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Child, teen and family therapy in Houston, TX. Joan's specializations include: ADD/ADHD, Anxiety, LGBT Issues, Abuse Issues, Adjustment Issues, Depression, Eating Disorders, School Trouble, Learning Disabilities, Trauma, Behavioral Problems, and Self-Mutilation. 

Parent Resources

This is a collection of psychiatry and psychology news and studies related to child, teen and family therapy.  These resources may be useful to parents interested in learning more about current topics influencing child, teen and family therapy.

Filtering by Category: Teen Therapy

Equivalent Child Outcomes in Same-Sex vs. Different-Sex Parent Households

Joan Lipuscek

In the United States, beliefs about child and family outcomes for same-sex versus different-sex parents have been a source of confusion and debate. To address this topic, the Journal of Developmental & Behavioral Pediatrics published the recent study, "Same-Sex and Different-Sex Parent Households and Child Health Outcomes: Findings from the National Survey of Children’s Health" by Henry M. W. Bos et al. This study found no significant difference between outcomes for children raised in similarly stable same-sex versus different-sex parent households. However, the study did find that same-sex parents report significantly higher levels of parenting stress compared to different-sex parents.

METHODS

In this study, the National Survey of Children's Health (NSCH) data set was used to examine 95 female same-sex parent families and 95 different-sex parent families. the NSCH is a population-based survey on children's health. Families were chosen if they were stable and didn’t experience a major stress event such as divorce or separation.  In order to participate, two parents had to be presently coupled and had to have raised their children since birth. Same-sex male parents were not selected because there were too few households meeting these criteria.  The researchers note that one of the strengths of the investigation was that "the data were drawn from a population-based survey on children's health that was not described to participants as a study of same-sex parent families, thus minimizing potential bias."

Researchers focused on data from households with children ages 6 through 17 and focused on questions about “family relationships, parenting stress and child outcomes.” This data set offered a chance for the researchers to examine whether there “are there differences in family relationships (spouse/partner relationships and parent-child relationships), parenting stress, or child outcomes (general health, emotional difficulties, coping behavior, and learning behavior)" between same-sex and different-sex parent households.

We have created the following visualization (best viewed in landscape on a mobile device) that summarizes the major findings from this study.

THE RESULTS

The study findings illustrate that there is no significant difference between same-sex and different-sex parent households in terms of spouse/partner relationship, parent/child relationship, child general health, child emotional difficulties, child coping behavior and child learning behavior. Thus, the researchers conclude that this study "contributes to the mounting evidence that children reared by same-sex parents fare at least as well as those reared by different-sex parents on a variety of measures used to assess psychological adjustment."  

The one exception to these otherwise equivalent results, however, was that the same sex couples reported experiencing greater parenting stress.  At this point in time little is known as to why same-sex parents experience greater stress as parents, but one theory suggests that the "cultural spotlight on child outcomes in families with same sex-parents” may be a causally contributing to the stress. 

Typically, greater parenting stress is a predictor that is "positively associated with children's emotional difficulties and negatively associated with child coping and learning behavior." Interestingly, however, greater parenting stress in same-sex parents did not manifest in these negative results. In an attempt to explain this, the researchers hypothesize that lesbian mothers are mitigating greater parenting stress by effectively utilizing support systems such as parenting groups and counseling services to allay negative child outcomes.

ADVICE FOR PARENTS

Unfortunately, homophobia in society and concerns about how societal attitudes may impact their families may be contributing to excess parenting stress among same-sex parents. These parents may also feel the pressure of other people judging them more closely and more critically compared to different-sex parents. 

Despite the societal challenges for same-sex parents, challenging days with children are common for all parents alike.  Parenting stress can be alleviated by understanding the triggers that contribute to your anxiety throughout the day. For example, you might feel stressed if your child is having a tantrum in a public place, especially if people begin to stare. Instead of saying, “I am a terrible parent because my child is acting out” try adjusting your self-talk to phrases such as: “my child is having a bad day,” “my child is hungry or tired” or “I am doing the best that I can." It is impossible to avoid all stressful parenting situations, but one key is to understand your limitations and allow yourself more time to accomplish tasks.

