Teenagers and “tweenagers” with type 1 diabetes have more trouble sticking to their treatment plan – thus raising their risk of blindness, kidney failure and heart disease – if their parents become increasingly lax about monitoring the child’s treatment, or if the mother-child relationship is poor.

That’s the conclusion of a new study by University of Utah psychologists that will be presented in Seattle Friday, April 9 during the Society of Behavioral Medicine’s annual meeting.

“The findings suggest that if we could improve the quality of the parent-adolescent relationship and increase parents’ monitoring of adolescents’ diabetes management, we could improve adolescents’ adherence to the type 1 diabetes regimen and, subsequently, their long-term health,” says the study’s first author, Pamela King, a postdoctoral researcher in psychology.

King says proper management of type 1 diabetes – also known as juvenile diabetes – requires adherence to a complicated, demanding treatment regimen, including multiple daily blood-glucose tests, multiple insulin injections or use of an insulin pump, regular meals, limited fat and carbohydrate intake, regular exercise, and adjustments to insulin dosage based on diet and exercise. Type 1 diabetics produce no insulin of their own.

The Juvenile Diabetes Research Foundation estimates that type 1 diabetes shortens life expectancy by seven to 10 years. “Of course, life expectancy will be influenced by how well people manage their diabetes over their lifetime,” says King.

Despite the fact that poor adherence has life-threatening consequences for health, previous research suggests that adherence declines significantly during adolescence. But most of the earlier studies were “cross-sectional,” meaning they only looked at a snapshot in time.
The Challenge of Teenagers with a Chronic Illness

The Utah psychologists conducted a “longitudinal” study, in which they analyzed the behavior of 252 adolescent type 1 diabetics and their parents over a two-year period, conducting interviews every six months about the youths’ adherence to their treatment regimen and different aspects of parental involvement.

The adolescent diabetics were recruited from the University of Utah’s Utah Diabetes Center and from Mountain Vista Medicine in South Jordan, Utah. Most of the diabetics live in Utah and Idaho, with a couple from Wyoming and Nevada.

When the study began, their ages ranged from 10 to 14; by the time it ended, some of the patients were turning 17.

The study revealed a decline in three markers of parental involvement as the adolescent diabetic grows older: a decline in mothers’ and fathers’ monitoring of adolescents’ diabetes care behaviors (for example, knowing what the adolescent eats), a decline in parents’ acceptance of the teen in general (an indicator of parent-adolescent relationship quality), and a decline in their assistance with diabetes management tasks (such as getting the adolescent diabetes supplies).

But only some of those declining indicators of involvement actually related significantly to declines in the youths’ adherence to their treatment regimen. In other words, teens and “tweens” who had more trouble following their treatment plan were those whose mothers became less accepting of them, and whose mothers and fathers had grown more lax about monitoring their offspring’s diabetes treatment and care.

“Adolescence is a challenging time for those with a chronic illness,” says King. “Adolescents experience a variety of biological, psychological and social changes before they reach adulthood. Adolescents with a chronic illness have to cope with these normal developmental challenges while trying to manage the demands of their chronic illness.”

King conducted the study with Cynthia Berg, professor and chair of psychology at the University of Utah; Jorie Butler, a postdoctoral researcher in psychology at the University of Utah; and Deborah Wiebe, a professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas.

