Special Editorial: Meds, meds, meds…Do we really need them or is it all in our heads?

Okay, so the medication debate is not as black and white as the title may suggest.  It sure is worth having, however, as an article that came out this June in APA’s Monitor on Psychology about the inappropriate prescribing of psychotropic medication spells out.

Before I go any further, I am completely aware that medication can be a game-changer for some people, allowing them to function in ways that they simply could not before being prescribed an appropriate medication.  For many others, more than we may guess, medication may not be as necessary or helpful as we are led to believe.  And when it comes to medicating children, I vote for being even more careful with prescribing, especially in light of the fact that many medications have not been thoroughly researched for kids.

So here’s the low down on the article:

  1. Many psychotropic medication prescriptions do not come from professionals that are well-versed in mental health issues (4 out of 5 come from non-psychiatrists).  Primary care physicians know a lot, but they may not know as much as we need for them to when it comes to something as serious as treating a mental health disorder with medication.  And they may not be in the know on other effective treatments, such as cognitive-behavioral treatment, that are non-pharmaceutical.
  2. The placebo effect is thought to be a major player in the effectiveness of anti-depressants.  Current research suggests that it’s mostly people with severe cases of depression that seem to truly benefit from the chemical impact of anti-depressants.  Most others reportedly benefit from simply knowing that they are taking something to help their depression.  (As would be expected, there is controversy about these findings.  One thing seems clear, though.  Cognitive-behavioral therapy continues to get positive results in the treatment of all levels of depression and the skills learned can last a lifetime.)
  3. Misdiagnosis can lead to inappropriate prescribing.  One should make certain that an appropriate evaluation has been conducted and confirms a diagnosis of ADHD, for example, before starting a child on a psychostimulant.
  4. Published research tends to include the studies that show positive outcomes for medication rather than being balanced by the publication of studies that do not.  An examination of FDA studies in 2008 reported that the studies were about half and half with positive to negative results; however, over 90% of the studies published were with positive results.
  5. There is a huge financial incentive, both to doctors and patients, to go down the medication route.  Docs get paid a whole lot more and patients pay a whole lot less, in general, when they pursue medication in lieu of therapy.  And advertising for psychotropic medication can lead to greater public awareness about the existence of a drug, which may contribute to patients pursuing this route more readily than therapy.
  6. Vulnerable populations, including the elderly, foster children, and infants, are prescribed psychotropic medications, oftentimes for off label use.  Foster children were found to be over four times more likely than other children to be on psychotropic meds, frequently more than one kind, including antipsychotic drugs.  In my field, we call these drug cocktails chemical restraints because they are oftentimes used to subdue children with difficult-to-manage behaviors.
  7. ADHD continues to prompt a lot of psychostimulant prescriptions.  Sometimes they are very helpful and sometimes not.  (Cognitive-behavioral therapy has been found to be useful in this area as well.)
  8. Psychologists across the country continue to explore the possibility of gaining prescribing privileges in order to add to the pool of mental health professionals that are well-versed in both medication and non-medication-based therapies.  New Mexico, Louisiana, Guam, and the armed forces have approved programs to train psychologists in prescribing.

And now I step up on my soapbox for a moment.  Ahem…I get why psychotropic medications are so popular, including in teens and children.  We want our kids to feel better, quickly.  And if our pediatrician tells us that we can have that happen with a pill, then we are inclined to listen.  I know that therapy takes time.  It is a process.  And I know that it can be expensive.  Keep in mind, however, that a good therapist will arm your child with skills that can carry them forward with a greater ability to handle a multitude of stressors and situations more effectively.

Of course, there will remain individuals that get better results when medication is added to the treatment plan.  For these children and teens, I implore parents and guardians to monitor them closely for medication effectiveness and side effects and to have regular check-ups with their prescribing physician.  If it is feasible, I also highly recommend seeing a child psychiatrist, at least to get things started.  Regardless of the provider you use, please include something like this in your initial discussions, “I am interested in learning about a variety of options, both pharmaceutical and otherwise.”

