Tuesday, August 28, 2012

The Abuse of Overparenting | Dr. Lisa Firestone psychalive.org

By Dr. Lisa Firestone
I recently watched my 11-year-old nephew play basketball in his local league. As I took in the scene of the freshly polished court, the paid referees, illuminated scoreboard, and live buzzers, I couldn’t help but think how grown up my nephew and his team had become. There they were independently taking coach instructions, chatting with the refs, and playing with skill and technique. That is until something out-of-sync occurred. One of the kids was accidentally elbowed, as several kids had been throughout the game. Seemingly hurt, the boy paused the game and covered his face with his hands, perhaps in tears, perhaps not. All at once, a frantic mother rapidly emerged from the bleachers rushing the court, armed with sweaters and Gatorade. She turned reassuringly to the crowd of stunned parents and in a grand gesture, swept her son into her arms. At this, the young boy shook away in surprise.  He immediately pulled himself together, and his face quickly went from grimacing in pain to flushing in humiliation.

As parents, we all have that innate desire to protect and provide for our kids. Yet, at some point we must ask ourselves, are we doing too much for them? When do our actions cross the line from offering security and support to embarrassing them in front of their entire basketball team? The mis-attunement in this particular mother’s actions was clear in everything from her lack of pause to the odd choice of items she brought to soothe her son, whose minor injury doubtfully rendered him either thirsty or cold. However, we are all guilty of mild and extreme acts of over-protectiveness and over-parenting that can be very damaging to a developing child.

When we assume our children need more than they do, we are undermining their abilities and hurting their confidence. I first noticed this when I took my 4-year-old daughter to a dance class. When we got there, she happily changed into her outfit and removed her shoes, then asked me to put her hair in a ponytail before she trotted off to class. Moments later a classmate of hers arrived in a stroller, hugging a blanket, and sucking a pacifier. Her father helped her out of her seat, removed her shoes, assured her that her very own personal bag of snacks would be there if she got hungry, and she trotted off to class. That day, my daughter stumbled through the new steps taught in her class, while the other girl spun through the class with the grace and skill of a pro. When she returned to her father, she cried and complained for her pacifier and her snacks.

The scene reminded me that, as parents, we often fail to recognize how capable our children are. Little acts like pushing them in a stroller instead of letting them walk or giving them a snack before they even feel hunger teaches them to believe they need more looking after than they actually do. Society’s recent pro-parenting shift has its positives. Children are people, and they deserve to have a voice within their home. Parents should always aim to treat their kids with respect, interest, and consideration. However, the trend of helicopter parenting has been taken to extremes and, in that, we are also witnessing pro-parenting’s negative effects.

A 2011 PEW Research survey further found that “40% of 18- to 24-year-olds currently live with their parents, and the vast majority of them say they did not move back home because of economic conditions.” Young adults who move out then back in with their parents, whether for financial reasons or not, have led people to refer to them as the Boomerang Generation. Though reasons for this are in part economical and societal, I personally believe there is value in investigating how the raising of our children might play some part in their lack of independence in adulthood.

Many parents are willing to overextend themselves in catering to their children and excessively meeting their needs. They then feel surprised or resentful when their children grow up feeling unable to care for themselves. Doing too much for our kids teaches them to be dependent. Growing up, by its very nature, is a series of weaning experiences for children. From the moment a child is born, they are weaned from the comfort and safety of their mother’s womb. Learning the lessons of how to get their needs met then transitioning to meeting their own needs is not only essential to a person’s survival but to their psychological well-being.

Similarly, many parents tend to offer kids praise as a means of boosting their confidence. While acknowledging our children’s positive traits is healthy and beneficial to their development, offering them empty praise can be just the opposite. A study showed that kids who were rewarded or complimented for menial or unfitting attributes saw no benefit from the praise. Conversely, acclaim offered to kids for real characteristics did have a positive effect on their self-esteem.

Unsubstantiated appraisals only leave kids feeling the pressure that they need to be great all the time to live up to the buildup instead of feeling like they are okay just being who they actually are. We can help our children get a real feeling for themselves by offering them real love and affection, while equipping them with skills that help them feel competent.

A helpful way to look at this is to imagine taking your kids to the park. How much do you let them explore and play independently from you? How much do you interfere and direct their behavior? Are you overly cautious about their safety? Do you discourage them from venturing out on their own? Are you over-attentive to their fears or encouraging of their resilience?