Source: University of Utah

It is hard enough being a teenager − or the parent of a teenager − without also having to deal with type 1 diabetes. Keeping good control can be a problem when the responsibility for administering insulin and checking blood glucose levels passes from parent to child.
A new study found that while conflict levels between teens with diabetes and their parents stayed steady during this shift in responsibilities, teens’ blood glucose levels were monitored less frequently and their levels of hemoglobin A1c − a measure of how well blood glucose has been controlled over time − became worse.
The study, which followed 147 teenagers with diabetes over six months, appears online in the Journal of Adolescent Health. Younger teenagers who took greater responsibility for their own care and who had more family conflict checked blood glucose less often after six months.
However, the relative steadiness of markers for family conflict was a good thing, said Korey Hood, Ph.D., a study co-author. “We were expecting diabetes-related conflict to rise, but it didn’t,” said Hood, an assistant professor of pediatrics at the University of Cincinnati College of Medicine Cincinnati Children’s Hospital.
However, he said, the rise in A1c levels was typical of that seen during late adolescence and early adulthood: “What you tend to see as you look at large-scale clinical data is that A1c trends from the age of 12 or 13 steadily climb into young adulthood. And then it starts to decline in the mid-20s.”
“This transition from managing diabetes with the parents to independent management is a huge issue,” said Aaron Kowalski, Ph.D., assistant vice president for glucose control research at the Juvenile Diabetes Research Foundation. As an adolescent with type 1 diabetes, he had experienced this transition firsthand.
Teenagers with diabetes go through the usual stresses and peer pressure of adolescence and might let management of their disease slide, Kowalski said, and this change in priorities in turn puts stress on the parents and on family dynamics.
The majority of teens in the study used insulin pumps, which can administer a continuous amount of insulin, rather than insulin injections from syringes or pens. Hood and Kowalski said that pumps are becoming the more common method of insulin administration in children and people newly diagnosed with diabetes because they are easier to use.
The Juvenile Diabetes Research Foundation is funding an initiative to improve insulin devices that monitor glucose levels continuously, Kowalski said, but he added that a recent study of these devices still found challenges with teen users: “It worked very well in adults and 8- to 12-year-olds, but 15- to 20-year-olds saw no glucose control benefit. What happened was that most teens would not wear them consistently.”
Journal of Adolescent Health: Contact Tor Berg at (415) 502-1373 or tor.berg@ucsf.edu or visit www.jahonline.org
Ingerski LM, et al. Blood glucose monitoring and glycemic control in adolescence: contribution of diabetes-specific responsibility and family conflict. J Adol Health online, 2010

Source: Health Behavior News Service

our child is wheezing. Your child must have asthma, right? Not always, says Julie Koehler, professor and chair of the Department of Pharmacy Practice in Butler University’s College of Pharmacy and Health Sciences and clinical pharmacy specialist in family medicine at Clarian Health.
While wheezing (a high-pitched whistling sound heard during exhalation) is a classic sign of asthma, it’s also a symptom of viral respiratory tract infections and reactive airway disease (RAD).
Viral respiratory tract infections can result from the common cold and influenza. In children up to 4 years of age, the infection often resides in the lower respiratory tract — the windpipe, airways and lungs. Because the airways of young children are small, wheezing and coughing, which mimic the symptoms of asthma, can occur as a result of the infection.
For infants and toddlers who do not have an infection but are experiencing asthma-like symptoms, RAD is often the diagnosis. This diagnosis simply means your child is experiencing asthma-like symptoms, but a definitive diagnosis of asthma cannot be made yet because the child is too young. Definitively diagnosing asthma in infants and toddlers is often difficult, because children under the age of 5 are not usually able to perform the special lung function testing that is often used in making the diagnosis.
Although it is possible that children who are labeled as having RAD may continue to have symptoms and ultimately go on to develop asthma, medications such as albuterol, which work to relax and open airways and relieve shortness of breath, are often prescribed when symptoms of wheezing are present. Data suggests that up to half of all children may have at least one episode of wheezing before age 3, but only about one-third of those children will definitively develop asthma before the age of 6.
So, at what point should a child who has been diagnosed with RAD be considered to have asthma? Here are some signs to look for:
1) Wheezing that doesn’t go away or keeps recurring. Be on the lookout especially for wheezing episodes that have occurred at least four times in a year, have lasted for more than one day and/or have affected your child’s ability to sleep.
2) Frequent coughing (especially at night) or coughing that worsens after physical activity or active play.
3) A diagnosis of eczema or atopic dermatitis (a dermatologic condition characterized by skin irritation and usually associated with allergies).
4) A parental history of asthma, allergies or eczema.
5) Evidence of sensitization to aeroallergens (such as hay fever).
6) Evidence of allergy or sensitization to foods.
7) A finding of greater than or equal to four percent eosinophils (a kind of white blood cell) in the bloodstream.
For children who have intermittent asthma symptoms (i.e., not more than twice weekly), albuterol may be enough to adequately control your child’s symptoms. For children who experience symptoms more often than twice weekly, or for children whose sleep is being affected by symptoms of asthma, a daily anti-inflammatory medication, such as an inhaled corticosteroid, is often necessary in addition to albuterol in order to gain optimal control of your child’s symptoms and to potentially minimize the chronic airway damage that can be caused by inflammation.
If you or your pediatrician suspects that your child may have asthma, a conversation about initiating proper treatment is definitely warranted.
In addition to serving as a professor at Butler University, Julie Koehler has been practicing as a clinical pharmacy specialist in family medicine with Clarian Health for the past 12 years. Since 1998, she has been a member of the Pulmonary Rehabilitation Team at Methodist Hospital, where she provides monthly instruction and consultation to patients with both obstructive and restrictive lung diseases. Koehler has given numerous national presentations on the topics of asthma and COPD and has co-presented with former physician members of the Expert Panel on the Diagnosis and Management of Asthma appointed by the National Heart, Lung, and Blood Institute (NHLBI), and with the president of the American Academy of Allergy Asthma and Immunology