And while your medical provider may know a lot, he/she is likely a busy individual that does not have time to read every relevant research article as it comes out.  You can keep yourself informed, however, by doing your own periodic searches, setting alerts for when relevant articles are published, and visiting reputable websites that specialize in what your child is being treated for.

Okay, I’ll climb back down now.  Thanks for reading.  -Anita

Source: Smith, B.L. (2012, June). Inappropriate prescribing. Monitor on Psychology, 43 (6), 36-40.

Special Editorial: Shooting Holes in the Argument for Ritalin

By Anita M. Schimizzi, Ph.D.

I became intrigued by an article that I read a few weeks ago in the NY Times and I keep finding myself coming back to it as I work with parents.  The topic?  Medication may not be as magical in treating ADHD as we had all hoped.

Now before I go any further, let me make clear that I am not a medical doctor and I am in no way trying to urge parents to discontinue their child’s ADHD medication.  I am, however, suggesting that parents continue to inform themselves of research findings in this area so they can discuss new information with their child’s treating physician and make informed choices as a result.

Dr. Sroufe, the author of the article and professor emeritus at the University of Minnesota’s Institute of Child Development, argues that the research world has a pattern of focusing on short-term effects of ADHD medication and fails to pay enough attention to long-term effects. 

It has been well-established that medications like Ritalin and Adderall can improve concentration and focus in individuals with ADHD.  These short-term effects can render a child once known for climbing the classroom walls able to sit and focus on reading.  Score one for medication!  (By the way, Dr. Sroufe states that these effects ring true for everyone and not just those with ADHD.) 

Dr. Sroufe goes on to look at the effects of long-term use of stimulant medication, and these don’t sound as fabulous.  He tells us that the positive effects lessen over time as people develop a tolerance to the drugs.  He also argues that the upsurge in behavior problems that parents report when they take their child off stimulant medication is actually due to withdrawal effects in a body that has become accustomed to the drug.  

Here’s the juicy part.  Dr. Sroufe reports that no studies have been able to support long-term benefits of using ADHD medication in the areas of behavior, academic performance, or relationships with peers.  “What?!” you may ask.  In fact, a long-term, well-conducted study that he cites from 2009 looked at a large group of children (almost 600) with attention problems that were placed into one of four groups: medication alone, medication + cognitive-behavioral therapy (CBT), CBT alone, or no treatment.  While initial results tooted medication’s horn, the results diminished over time to the extent that by eight years there were no detectable benefits to medication use in the areas of behavior and academics.  “Double what?!” you may now ask.

Argument is also made for a profound environmental component to the development of ADHD, effects that Dr. Sroufe says the research community has not addressed because the focus has been placed on brain and biological research.  And, Dr. Sroufe states, medication is no cure for environmental causes of ADHD symptoms.  For example, exposure to trauma can change the way our brains operate and the way we think, feel, and behave.  In fact, many trauma-related symptoms look a whole lot like what we see in ADHD.  A psychostimulant may help the traumatized child focus better at school, but does it address the trauma? 

In my own work with children with ADHD and their parents, I find that the most work gets done when there is a meaningful shift made at home and at school.  More structure, more predictability, more skills to help regulate emotions, plenty of fresh air and active play, changes meant to soothe and to ease anxiety and distress, improve adult-child communication and increase self-care in academic and social settings.  I could go on and on here.  My point is that there really are an astounding number of ways to change the experiences of children with ADHD.  Yes, medication may help and it sure is quick.  Over the long-term, we may need to be considering a whole lot more than that, though.

Thanks for reading.  –Anita

Source: Sroufe, L.A. (2012 January 28). Ritalin Gone Wrong. The New York Times.  Retrieved from www.nytimes.com

Special Editorial: The [Mis]Interpretation of Anti-Bullying Efforts

By Anita M. Schimizzi, Ph.D.

An article in the New York Times caught my eye last week.  Two first graders engaged in recess roughhousing and one classmate purportedly touched the upper thigh and/or groin of the other.  No witnesses.  The six year-old accused of the touching was promptly suspended from school for sexual assault.  “Sexual assault?!” you say?

