Toronto, stressed that while her study shows there appears to be a relationship between handheld device use and communication delays in young children, much more research is needed to determine if the device use is actually causing the speech delay.

Further research also needs to look into what content the young children are reviewing and whether they are using devices with a parent and/or caregiver present, she said.

“I think in order to actually develop the evidence to inform parents and clinicians about what to recommend, we need more definitive research,” Birken said. “You need trials. You need good evidence, at least longitudinal studies, but this, at least, this finding is identifying an association and it does support the current recommendation” from the American Academy of Pediatrics.

That group recommends no screens at all, other than video-chatting with family, for children younger than 18 months. The noise and activity of a screen can be distracting for a small child and can cause a disconnect between them and their parents, pediatricians have said.

For kids between the ages of 18 to 24 months, the American Academy of Pediatrics moved away last year from recommending a total screen ban for this age group. Instead, it recommends parents choose high-quality programming and watch it with their children to help them understand what exactly they are seeing.

Nearly 40% of children under age 2 have used a mobile device, an increase from just 10% in 2011, according to a 2013 study by Common Sense Media, a nonprofit organization which is focused on helping children, parents and educators navigate the world of media and technology. Those numbers are likely to be even higher today as smartphones have only grown in popularity.

“This is an important study in highlighting some of the potential risks associated with media use, and specifically handheld mobile devices,” said Michael Robb, research director for Common Sense Media. “What’s driving the effect is very important. The negative effects may be due to screen time replacing parent-child interaction (playing, reading, talking, singing, etc.) which are critical for healthy development,” said Robb via email.

Screens are ‘everywhere’

Michelle MacRoy-Higgins and Carlyn Kolker are co-authors of the just released “Time to Talk: What You Need to Know About Your Child’s Speech and Language Development,” which explores how speech develops in babies and young children.

MacRoy-Higgins, who has worked with hundreds of infants, toddlers and young children as a speech-language therapist, said she was not at all surprised by the findings.

“We do know that young kids learn language best through interaction and engagement with other people, and we also know that children who hear less language in their homes have lower vocabularies.”

It may be the case that the more young children are engaged in screen time, then the less time they have to engage with caretakers, parents and siblings, said MacRoy-Higgins, who is also an associate professor in the department of speech-language pathology and audiology at Hunter College.

The first two years are incredibly important for children and their early foundation of language is important for academic success, she said. “Delays can be associated with difficulties learning to read and to write in elementary school so these early years, these first two years, the language influence that kids get is really very, very important and we want our kids to stay on track with their language development, because if they’re not, they’re really at risk for having some difficulties.”

When my first daughter was born in 2006, there was no such thing as an iPhone or an iPad. But today, handheld devices are ubiquitous, which is part of the reason why there is more attention and perhaps concern about the impact they might have on kids, especially babies.

“They are everywhere and we can’t ignore that fact,” said Kolker, a former Bloomberg News and Reuters reporter, who started working on “Time to Talk” with MacRoy-Higgins almost five years ago. “We’re not all going to throw our phones away.”

Devices are a reality today, but parents need to be informed, she said.

“I think what this study shows is how much we really need to delve into what affects they’re having on children, and how a parent, while we may have them and while they may be there, we need to know how exactly we can regulate them,” Kolker said.

The best advice for parents, the co-authors say, is to interact with your child. The best way to teach them language is by interacting with them, talking with them, playing with them, using different vocabulary, pointing things out to them and telling them stories.

“They’re free and they’re easy to do,” said MacRoy-Higgins, a mother of two who said she wanted to write a book because she is constantly approached by fellow parents with questions about their children’s language development. “Sometimes parents want to know ‘What type of toy should I buy?’ … ‘What types of things can I buy to help my child learn?’ and you don’t have to spend a lot of money, just time and engagement is really the easiest thing that you can do.”

But most parents today, even those who are aware of the research, may find it useful to let their baby be preoccupied by a handheld device from time to time and that’s OK, said Kolker, who is also a mom of two.

“Every parent is going to need a device at some moment, a screen or a device, a tablet with their child at some point,” Kolker said. “It’s just going to happen and you can do that without some level of guilt, but I think you need to know that those are effectively tools to help yourself perhaps in a down moment but they aren’t tools that are really going to help your child.”