Source: Butler University

When a child develops red, watery eyes, it could be just allergies – or it may be the sign of a more serious eye condition, according to a leading pediatric ophthalmologist.
According to Bibiana Jin Reiser, M.D., M.S., a pediatric ophthalmologist with The Vision Center at Childrens Hospital Los Angeles, “Red, itchy, watery eyes can be a temporary allergic reaction to pollen or other environmental irritants and should go away after a few days or weeks. However, if your child has red, itchy eyes year-round, if their eyes become seriously inflamed and produce a sticky, mucous-like fluid, or if they become very sensitive to the sun, it could be the sign of a more serious condition.”

Dr. Reiser said that the common, mild form of seasonal or environmental ocular allergy is called allergic conjunctivitis. The conjunctiva is the thin, clear membrane covering the white part of the eye. This common condition can usually be treated effectively with eye drops or decongestants.
If your child is prone to this type of allergy, you should consider using hypoallergenic pillows, wrapping mattresses to prevent dust mites, closing windows and using air conditioning during high allergy season, removing pet dander and utilizing a vacuum with a HEPA (high efficiency particulate air) filter.
The more serious types of conditions that may initially mimic eye allergies are atopic conjunctivitis and vernal conjunctivitis. In the former, the child has red, watery eyes year-round and in the latter during the warmer months: April to August.
In vernal conjunctivitis, the child’s eyes have severe redness and itching and may exude a sticky, mucous like substance. The child may complain of photophobia, a painful sensitivity to strong light. Vernal conjunctivitis is often seen in young males and can be associated with asthma or eczema.
Dr. Reiser said it is essential to see a family doctor or an eye doctor promptly if the child has one or more of these symptoms:
–says sunlight hurts his eyes;
–his eyes discharge a thick, mucous like substance;
–has symptoms that are not relieved by eye drops or decongestants;
–has additional allergic symptoms, like eczema or asthma.
Dr. Reiser noted that your family physician may refer you to a pediatric ophthalmologist if the symptoms persist or get worse.
“It is important to treat serious conditions like vernal conjunctivitis promptly, because if left untreated, they may lead to ulcers in the eye or even corneal scarring,” Dr. Reiser said.
The Vision Center at Childrens Hospital Los Angeles is an international referral center known for its family friendly environment of children afflicted with all forms of eye disease and provides a full range of inpatient and outpatient services. It is the largest pediatric ophthalmology program in the nation with multiple subspecialty programs that are considered to be among today’s finest resources for diagnosis, treatment and research.

Source: Children’s Hospital Los Angeles

Skilsmässobarn är psykiskt och fysiskt lika friska som andra när de nått vuxen ålder, visar en doktorsavhandling vid Linköpings universitet. Undantaget är en mindre grupp yngre kvinnor med sämre mental hälsa och personliga resurser än de övriga i studien.

Forskare i barn- och ungdomspsykiatri vid LiU har studerat hur barn i skilsmässofamiljer mår när de blivit vuxna, 15-20 år senare. Studierna, som omfattat barn vars föräldrar skilde sig under ett år på 1980-talet, redovisas nu i en avhandling av doktoranden Teresia Ängarne-Lindberg.

Trots att dessa barn utöver själva skilsmässan fått vara med om fler omvälvande livshändelser än jämnåriga i intakta familjer – som konflikter mellan föräldrarna, flyttningar och försämrad ekonomi – märks ingen avgörande skillnad i mental hälsa när de kommit upp i 20-30-årsåldern.