Also, attempt to prioritize the duties and responsibilities in your day so that you don’t become overwhelmed while setting healthy boundaries with others. Making time for yourself by eating healthy foods, getting enough sleep and daily exercise may also be beneficial. Finally, forming close emotional connections with family members, friends and cultivating a strong support system can also contribute to a healthier lifestyle. If you find that you are not able to deal effectively with the level of stress in your life or if you find that it is getting in the way of effective parenting, it may be time to contact a professional. 

Youngest Children in Class at Greater Risk for ADHD Diagnosis & Medication

Joan Lipuscek

In March 2016, a new Taiwanese study was published in The Journal of Pediatrics that showed that the youngest children in a class are at greater risk of being diagnosed and medicated for ADHD compared to older classmates. The implication is that the youngest children in a class are overdiagnosed with ADHD due simply to immaturity. 

The results of this study appear consistent with a number of other studies from around the world. The U.S., Canada, Iceland and now Taiwan have all produced studies that find that relative age in a classroom is a very important factor when diagnosing and medicating for ADHD.

Although countries and states have different cutoff dates for school children to enter a class, we adjusted the data for each study so that readers can easily see the trend of higher rates of ADHD diagnosis and medication for the youngest children in the class.

THE STUDIES

  1. Taiwan, 2016 Chen, et al. "Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Taiwanese Children" This is the latest study on the importance of relative age in diagnosing ADHD.  The sample was 378,881 Taiwanese school children ages 4-17 in school from 1997 to 2011. Kids born just one month prior to the grade cutoff date were 61% more likely to be diagnosed with ADHD compared to their oldest classmates. These youngest children were also 75% more likely to be medicated compared to their oldest classmates. Results were consistent for both boys and girls.

  2. Canada, 2012Morrow, et al. "Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children" Consistent with the findings in Taiwan, this Canadian study also found a higher risk for the youngest boys and girls of a class being both diagnosed and medicated for ADHD. The sample was 937,943 children in British Columbia ranging between 6 and 12 years of age using data from the 11 years between 1997 through 2008. The study found that male children born one month prior to the grade cutoff date were 30% more likely to be diagnosed with ADHD and 41% more likely to be medicated compared to the oldest male children in the same grade. Female children born one month prior to the grade cutoff date were 69% more likely to be diagnosed with ADHD and 73% more likely to be medicated compared to the oldest female children in the same grade. According to the study, "The potential harms of overdiagnosis and overprescribing and the lack of an objective test for ADHD strongly suggest caution be taken in assessing children for this disorder and providing treatment."

  3. Iceland, 2012 (Medication Only)Zoëga et al. "Age, Academic Performance, and Stimulant Prescribing for ADHD: A Nationwide Cohort Study" Although this study did not include statistics on ADHD diagnoses or monthly statistics, it's findings for ADHD medication in children are consistent with other studies. The study reviewed data from 11,785 Icelandic children at ages 9 and 12. Male children born 1-4 months prior to the grade cutoff date were 52% more likely to be medicated for ADHD compared to the oldest male children in the same grade. Female children born 1-4 months prior to the grade cutoff date were 73% more likely to be medicated for ADHD compared to the oldest female children in the same grade. The study concluded that, “Relative age among classmates affects children’s…risk of being prescribed stimulants for ADHD.” (Note: Data from this study was approximated from graphics included in the published version.)