The park example provides a good metaphor for how we raise our children. A parent should be a secure base from which a child can explore the world. At the park, we can let them be independent while always letting them know that we are there to help, support, and guide them in their own unique adventure. We can be standing by when they need us, and we can step aside when they do not. In doing so, we should allow our children to experience the world for themselves.

Often, the reasons it is difficult for us to let our kids explore and develop their autonomy has more to do with us than with our children. As parents, it is invaluable to be aware of when we are using our children to fulfill our own needs. How much does our desire to protect them come from them? And how much does it come from our own need to act a protector? How often are the hugs we give them to provide affection, and how often are they to take affection from them?

So much of parenting involves how we feel about ourselves. As psychologist and author Pat Love has said, the best thing adults can do as parents is to have their needs met by other adults and not by their children. Our kids need us to be the best, most developed, and most fulfilled versions of ourselves in all areas of our lives in order to feel independent and secure in theirs. That way, they can emulate and learn from us without feeling they must fill the voids we experience in our own lives.

When we give our kids too much power, we start to act like victims to our children instead of the teachers, caregivers, and role models we should be. Overindulging, over-rewarding, or babying our children actually serves as a sort of pressure for greatness and a set up for disappointment. The empty acts we mistake for nurturance are at best substitutes for real love and at worst forms of actual abuse. It’s no great coincidence that many of the children we see being spoiled or indulged also appear unhappy and dissatisfied. The most honest proof of good parenting is seeing our child doing well, showing interest, learning skills, finding contentment, and finding him/herself. What we can offer as parents is love, safety, support, and guidance, a strong security from which our children can confidently venture out and independently experience the world.

Sunday, August 26, 2012

An Immune Disorder at the Root of Autism | NYT Opinion MOISES VELASQUEZ-MANOFF


Published: August 25, 2012

IN recent years, scientists have made extraordinary advances in understanding the causes of autism, now estimated to afflict 1 in 88 children. But remarkably little of this understanding has percolated into popular awareness, which often remains fixated on vaccines.

Eleanor Davis
So here’s the short of it: At least a subset of autism — perhaps one-third, and very likely more — looks like a type of inflammatory disease. And it begins in the womb.

It starts with what scientists call immune dysregulation. Ideally, your immune system should operate like an enlightened action hero, meting out inflammation precisely, accurately and with deadly force when necessary, but then quickly returning to a Zen-like calm. Doing so requires an optimal balance of pro- and anti-inflammatory muscle.

In autistic individuals, the immune system fails at this balancing act. Inflammatory signals dominate. Anti-inflammatory ones are inadequate. A state of chronic activation prevails. And the more skewed toward inflammation, the more acute the autistic symptoms.

Nowhere are the consequences of this dysregulation more evident than in the autistic brain. Spidery cells that help maintain neurons — called astroglia and microglia — are enlarged from chronic activation. Pro-inflammatory signaling molecules abound. Genes involved in inflammation are switched on.

These findings are important for many reasons, but perhaps the most noteworthy is that they provide evidence of an abnormal, continuing biological process. That means that there is finally a therapeutic target for a disorder defined by behavioral criteria like social impairments, difficulty communicating and repetitive behaviors.

But how to address it, and where to begin? That question has led scientists to the womb. A population-wide study from Denmark spanning two decades of births indicates that infection during pregnancy increases the risk of autism in the child. Hospitalization for a viral infection, like the flu, during the first trimester of pregnancy triples the odds. Bacterial infection, including of the urinary tract, during the second trimester increases chances by 40 percent.

The lesson here isn’t necessarily that viruses and bacteria directly damage the fetus. Rather, the mother’s attempt to repel invaders — her inflammatory response — seems at fault. Research by Paul Patterson, an expert in neuroimmunity at Caltech, demonstrates this important principle. Inflaming pregnant mice artificially — without a living infective agent — prompts behavioral problems in the young. In this model, autism results from collateral damage. It’s an unintended consequence of self-defense during pregnancy.

Yet to blame infections for the autism epidemic is folly. First, in the broadest sense, the epidemiology doesn’t jibe. Leo Kanner first described infantile autism in 1943. Diagnoses have increased tenfold, although a careful assessment suggests that the true increase in incidences is less than half that. But in that same period, viral and bacterial infections have generally declined. By many measures, we’re more infection-free than ever before in human history.