I intervjuer och enkäter har deltagarna svarat på frågor om sina upplevelser av skilsmässan, mental hälsa, livshändelser utöver skilsmässan samt personliga resurser (känsla av sammanhang). Dessa uppgifter har kompletterats med data från psykiatrijournaler och sjukvårdsregister. Resultaten från gruppen skilsmässobarn har jämförts med motsvarande från en kontrollgrupp av personer vars föräldrar fortsatt att leva tillsammans.

Under barn- och ungdomsåren närmast efter skilsmässan var däremot de psykiatriska kontakterna betydligt vanligare i skilsmässogruppen – framförallt bland flickor – än i kontrollgruppen. Detta kan vara en av förklaringarna till att skilsmässorna oftast inte orsakat några avgörande konsekvenser i vuxen ålder. Andra positiva faktorer är goda personliga resurser hos barnen och att föräldrarna hanterat situationen på ett bra sätt.

En grupp av kvinnor mellan 22 och 27 år avviker från den generella bilden i studien. Vid tiden för föräldrarnas skilsmässa var de 7-12 år gamla och utgör eventuellt en mer sårbar kategori med bland annat sämre mental hälsa och känsla av sammanhang (KASAM). Höga värden på KASAM innebär att individen har en god förmåga att hantera utmaningar. Tidigare forskning har också visat att flickor i de tidiga tonåren löper större risk än pojkar att drabbas av depression i samband med negativa livshändelser.

Varje år spricker cirka 20 000 äktenskap i Sverige. 2008 fick 47 000 barn uppleva att deras föräldrar separerade, upplösta samboförhållanden inräknade.

- Trots att resultaten visar på god hälsa hos barnen 15-20 år efter skilsmässan är det viktigt att framhålla att inga barn önskar att deras föräldrar ska skilja sig. Men om föräldrarna inte har det bra tillsammans ansåg många av de intervjuade att skilsmässa kanske var den bästa lösningen, säger Teresia Ängarne-Lindberg.

Avhandlingen Grown-up children of divorce: Experiences and health är utgiven på LiU Electronic Press, se http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-54630. Disputationen äger rum torsdag 29 april kl 9:00 i Berzeliussalen, Campus US, Aschans gata, Linköping. Opponent är docent Michael Gähler, Stockholms universitet.

Källa: Linköpings Universitet

Som första barnklinik i Sverige startar Astrid Lindgrens Barnsjukhus ett barnskyddsteam. Teamet består av specialister som handlägger fall där man misstänker att barn försummats, misshandlats eller utsatts för sexuella övergrepp

Med start under våren, kommer barnskyddsteamet Mio att byggas upp under 2010. Barnskyddsteamet bygger vidare på det arbete som Mio-gruppen startade på Karolinska Universitetssjukhuset 2004, och som fungerat som ett nätverk av olika professioner med lång erfarenhet inom området. Barnskyddsteamet Mio kommer att kunna konsulteras via remiss när det gäller handläggning och utredning av barn som omfattas av socialtjänstlagens anmälningsplikt. I teamet ingår barnläkare, sjuksköterskor och socionom. De är placerade på Astrid Lindgrens Barnsjukhus i Solna, och fungerar som konsulter för dessa ärenden i hela Stockholms läns landsting.

I barnskyddsteamets uppdrag ingår dessutom att bemanna tre av Storstockholms barnahus, Kungsholmen, Huddinge och Sollentuna. Teamet bidrar då med särskild medicinsk och omvårdnadskompetens vid samråd med andra myndigheter, samt ansvarar tillsammans med Rättsmedicinalverket för de rättsmedicinska undersökningarna av barn där polisen utreder brott mot barnet.

Sedan flera år finns barnskyddsteam på barnsjukhusen (Child Protection Team) främst i Nordamerika och i England.