The author of the article went on to discuss this incident within the framework of heightened bullying awareness and the pressure that administrators feel to react strongly when students are threatened in some way.  As our readers know, we take bullying very seriously.  In this day and age when research has shown us that bullying leads to outcomes such as increased depression,anxiety, poor academic performance, and suicide risk, we can not afford to ignore the seriousness of this issue that affects children of all ages, races, religions, cultures, sexual orientation, abilities, socio-economic status, and gender.  

In her book The Bully, the Bullied, and the Bystander, Barbara Colorosa includes a section titled “Beware: Zero Tolerance Can Equal Zero Thinking”.  She goes on to describe an array of incidents that underscore her point.  I think that my favorite was the ten year-old that got to school and realized that she had accidentally picked up her mom’s lunch instead of her own.  It contained a knife to cut the apple inside, which she promptly turned in to her teacher, received a thank you, and was then suspended by the principal because rules are rules.

When it comes to understanding behavior, context matters.  That bears repeating.  Context matters!  If we are truly going to address bullying, then part of that work needs to be proper training and ongoing support so teachers, administrators, and others who work with children are taught how to properly identify it, how to take it seriously without overreacting, and how to dole out appropriate consequences that not only keep people safe but also help the child learn and move forward in a more positive way.

Dealing with bullying from the individual all the way up to the system level is a complicated process.  Note that I mentioned both training and ongoing support above.  They are both vital.  We can’t expect school staff to receive all that they need through training alone.  Support that occurs in the trenches is equally important.   

I wonder what would have happened in the “sexual assault” scenario if the principal had someone well-versed in bullying that she could have turned to and thoughtfully discussed the incident.  Factors such as his intentions behind and understanding of his behavior could have been explored.  True, she may have come to the same conclusion and suspended the student.  On the other hand, she may have found that it really was playground roughhousing with no intent of harm or intimidation.  For now, the student has switched schools amidst some confusing uproar.  Thanks for reading.  -Anita

Sources:

Colorosa, B. (2002). The bully, the bullied, and the bystander: From preschool to high school  how parents and teachers can help break the cycle of violence. New York: Harper Collins.

James, S. (2012, January 26). Boy, 6, suspended in sexual assault case at elementary school. The New York Times. Retrieved from http://www.nytimes.com

Special Editorial: Should I vaccinate my child against HPV?

By Nestor Lopez-Duran PhD

Last week the Center for Disease Control (CDC) Advisory Committee on Immunizations recommended that boys as young as 9 years of age be vaccinated against the HPV virus, the most common sexually transmitted infection. HPV is also a leading cause of cervical cancer in women and throat cancer in men. Thus, according to the CDC and other independent investigators, vaccination against HPV can significantly reduce cancer rate and save thousands of lives.

Although research suggests that parental acceptance of HPV is actually much higher than anticipated (around 50% in most studies), a substantial number of parents (as high as 25%) are opposed to vaccinating their kids. In addition, despite relatively high parental acceptance of HPV vaccination, only about 1/3 of teen girls have been properly vaccinated. That is, most teens have not been vaccinated and are therefore unnecessarily at high risk of getting HPV.

Why are some parents opposed to HPV vaccination and why are the majority of kids not being vaccinated? Fortunately, research suggests that misinformation may be the most likely culprit and that providing accurate information to parents may significantly increase parental acceptability of these vaccines. For example, in one study (Davis et al., 2004) parental acceptability of HPV vaccination increased from 50% to 75% after receiving basic about HPV and the vaccine. This is why it is so important for parents to talk to their pediatricians openly about HPV vaccinations.

In addition, I wanted to address some concerns that parents may have regarding HPV vaccination.


First, parents may be wondering why it is necessary to vaccinate children and young teen boys and girls, given the HPV is a sexually transmitted condition. After all, most agree that kids and young teens should not be sexually active. The reason is that the HPV vaccine is most effective when the person is vaccinated before he or she is exposed to the virus; that is, before sexual activity starts. Some parents may saybut my teen is not sexually active. that may be true, but unless your teen is planning on joining a celibate order, one day your teen WILL be sexually active, whether as a teen or as an adult. So vaccination before this happens is critical. But the reality is that many, many teens ARE sexually active. In fact, close to 20% of teens will have sexual intercourse by age 14 and 46-48% of high school students are already sexually active (CDC 2006). In addition, a significantly higher percentage of teens will engage in other sexual activities, such as oral sex, even when delaying sexual intercourse which puts them at risk for HPV. This means that even if your teen is not engaging in sexual intercourse now, he or she may be engaging in other types of sexual activity that increase the chances of contracting HPV.