  4. USA, 2010 (Elder)Elder, "The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates" Of all the studies reviewed, this study from the USA shows the highest increase in risk for diagnosis and medication of ADHD for the youngest children in a class. The study utilized data from 11,784 children in the Early Childhood Longitudinal Study-Kindergarten longitudinal survey that tracked kindergartners in the fall of the 1998–1999 school year through the next nine years. Children born 1 month prior to the September 1st class grade cutoff date were 122% more likely to be diagnosed with ADHD and 137% more likely to be medicated for ADHD. The study concludes by noting a point applicable to all included studies, "Whether relatively young children are overdiagnosed, relatively old children are underdiagnosed, or both, current efforts to define and diagnose ADHD evidently fall short of an objective standard." (Note: Data from this study was approximated from graphics included in the published version.)

  5. USA, 2010 (Evans)Evans, et al. "Measuring Inappropriate Medical Diagnosis and Treatment in Survey Data: The Case of ADHD among School-Age Children" This study used a sample of 35,343 children from the National Health Interview Survey and 18,559 children from the Medical Expenditures Panel Survey. Children born 1-3 months prior to the grade cutoff date were 27% more likely to be diagnosed for ADHD and 24% more likely to be medicated for ADHD compared to children born 10-12 months prior to the grade cutoff data. The study does a nice job of relating its findings to the "real world" scale of the problem when it states, "To put our estimates into perspective, an excess of 2 percentage points implies that approximately 1.1 million children received an inappropriate diagnosis and over 800,000 received stimulant medication due only to relative maturity."

COUNTER EVIDENCE

In this post we concentrated on studies that have been consistently finding evidence of increased risk of ADHD in the youngest children in a class as evidence for the misdiagnosis and potential over-medication of this population. However, a 2014 Danish study, Pottegard et al. "Children’s relative age in class and use of medication for ADHD: a Danish Nationwide Study" did not support these findings. Although the authors had hypothesized that they would find results consistent with those of other international studies, this did not prove to be the case. In explaining the difference, the researchers postulate, "...that this may be due to the high proportion of relatively young children held back by 1 year in the Danish school system and/or a generally low prevalence of ADHD medication use in the country."

ADVICE FOR PARENTS

Although many of these studies urge "caution" in diagnosing and medicating children for ADHD, they do not provide prescriptive advice to parents. However, using the evidence, it is possible to begin to construct a road map for parents challenged by a child that may have ADHD.

  1. Consider the Age of Your Child - Is your child one of the youngest children in his/her class?  If so, is his/her behavior outside the norm for not just his/her grade level, but for kids of his/her specific age? Consider a school with a class cutoff date of September 1st. A child born on August 31st will be in the same class as children born on September 2nd, but will be nearly an entire year younger. This may not seem like a big difference to an adult, but for seven and eight-year-olds, the oldest children in the class will have had a 14% longer life compared to the youngest children in the class. This is no small amount in the context of rapid development in young children and behavior expectations in schools.

  2. Weigh Behavior Outside of School - Is your child also experiencing problems in the home or at play? Do problems seem to manifest in the school disproportionately to other environments? As recommended by the Canadian paper included above, "Greater emphasis on a child’s behavior outside of school may be warranted when assessing children for ADHD to lessen the risk of inappropriate diagnosis." This increases the likelihood that the child's behavior will be based on its own merits and not relative to students that may have a significant age advantage.

  3. Consider Holding a Young Child Back a Year - The possibility that "the high proportion of relatively young children held back by 1 year in the Danish school system" is one of the reasons that the Danish study did not find results consistent with other countries is very intriguing. Parents should carefully consider this option if they suspect that some of a child's school behavior issues may be due to immaturity relative to other classmates.

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Characteristics and Effects of Child & Teen Bullying

Joan Lipuscek

Research on bullying has become increasingly sophisticated and a growing number of mental health researchers are interested in the topic. In this post we present the results of the study Adult Psychiatric Outcomes of Bullying and Being Bullied by Peers in Childhood and Adolescence by Copeland et al. published in JAMA Psychiatry on 2/20/2013.