A Time to Talk

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Dr. Michelle MacRoy-Higgins, a Brooklyn Letters SLP, is a co-author of Time to Talk , an easy-to-read, straightforward guide for parents about how babies and young children learn to talk. A collaboration between Dr. Michelle MacRoy-Higgins, an associate professor in the Department of Speech-Language Pathology and Audiology at Hunter College and a practicing speech-language therapist, and Carlyn Kolker, a freelance writer, Time To Talk explains how children acquire the physical, cognitive, social, and emotional tools to build communication proficiency. The book provides a practical, insightful look at the core components of listening, speaking, and reading. Time to Talk highlights developmental milestones and red flags to stay alert for, and each chapter features expert answers to common questions, research insights with real-life relevance, tips and takeaways for nurturing a child’s communication skills, and personal perspectives from parents who have faced and overcome speech and language challenges with their child. The book includes chapters on hearing, speech development, language development, speech fluency and stuttering, literacy, bilingualism, as well as causes for concern and finding the right professional help. Empowering and reassuring, Time to Talk is a trusted resource and welcome companion for every parent committed to giving their child a firm foundation in literacy, learning, and life. The website is www.timetotalkbook.com, and the book is available at local bookstores and at Amazon.

Brain Games

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A recent literature review published in the journal Psychological Science in the Public Interest reported that there is no conclusive evidence that brain games improve intelligence, focus or memory problems. See the NPR story here.

Self-Esteem

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Everyone has potential. To discover it is a road to success. To apply it is a road to happiness.

by Dr. Veronica Brodsky, PsyD

The above statement has been my philosophy and core belief ever since I have established Interactive Discovery in 2007. However, one of the main challenges for me as a clinician is not only to recognize someone’s potential, but to help adults and children learn to recognize this within themselves. How can one apply their potential and their talent when they face struggles with low self-esteem on daily basis? While many educators, mental health providers and even politicians recognize the importance of self-esteem as a way to improve performance and feel more satisfied in life, we are still faced with many people feeling that they are simply not good enough. Most clinicians will attest that a common treatment plan goal, regardless of the presenting problem, is to improve self-worth and confidence and yet few feel that this is an easy goal to accomplish.

We all have a history and past that can influence how we experience ourselves. What is striking in my practice is that regardless of how bad or good one’s past experience has been, the struggle with self-esteem is very similar across the board. It just varies in its intensity. One of the things I have observed over the span of 20 years of working and studying psychology, is that one common element the majority of my patients have is high self-criticism and low self-compassion. Teaching children and adults to be kind, loving, and gentle with themselves has been one of the most important, and yes, the most difficult aspects of my practice. Unwiring the habit of self-criticism is a lot more challenging than receiving a promotion at work, high grades in school, and being selected for an Ivy League college.

Recently I came across an article in The Atlantic by Olga Khazan about why self-compassion works better than self-esteem. This article resonated with what I have observed over the span of my work as therapist. In her interview with Dr. Christine Neff, a psychology professor at the University of Texas, she speaks about how we as a society promote high self-esteem. However, what it actually means is to “feel special and above average.”

As a society, we are competitive. The term “keeping up with the Joneses” is an understatement. We are constantly comparing ourselves to others. We want a lot more than we need and feel that by obtaining things, status, senior positions, and real estate, we will be happier. In his book Happier, Tal Ben’ Shahar, a Harvard professor of psychology, states that “While levels of material prosperity are on the rise so are levels of depression.”

We want our kids to go to the best schools, get the best grades and be the best in everything –athletics, music, arts, social leadership; the list goes on and on. Kids know this & they feel it. Just the Middle School selection process in New York City is enough to make a healthy child develop anxiety, panic attacks and depression. If you didn’t get “that” job, didn’t get into “that” school, didn’t pass “that” test, what does it say about you? So when we equate our accomplishments with self-esteem, it is not surprising that we often don’t feel good about ourselves, no matter how much we accomplish, because there will always be something that we didn’t get. According to Neff, “When we fail, self-esteem deserts us, which is precisely when we need it most…The best way to think about the problem of self-esteem is not whether or not you have it, but what you do to get it… usually self-esteem is highly contingent on success.”

I think it is very important to have goals, ambitions and purpose, but it is no less important to have self-compassion. Being gentle with yourself, setting realistic expectations, forgiving yourself for mistakes, allowing yourself to be taken care of, asking for help, making space and time to do something you truly enjoy and nurturing yourself helps to develop self-compassion. Neff suggests that self-compassion is “treating yourself with the same kind of kindness, care, compassion as you would treat those you care about — your good friends, and your loved ones.” Without self-compassion, the road towards achieving our dreams can be self-destructive. Applying one’s potential cannot lead to the road of happiness if self-compassion is missing.