Another potential area of concern is the belief that teens may interpret the parental acceptance of HPV vaccines as an approval of sexual activity and thus they would start sexual activity early or would otherwise engage in unsafe sex practices. First, there is no evidence that suggests that HPV vaccination leads to early or unsafe sexual activity. That belief is simply not supported by the science. Yet, parents can greatly influence their kids views and behaviors on early sexual activity and safe sex. For example, teens who delay sexual activity or otherwise engage in safer sexual practices have parents who have open, supportive, communication about sexually transmitted diseases, methods of birth control, and the benefits of delaying sexual activity (Aspy et al., 2007). Thus if parents are interested in keeping their kids from having sex too early and being safe once they become sexually active, they should have open discussions about this topic. That is a much better option than not vaccinating against HPV!

In sum, the HPV vaccine has the potential to save thousands of lives by preventing cervical and other types of cancer.  As discussed in this article, it is unlikely that the HPV vaccine would lead to early or unsafe sexual activity in teens. Instead, parents can have a greater influence in delaying their kids sexual initiation and ensuring they they engage in safer sexual practices by having supportive discussions about sexuality, abstinence, and safe sex. Finally, it is important for parents to talk to their pediatricians about the potential risks and benefits of HPV vaccines and make a decision base on accurate information about such benefits and risks.

References:

C. B. Aspy, S.K. Vesely, R.F. Oman, S. Rodine, L. Marshall, K. McLeroy. (2007). Parental communication and youth sexual behaviour, Journal of Adolescence, Volume 30, Issue 3, 449-466

Centers for Disease Control (CDC). (2006). Youth behavior surveillance-United States, 2005. Morbidity & Mortality Weekly
Report, 55, 1–108

K. Davis, E.D. Dickman, D. Ferris and J.K. Dias, Human papillomavirus vaccine acceptability among parents of 10- to 15-year-old adolescents. J Low Genit Tract Dis 8  (2004), pp. 188–194.

 

Special Editorial: Smoke Signals? How Second Hand Smoke Can Impact Your Child’s Mental Health

By Anita M. Schimizzi, Ph.D.

We have known for a long time that secondhand smoke can have a serious impact on the physical health of children.  Asthma, sudden infant death syndrome, respiratory tract infections, dental decay, and middle ear infections are just a few of the illnesses that children exposed to secondhand smoke develop at significant rates.  In case parents needed an even greater incentive to quit smoking, there is now a growing body of research that suggests that secondhand smoke negatively affects the mental health of children. 

Two recent studies published in the Archives of Pediatric and Adolescent Medicine looked at the exposure of children and adolescents to secondhand smoke and whether there was a significant link between the exposure and the development of mental health problems, such as ADHD, depression, and poor behavioral conduct. 

In Bandera and colleagues’ U.S. study, the researchers found that a large sample of 8-15 year-old non-smokers regularly exposed to secondhand smoke had significantly more symptoms related to attention-deficit/hyperactivity disorder, major depressive disorder, generalized anxiety disorder, and conduct disorder.  Boys and non-Hispanic whites tended to be most vulnerable to the development of mental health symptoms.  When examining children with ADHD diagnoses more closely, the researchers found that the most significant predictor was maternal smoking during pregnancy.

Hamer and colleagues conducted a study in Scotland, also with a large group of children (ages 4-12 years).  The researchers found that the higher the amount of secondhand smoke exposure, the higher the rate of reported mental health symptoms.  After controlling for variables such as SES, chronic illness, and physical activity, the participants with high secondhand smoke exposure reported significant symptoms of hyperactivity and conduct disorder.  