Children with sickle cell disease who also have lower blood oxygen levels while both asleep and awake are likely to have heart abnormalities, researchers at Washington University School of Medicine in St. Louis and other institutions have found.
Heart problems are fairly common in young adults with sickle cell disease, but physicians don’t fully understand why. The researchers demonstrated that lower oxygen saturation in the blood was linked to the heart structure seen in the 44 children studied.
Sickle cell disease is an inherited blood disorder affecting red blood cells, which contain hemoglobin, the substance that carries oxygen from the lungs to all parts of the body. In patients with this disease, red blood cells contain an abnormal type of hemoglobin that causes the normally round, flexible red blood cells to become stiff and sickle- or crescent-shaped. The sickle cells can’t pass through tiny blood vessels, which can prevent blood from reaching some tissues and can result in tissue and organ damage, pain and stroke.
In addition, sickle cells are short lived and lead to a shortage of red blood cells and anemia, which make the heart grow bigger because it has to work harder, says Mark C. Johnson, MD, associate professor of pediatrics at Washington University School of Medicine and first author of the study.
In this study, the first to analyze sleep studies and echocardiograms of children with sickle cell disease, these heart abnormalities were found in the left pumping chamber, or left ventricle, of the children’s hearts. The findings included an enlarged left ventricle, called ventricular hypertrophy, and abnormal blood filling of the left ventricle, called diastolic dysfunction. Both are associated with early death in adults with sickle cell disease, but the meanings of the same results in children are unclear.
“This suggests that the beginning of adult heart disease may start in children, but we need to follow these patients longitudinally to strengthen the meaning of the findings,” says Michael R. DeBaun, MD, a Washington University sickle cell disease specialist at St. Louis Children’s Hospital and senior author of the study, published online in Blood First Edition April 8, 2010.
“Many researchers assumed it was the anemia alone that makes the heart enlarge, but this study suggests it’s not that simple,” Johnson says.
Researchers began the study thinking that the abnormalities in the left ventricle, the heart’s main blood-pumping chamber, would be the result of sleep-disordered breathing, such as sleep apnea, commonly found in children with sickle cell disease. Sleep-disordered breathing has previously been associated with left ventricle hypertrophy and with diastolic dysfunction in children and adults. But only about one-fifth of the children had some evidence of obstructive apnea hypopnea, or recurrent episodes of upper airway collapse and obstruction during sleep.
Researchers also thought they would find lower oxygen saturation while patients were sleeping compared to when they were awake. However, the average oxygen saturation while asleep and awake were similar. Only about one-fourth of patients had average oxygen saturation values below normal.
The echocardiograms showed that 46 percent of participants had left ventricle hypertrophy in which the chamber of the left ventricle was enlarged. The research team’s analysis showed that for every 1 percent drop in oxygen saturation, there was a measurable increase in the mass of the heart’s left ventricle.
“The average oxygen saturation of 97 percent in these children is in a normal range, but the patients with slightly lower levels had enlarged hearts,” Johnson says. “A relatively small change in oxygen levels caused a big change in the heart. That’s what makes us think there’s something under the surface that we don’t quite understand yet.”
The team also measured an indicator of pulmonary hypertension, or high blood pressure in the lungs, the major cause of death in adults with sickle cell disease. When the pulmonary hypertension level is raised in adults with sickle cell disease, it is a strong predictor of death within 24 months. However, despite the strong association between pulmonary hypertension and sleep abnormalities, no such association was demonstrated in this study, DeBaun says.
Johnson and DeBaun say more sleep and cardiac studies are needed to confirm the association of left ventricle abnormalities with low blood oxygen levels. In the future, the researchers plan to look at other indicators to find potential new therapies to prevent progression of the disease.
Johnson M, Kirkham F, Redline S, Rosen C, Yan Y, Roberts I, Gruenwald J, Marek J, DeBaun M. Left Ventricular Hypertrophy and Diastolic Dysfunction in Children with Sickle Cell Disease are Related to Asleep and Waking Oxygen Desaturation. Blood First Edition. Prepublished online April 8, 2010.
Funding for this study was provided by the National Heart, Lung, and Blood Institute.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