The data for this study is from the Great Smoky Mountain Study which assessed children and teens from ages 9-16 and followed them through ages 19-26. The series of visualizations that we have created attempts to summarize the study's findings into three primary questions.

Question #1 (Visualization Tab - "Child/Teen Bullies & Victims") - What are the characteristics of children and teens who are victims of bullying, both bullies and victims, and bullies?

We begin with the characteristics of children and teens who were neither bullies nor victims. We report the prevalence of psychiatric disorders and social hardship for this group of children and teens in the blue bars. Then, we overlay the study's findings of these same psychiatric disorders and social hardships for children and teens that were identified as victims of bullying, both bullies and victims, and bullies. As shown on the visualization, the study found that child and teen victims, both bullies and victims, and bullies are significantly more likely to have a variety of psychiatric disorders and social hardship. These findings are consistent with earlier studies.

Question #2 (Visualization Tab - "Young Adult Outcomes") - What are the psychiatric characteristics of young adults that were victims, both bullies and victims, and bullies as children and teens?

As we follow the population into young adulthood, several trends emerge.  

1) Bullies - First, child and teen bullies are at elevated risk for very few mental disorders as young adults. There is a statistically significant increase in risk for only antisocial personality disorder for child and teen bullies as young adults.

2) Victims - Young adults who were victimized as children and teens, on the other hand, showed significant increases in risk for a variety of mental disorders including agoraphobia, anxiety disorders, generalized anxiety, depressive disorders and panic disorders.

3) Bullies and Victims - Young adults that were both bullies and victims as children and teens show the most elevated risks for mental disorders as young adults.  This group faces increased risk in both the breath and prevalence of mental disorders as young adults.

Question #3 (Visualization Tab - "Risks for Young Adults") - After controlling for psychiatric disorders and social hardships as a child and teen, how much does being a victim, bully and victim, and bully as a child and teen increase one's risk for psychiatric disorders as a young adult?

1)  Bullies - Again, children and teens who were bullies show increased risk of only antisocial personality behavior as young adults.

2) Victims - After controlling for childhood and teen psychiatric disorders and social hardships, victims of bullying continue to show significant increased risk for agoraphobia, anxiety disorders, panic disorders and generalized anxiety as young adults. The increased risk for depressive disorders is no longer statistically significant after controlling for childhood and teen psychiatric disorders and social hardships.

3) Bullies and Victims -  After controlling for childhood and teen psychiatric disorders and social hardships, bullies and victims continue to show significant increased risk for panic and depressive disorders. Interestingly, male bullies and victims show a very high increase in risk for suicidality as young adults, while females do not. Female bullies and victims show a very high increase in risk for agoraphobia as young adults, while males do not.

ADVICE FOR PARENTS

Childhood bullying should not be ignored or dismissed by parents or school administrators as a rite of passage. Instead, it is a serious issue that significantly increases risks for psychiatric disorders for childhood and teen victims, both victims and bullies, and bullies as they age and become young adults. Parents should take claims of bullying and victimization from children seriously and look to intervene by working with school administrators and teachers to stop the bullying behavior and prevent it from happening in the future.  

The study "Effectiveness of School-Based Programs to Reduce Bullying: A Systematic and Meta-analytic Review" by Ttofi et al. was conducted to evaluate the effectiveness of school-based anti-bullying programs. The study found programs to be effective by decreasing bullying by 20-23% and victimization by 17-20% on average. In evaluating what makes school-based anti-bullying programs effective, the study found that, "More intensive programs were more effective, as were programs including parent meetings, firm disciplinary methods, and improved playground supervision."  Parents of children and teens struggling with bullying behavior should ask their schools about their anti-bullying programs and raise awareness about the effectiveness of these programs in order to enact a positive change.

Note: To calculate the risk presented in the visualizations, we used the formula Relative Risk = Odds Ratio/((1 - p)+(Odds Ratio * p)) where p is the prevalence of psychiatric disorders in young adults that were not bullies or victims as children and teens.

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