Hopefully, these findings have caught your eye.  Not only does secondhand smoke have detrimental effects on the physical health of children, it also appears to impact their mental health and this can, in turn,  affect other important areas of functioning such as school and social relationships.  Exposing children to secondhand smoke may be best thought of as a non-option.  The dilemma: smoking is one of the toughest addictions to battle.  Here’s the thing.  Your children need for you to quit smoking.

There are resources upon resources out there for people trying to kick the smoking habit.  And kicking it can take many tries.  In fact, it usually does.  In working with parents, therapists will sometimes ask them to keep a photo of their child(ren) handy so their purpose is always fresh in their minds.  So get that picture out and keep it with you.  Take it out when things feel really tough.  Know that it’s worth it.  And get lots and lots of support.  Here are a couple of sites that may be of use to you as you take on this extremely trying challenge: Webmd has some good information for quitting during pregnancy and the CDC has information for anyone trying to quit. 

A few years ago, a childhood friend of mine lost her mother to lung cancer after a long history of smoking.  She left behind a husband, two adult children, and two young grandchildren, not to mention a huge community of family and friends that were just crazy about her.  She was, to this day, one of the best mothers and spunkiest individuals I have ever encountered.  We would all rather have her here.  I write this post in her memory.  

Thanks for reading.  -Anita

Sources: Bandiera FC, Richardson AK, Lee DJ, He JP, & Merikangas KR (2011). Secondhand smoke exposure and mental health among children and adolescents. Archives of pediatrics & adolescent medicine, 165 (4), 332-8 PMID: 21464381

Hamer M, Ford T, Stamatakis E, Dockray S, & Batty GD (2011). Objectively measured secondhand smoke exposure and mental health in children: evidence from the Scottish Health Survey. Archives of pediatrics & adolescent medicine, 165 (4), 326-31 PMID: 21135317

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Special Editorial: Does Early Enrichment Still Let a Kid Be a Kid?

By Anita M. Schimizzi, Ph.D.

The New York Times recently published an article about Junior Kumon, a Japanese developed tutoring program brought to the U.S.  The author sets the scene with a three year-old that is practicing writing double-digit numbers for which she gets a sticker when completed correctly.  Most students attend the program a couple of times a week for up to an hour each time and they have nightly homework to be completed with their parents.  It is easy for me to respect the program’s goal: cultivate globally competitive students who can then become globally competitive professionals.  Here is where I started having difficulty: the Junior Kumon program enrolls students from two to five years of age and primarily utilizes a drill and kill methodology designed to provide early reading and math enrichment.  The primary problem that I saw was that the author could find no evidence that this method actually leads to these little people growing into big people with greater chances for professional success.  In fact, the research overall seems to be lacking.  For example, the US Department of Education explored several studies of Kumon Math and could not draw any conclusions on the effectiveness of the program due to both a limited number of studies and research flaws.  The Kumon approach also makes me wonder about the potential impact that these methods may have on the development of other important skills, such as creativity and reasoning.

The author reported information from the fields of psychology and child development.  The consensus?  True, Junior Kumon can help children learn math facts and literacy skills.  The rest of the feedback from the experts suggests that the Kumon approach misses the beauty of early childhood learning.  Okay, so those are my words, but there really wasn’t support for the program’s approach while there was a lot of support for good old experiential learning.  You know, the kind that happens when junior is stacking blocks, making a castle in the sand, sorting objects by color, or working with a friend on building a fort out of the sofa cushions.  The creativity, critical thinking, and interpersonal skills that go into these types of early experiences pave the way for future academic and social development, which lies at the heart of why play has been so valued for so long.  A 2008 article by the National Association for the Education of Young Children (NAEYC) reviewed research on play and found that social interaction during play enhanced vocabulary and social skills, exposure to print in play fostered early literacy, and the use of materials such as blocks helped with spatial relationships and logical thinking.

Programs like Junior Kumon remind me of the predicament that public schools have faced since the onslaught of standardized tests designed to leave no child behind.  Teaching to the test at the expense of rich learning experiences, reduced participation in the arts and other subjects deemed to be not academic enough, and less time spent outside going bonkers in the fresh air are some of the side effects of this shift in public education.  Good intentions?  Yes!  The best we can do for our children to help them flourish into smart, critical thinkers capable of working on teams to generate ideas that propel our world to a better place?  Not so sure…but probably not.