References:

Ben-Shahar, T. (2007). Happier. New York: McGraw Hill Publication.

Khazan, O. (2016). Why self-compassion works better than self-esteem. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2016/05/why-self-compassion-works-better-than-self-esteem/481473/.

Dr. Brodsky received her doctorate from New York University. Her research interests are in the areas of examining child and parent relationships and their effects on child development.
BLOG: EMDR, Separation And Divorce And Its Impact On Children Part I, Separation And Divorce And Its Impact On Children Part IIWays to decrease anxiety through rewiring our brain: Mind-Body Connection

EMDR

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by Dr. Veronica Brodsky, PsyD

“Wow, I have just processed in this two-hour session what I have tried to process in therapy for years.” This was a statement made by a client after I had incorporated EMDR into his session. While not everyone has this experience, many patients do report that past traumatic or highly disturbing experiences have been processed, through bilateral stimulation, in an accelerated manner. Many studies indicate that by using EMDR therapy, people can experience the benefits of psychotherapy that once took years to make a difference. In addition, what is remarkable is that EMDR therapy shows that the mind can heal from psychological trauma much as the body can recover from physical trauma.

I became particularly interested in EMDR after recognizing that many of my own patients felt “stuck.” Although we made many connections to their past and its impact on their current functioning, simply recognizing this connection was just not enough to help patients move forward in a way that freed them from their past. As a result, “talk therapy” alone became less productive, so I was in search of other modalities that could be of help.

What attracted me to EMDR was its fundamental link to our physiology and “mind-body” connection. I observed that many people with a history of trauma, especially complex trauma, held on to these experiences in their bodies. Somehow I wanted to aide in helping them to release these experiences from their body, similarly as we want a massage therapist to help us to release a tense knot in our body.

EMDR Institute describes Eye Movement Desensitization and Reprocessing (EMDR) as a “Psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories (Shapiro, 1989a, 1989b). Francine Shapiro developed this modality about 20 years ago. Shapiro’s (2001) Adaptive Information Processing model posits that EMDR therapy facilitates the accessing and processing of traumatic memories and other adverse life experience to bring these to an adaptive resolution. After successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced.”

EMDR is used for a huge range of clinical application. The premise is that 1) we move towards health and wholeness; 2) we have a natural impulse to heal; 3) we have wisdom within us. EMDR incorporates the Adaptive Information Processing model and its main premise is that we move from a dysfunctional state to a functional one. Trauma impacts the integration of the information and stores traumatic experience in a fragmented way on the right side of the brain. By incorporating bilateral stimulation, we are reprocessing this experience and moving it in more organized way to the left side of the brain. The other important premise of EMDR is that you don’t lose anything you need.

Often in this work we refer to various traumatic events as “Large T” or “Small t.” Large T traumas are referred to the events that were life threatening (e.g. war, accident, rape, etc.). Small t – traumas are referred to the events that were experienced by individuals as traumatic, but were not life threatening (e.g. humiliations, sense of inadequacy, shame, difficult interpersonal relationships). Thus, these experiences limit how we view ourselves in the world. The impact of many “small t (s)” on one’s psyche can be just as devastating as experiencing one “large T” trauma.

In my training with Dr. Laurel Parnell, who had modified the original protocol and incorporated “Attachment Focused EMDR” I have learned that a lot of the techniques and the use of bilateral stimulation can also reduce anxiety, improve sleep, and overcome trauma. With successful EMDR process often “anger turns into power and fear turns into love.” While the techniques used in EMDR can be helpful to many, they are not for everyone and the success rate can vary depending on the individual and other factors. However, I feel fortunate in having this technique in my “tool-box” and have seen impressive results when they are incorporated into “talk therapy.”


References:
Parnell, L. (2007). A therapist’s guide to EMDR; Tools and techniques for successful treatment. New York: W.W. Norton & Company.

Parnell, L. (2013). Attachment focused EMDR; Healing relational trauma. New York: W.W. Norton & Company.

Shapiro, F. (1995). Eye movement desensitization and reprocessing; Basic principles, protocols, and procedures. New York: The Guilford Press.

Dr. Brodsky received her doctorate from New York University. Her research interests are in the areas of examining child and parent relationships and their effects on child development.
BLOG: Self-EsteemSeparation And Divorce And Its Impact On Children Part I, Separation And Divorce And Its Impact On Children Part IIWays to decrease anxiety through rewiring our brain: Mind-Body Connection