Source: Washington University in St. Louis

The American Heart Association (AHA) has released a new guideline, endorsed by the American Academy of Pediatrics, which focuses on the prevention of rheumatic fever (RF) and on diagnosis and treatment of acute group A streptococcal (GAS) pharyngitis. Also included in the scientific statement are prophylaxis recommendations for recurrent RF and bacterial endocarditis and discussion of poststreptococcal reactive arthritis and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. Although much of the information is not new, the report confirms many recommendations in the AAP Committee on Infectious Diseases’ Red Book. Highlights of the report include the following:
— One third of acute RF episodes result from streptococcal infections that are not evident.
— GAS pharyngitis primarily affects children between ages 5 and 15 years. Infants with GAS infections might present with excoriated nares or purulent nasal discharge. Acute RF is rare in children younger than 3 years.
— Microbiological confirmation is necessary to differentiate GAS pharyngitis from pharyngitis caused by other pathogens. Neither rapid antigen tests nor traditional throat culture can differentiate between people who have GAS infection and those who are carriers.
— Antigen tests are very specific, but sensitivity is unacceptably low. If a patient has a negative rapid test but the clinician has a high index of suspicion for GAS pharyngitis, a culture should be performed.
— Treatment is indicated for patients with acute pharyngitis and either a positive antigen test or a positive culture. In general, follow-up cultures are not recommended.
— Recommended treatments for primary prevention of RF are the following:
Penicillin V (250 mg for children 27 kg or 500 mg for children >27 kg 2 to 3 times/day for 10 days)
Amoxicillin (50 mg/kg once daily [maximum, 1 g] for 10 days)
Benzathine penicillin G (1 dose of 600,000 U for children 27 kg or 1,200,000 U for patients >27 kg)
— Recommended treatments for patients allergic to penicillin are the following:
Clindamycin (20 mg/kg/day divided in 3 doses [maximum, 1.8 g/day] for 10 days)
Azithromycin (12 mg/kg/day [maximum dose, 500 mg/day] for 5 days)
Clarithromycin (15 mg/kg/day divided in 2 doses [maximum, 250 mg twice per day] for 10 days)
— Repeated courses of antibiotics are rarely indicated in asymptomatic children who continue to be culture positive for GAS.

Published in Journal Watch Pediatrics and Adolescent Medicine April 1, 2009

Small-scale studies have documented low vitamin D levels in children and adolescents, even as evidence mounts about the role of this vitamin in maintaining health and preventing disease. Three studies further our understanding of vitamin D status in children.
One study was based on data from 6275 children and adolescents who participated in the 2001–2004 National Health and Nutrition Examination Survey (NHANES). Overall, 9% of respondents (representing 7.6 million children and adolescents) were vitamin D deficient (serum 25 hydroxyvitamin D [25(OH)D] <15 ng/mL), and 61% (representing 50.8 million) were vitamin D insufficient (serum 25[OH]D, 15–29 ng/mL). Only 4% of participants reported taking 400 IU of vitamin D daily during the past 30 days. Among those aged 13–21 years, vitamin D deficiency was detected in 3% and 5% of white boys and girls, 43% and 59% of non-Hispanic black boys and girls, and 7% and 20% of Mexican American boys and girls. Deficiency rates were generally lower in children aged 7–12 years and lowest in children aged 1–6 years. Risk factors associated with deficiency were obesity (odds ratio, 1.9), drinking milk less than once per week (OR, 2.9), and television /video/computer use for more than 4 hours per day (OR, 1.6). Reported use of daily vitamin D supplements reduced the risk for deficiency (OR, 0.4). Compared with participants with vitamin D levels 30 ng/mL, those with deficiency had higher parathyroid hormone (PTH) levels and systolic blood pressure (BP) and lower HDL and serum calcium levels.
Other investigators used the same dataset to examine the effects of low serum 25(OH)D levels in 3577 fasting adolescents (age range, 12–19 years). In analyses that were adjusted for sociodemographic factors and physical activity, 25(OH)D levels were inversely associated with systolic BP and plasma glucose concentrations. Compared with children with vitamin D levels in the highest quartile (>26 ng/mL), those with levels in the lowest quartile (<15 ng/mL) had adjusted ORs of 2.36 for hypertension, 2.54 for fasting hyperglycemia (glucose 100 mg/dL), and 3.88 for metabolic syndrome.
In the third study, investigators examined the relation between serum 25(OH)D levels and insulin and glucose dynamics in 51 black adolescents (mean body-mass index, 43.3 kg/m2) at a hospital-based weight-management clinic. After controlling for BMI and PTH levels, the investigators found no metabolic differences between children with 25(OH)D levels <20 ng/mL and those with levels >20 ng/mL. However, insulin sensitivity was significantly lower and insulin resistance was higher among those with 25(OH)D levels <15 ng/mL compared with those with levels 15 ng/mL.