Source: Zernike, K (2011, May 13).  Fast-tracking to Kindergarten? The New York Times. Retrieved May 15, 2011 from http://www.nytimes.com/2011/05/15/fashion/with-kumon-fast-tracking-to-kindergarten.html#

Special editorial: Bullying, gay teen suicides, and a need for a solution

By Nestor Lopez-Duran PhD

A call for support of anti-bullying efforts and the The Safe Schools Improvement Act.

Last Sunday a 30 year old gay man was lured into a house in the Bronx where he thought he would be attending a party. Instead, he was tortured and sodomized by a group of teenagers and young adults. He was the third person tortured by the group for being gay that same weekend. The other two victims were just 17. Also last week, Tyler Clementi, a teenager and accomplished violinist who was just starting his freshman year at Rutgers University committed suicide after he was outed by his roommate who secretly video taped him having an encounter with another boy and streamed the video on the internet to other students. Earlier last month Billy Lucas hanged himself after being bullied because his classmates thought he was gay. Likewise, thirteen-year- old Asher Brown shot himself in the head and died after experiencing severe bullying by classmates in 2 different schools. Asher had recently told his parents that he was gay. Within days Seth Walsh, another 13 year old gay teen who had been bullied at his school killed himself. And the cases seem never ending. Eric Mohah, just 17, shot himself to death after being bullied relentlessly and called homo and gay and fag. He was 1 of 4 teens who had been bullied to death at the same Ohio school. The others included 16 year old Sladjana Vidovic, 16 year old Jennifer Eyring, and 16 year old Meredith Rezak, who was tormented by her peers after coming out as gay. In light of these tragedies, how could anyone oppose efforts to keep these kids from being bullied?

So, last Friday I stepped in unfamiliar territory when I posted on child-psych.org twitter account (@childpsychology) a call to our followers to tell the organization Focus on the Family to stop opposing anti-bullying programs at schools. I had been following the stories about Focus on the Family, a conservative Christian organization that has a strong anti-gay position and opposes Senator Bob Casey (D-PA) and Congresswoman Linda Sanchez (D-PA) anti-bullying legislation, as well as stories about other Christian organizations that also oppose efforts to specifically protect gay teens from being bullied. But, from the messages that arrived soon after my twitter post, I learned that some of my followers actually agreed with the position of these conservative organizations and were upset at my post. I spent time trying to understand their logic, reading the official position of these organizations, and reading the comments on many websites where people adamantly oppose such anti-bullying efforts. And as I sat thinking how to respond, I realized that it was nearly impossible to argue with those whose views are driven by fundamentalist religious convictions. Beliefs such as that gays are impure, that they are worse than terrorists, or that those trying to stop bullying at our schools have a secret homosexual agenda and want to turn our kindergarten kids into the homosexual lifestyle, reflect a degree of hate and irrational paranoia that precludes the possibility for productive discussion. However, there was another line of arguments I found more sensible; at least as so far as it opened the door for a real scientific debate. Some indicated that the reason they opposed efforts to prevent bullying at schools is because they believe (incorrectly) that bullying prevention programs dont work.

Putting aside the fact that these programs dont work is not the argument used by Focus on the Family to oppose bullying prevention efforts, I want to tackle the assertion that anti-bullying programs dont work. Efforts to stop bullying in schools are not new. Schools have tried to stop bullying for decades to various degrees of success. Likewise, researchers have been examining the effectiveness of these programs for years, which has greatly informed our understanding of what type of program work and what doesnt work. For example, in 2007, Dr. Chael Vreeman and Dr. Aaron Carroll published an extensive examination of the effectiveness of bullying prevention programs around the world. The authors examined 3 main types of programs: 1) Curriculum interventions, 2) Whole School Interventions, and 3) Social Skills Training programs. Curriculum interventions are interventions that focus on modifications of the curriculum, which may include videos, classroom discussions, classroom presentations, etc. Whole School Interventions refer to programs that go beyond changes in curriculum to include school-wide efforts, such as teacher training, conflict resolution training, changes in school policies and sanctions, and individual counseling.  Social Skill Training programs are mostly focused on providing social and behavioral group interventions to kids involved in bullying. The authors examined 10 studies of curriculum based interventions, 10 studies of whole-school interventions, and 4 studies of social skills training programs.