Published in Journal Watch Pediatrics and Adolescent Medicine November 4, 2009

A 16-year-old might be quite capable of making an informed decision about whether to end a pregnancy – a decision likely to be made after due consideration and consultation with an adult – but this same adolescent may not possess the maturity to be held to adult levels of responsibility if she commits a violent crime, according to new research into adolescent psychological development.
“Adolescents likely possess the necessary intellectual skills to make informed choices about terminating a pregnancy but may lack the social and emotional maturity to control impulses, resist peer pressure and fully appreciate the riskiness of dangerous decisions,” said Laurence Steinberg, PhD, a professor of developmental psychology at Temple University and lead author of the study. “This immaturity mitigates their criminal responsibility.”
The findings appear in the October issue of American Psychologist, published by the American Psychological Association.
Steinberg and his co-authors address this seeming contradiction in a study showing that cognitive and emotional abilities mature at different rates. They recruited 935 10- to 30- year-olds to examine age differences in a variety of cognitive and psychosocial capacities.
The participants took different tests measuring psychosocial maturity and cognitive ability to examine age patterns in numerous factors that affect judgment and decision-making. The maturity measures included tests of impulse control, sensation-seeking, resistance to peer influence, future orientation and risk perception. The cognitive battery included measures of basic intellectual abilities.

There were no differences among the youngest four age groups (10-11, 12-13, 14-15 and 16-17) on the measures of psychosocial maturity. But significant differences in maturity, favoring adults, were found between the 16- to 17-year-olds and those 22 years and older, and between the 18- to 21-year-olds and those 26 and older. Results were the same for males and females, the authors said.
“It is very difficult for a 16-year-old to resist peer pressure in a heated, volatile situation,” Steinberg said. “Most times, there is no time to talk to an adult to inject some reason and reality to the situation. Many crimes committed by adolescents are done in groups with other teens and are not premeditated.”
In contrast, differences in cognitive capacity measures increased from ages 11 to 16 and then showed no improvements after age 16 – exactly the opposite of the pattern found on the psychosocial measures. Certain cognitive abilities, such as the ability to reason logically, reach adult levels long before psychosocial maturity is attained, Steinberg said.
“Medical decisions are those where adolescents can take the time to understand and weigh options provided by health care practitioners,” said Steinberg. “Rarely are these decisions made in the heat of the moment without consultation with adults. Under these circumstances, adolescents exhibit adult maturity.”
Two friend-of-the-court briefs filed by APA in cases heard by the Supreme Court spurred questions about these maturity differences and the apparent inconsistency between APA’s positions in the two cases. In its amicus brief filed in Roper v. Simmons (2005), the case that abolished the juvenile death penalty, APA presented research showing that adolescents are developmentally immature in ways that are relevant to their criminal culpability. In an earlier brief filed in Hodgson v. Minnesota (1990), which upheld adolescents’ right to seek an abortion without parental approval, APA presented research regarding cognitive abilities that bear on medical choices, showing that adolescents are as mature as adults.
APA differentiated these two scenarios by looking at the decision-making processes required for each situation. In the Hodgson case, APA described adolescents as being competent to make informed and sound health care decisions. In the Roper case, APA characterized adolescents as too short-sighted and impulsive to warrant capital punishment, no matter what the crime. APA placed the research about psychosocial development of adolescents in the context of a court’s need to determine as part of a death penalty sentence that the perpetrator can reliably be assessed as among the “worst of the worst.”
In November, the Supreme Court is slated to hear two cases concerning the constitutionality of sentencing juveniles to life without the possibility of parole. “Similar questions about adolescent development may be raised in these cases,” Steinberg said. APA has filed an amicus curiae brief in those cases presenting relevant research, including Steinberg’s most recent study, to the court.
Adolescents’ legal rights, said Steinberg, should be guided by accurate and timely scientific evidence on the nature and course of psychological development. “It is crucial to understand that brain systems responsible for logical reasoning and basic information processing mature earlier than systems responsible for self-regulation and the coordination of emotion and thinking,” he said.
Article: “Are Adolescents Less Mature than Adults? Minors’ Access to Abortion, the Juvenile Death Penalty, and the Alleged APA ‘Flip-Flop’” Laurence Steinberg, PhD, Temple University; Elizabeth Cauffman, PhD, University of California, Irvine; Jennifer Woolard, PhD, Georgetown University; Sandra Graham, PhD, University of California, Los Angeles; Marie Banich, PhD, University of Colorado; American Psychologist, Vol. 64, No. 7.

Source: American Psychological Association (APA)