So, do these programs work? It depends. The authors found that curriculum-based interventions did not usually work and in some cases made the problem worse. For example, one study found that bullying increased among young children exposed to the intervention. Likewise, another study showed that children previously identified as aggressive became even more aggressive when exposed to the curriculum-based intervention. In contrast, whole-school interventions were found to be very effective in reducing bullying, victimization, and anti-social behavior. Of the 10 programs examined, 8 showed significant benefits. However, two studies of the same program (the Olweus Bullying Prevention Program) provide some striking cues about how programs should be implemented. One study found this program to be extremely effective leading to decreased bullying, decreased victimization, decreased antisocial behavior, and improved school climate after the intervention. Yet, another study of the same program, as implemented at different schools, found that the program made the problem worse! That is, bullying among males actually increased! Why the difference? The two implementations of same program varied significantly in the degree to which the school staff members were involved, and how much the schools had contact with the researchers (who provided oversight). The schools where the program didnt work had less involvement by the school staff and had limited contact with the researchers. It appears that external oversight of the implementation of the program and more involvement by school staff is critical and necessary to make these programs work. Finally, of the 4 social skills training programs examined, only 1 showed significant benefits and this was implemented with younger (3rd grade) students. There were no benefits when the social skills training program was provided to older students.

In sum, the research to date suggests that curriculum based interventions dont appear to work. Bullying is a systemic problem and trying to solve it with simple modifications of the curriculum without addressing the entire school culture and other systemic issues is likely not effective. However, whole-school interventions can be very effective. These interventions are the model that schools should follow when implementing future anti-bullying campaigns. These results also tells us that we should reject the assertion that anti-bullying efforts dont work as an excuse for opposing the implementations of programs to curve this grave problem. Anti-Bullying programs are necessary, can be effective, and need your support. Please contact your senators and ask them to support The Safe Schools Improvement Act.


And finally on a personal note, I wish we could stop the bullying of gay teens by simply asking parents to teach their children respect for their peers, but sadly too many parents hold beliefs that implicitly condone the harassment of gay teens. When we support politicians, religious leaders, and organizations that denigrate gay individuals, we become part of the problem. When you say that gay individuals are immoral and impure like Mormon leader Boyd K. Packer did, or that gays should be barred from teaching positions, like South Carolina Sen. Jim DeMint stated, or that AIDS is Gods punishment for the society that tolerates homosexuals like Jerry Falwell asserted, or that gays are the biggest threat that our nation has even more so than terrorism, like Oklahoma State Rep Sally Ker indicated, or when you have the Boy Scouts of America stating that gay individuals are immoral and not clean in thought, word, and deed, you are dehumanizing and denigrating gay teens and providing bullies with the moral justification for their actions.  I believe that the vicious anti-gay rhetoric that fills our airwaves, our churches, mosques, and synagogues, our political speeches, and our dinner tables, is partially responsible for the death of these children.  Words matter. Hate speech matters. We need The Safe Schools Improvement Act precisely because the Focus on the Family and other homophobic organizations are opposed to it. We need a law that facilitates the implementation of effective anti-bullying efforts that explicitly protect gay teens because we live in a society in which hatred and discrimination against gay teens and adults is not only accepted by many, but preached by our politicians, religious leaders and civic organizations.

Additional Resources:
The Trevor Project: Devoted to suicide prevention and gay youth acceptance.
The It Gets Better Project: Provides stories of hope to gay teens contemplating suicide.

The reference:
Vreeman, R., & Carroll, A. (2007). A Systematic Review of School-Based Interventions to Prevent Bullying Archives of Pediatrics and Adolescent Medicine, 161 (1), 78-88 DOI: 10.1001/archpedi.161.1.78