Better clues to the causes of the autism phenomenon come from parallel “epidemics.” The prevalence of inflammatory diseases in general has increased significantly in the past 60 years. As a group, they include asthma, now estimated to affect 1 in 10 children — at least double the prevalence of 1980 — and autoimmune disorders, which afflict 1 in 20.

Both are linked to autism, especially in the mother. One large Danish study, which included nearly 700,000 births over a decade, found that a mother’s rheumatoid arthritis, a degenerative disease of the joints, elevated a child’s risk of autism by 80 percent. Her celiac disease, an inflammatory disease prompted by proteins in wheat and other grains, increased it 350 percent. Genetic studies tell a similar tale. Gene variants associated with autoimmune disease — genes of the immune system — also increase the risk of autism, especially when they occur in the mother.

In some cases, scientists even see a misguided immune response in action. Mothers of autistic children often have unique antibodies that bind to fetal brain proteins. A few years back, scientists at the MIND Institute, a research center for neurodevelopmental disorders at the University of California, Davis, injected these antibodies into pregnant macaques. (Control animals got antibodies from mothers of typical children.) Animals whose mothers received “autistic” antibodies displayed repetitive behavior. They had trouble socializing with others in the troop. In this model, autism results from an attack on the developing fetus.

But there are still other paths to the disorder. A mother’s diagnosis of asthma or allergies during the second trimester of pregnancy increases her child’s risk of autism.

So does metabolic syndrome, a disorder associated with insulin resistance, obesity and, crucially, low-grade inflammation. The theme here is maternal immune dysregulation. Earlier this year, scientists presented direct evidence of this prenatal imbalance. Amniotic fluid collected from Danish newborns who later developed autism looked mildly inflamed.

Debate swirls around the reality of the autism phenomenon, and rightly so. Diagnostic criteria have changed repeatedly, and awareness has increased. How much — if any — of the “autism epidemic” is real, how much artifact?

YET when you consider that, as a whole, diseases of immune dysregulation have increased in the past 60 years — and that these disorders are linked to autism — the question seems a little moot. The better question is: Why are we so prone to inflammatory disorders? What has happened to the modern immune system?

There’s a good evolutionary answer to that query, it turns out. Scientists have repeatedly observed that people living in environments that resemble our evolutionary past, full of microbes and parasites, don’t suffer from inflammatory diseases as frequently as we do.

Generally speaking, autism also follows this pattern. It seems to be less prevalent in the developing world. Usually, epidemiologists fault lack of diagnosis for the apparent absence. A dearth of expertise in the disorder, the argument goes, gives a false impression of scarcity. Yet at least one Western doctor who specializes in autism has explicitly noted that, in a Cambodian population rife with parasites and acute infections, autism was nearly nonexistent.

For autoimmune and allergic diseases linked to autism, meanwhile, the evidence is compelling. In environments that resemble the world of yore, the immune system is much less prone to diseases of dysregulation.

Generally, the scientists working on autism and inflammation aren’t aware of this — or if they are, they don’t let on. But Kevin Becker, a geneticist at the National Institutes of Health, has pointed out that asthma and autism follow similar epidemiological patterns. They’re both more common in urban areas than rural; firstborns seem to be at greater risk; they disproportionately afflict young boys.

In the context of allergic disease, the hygiene hypothesis — that we suffer from microbial deprivation — has long been invoked to explain these patterns. Dr. Becker argues that it should apply to autism as well. (Why the male bias? Male fetuses, it turns out, are more sensitive to Mom’s inflammation than females.)

More recently, William Parker at Duke University has chimed in. He’s not, by training, an autism expert. But his work focuses on the immune system and its role in biology and disease, so he’s particularly qualified to point out the following: the immune system we consider normal is actually an evolutionary aberration.

Some years back, he began comparing wild sewer rats with clean lab rats. They were, in his words, “completely different organisms.” Wild rats tightly controlled inflammation. Not so the lab rats. Why? The wild rodents were rife with parasites. Parasites are famous for limiting inflammation.

Humans also evolved with plenty of parasites. Dr. Parker and many others think that we’re biologically dependent on the immune suppression provided by these hangers-on and that their removal has left us prone to inflammation. “We were willing to put up with hay fever, even some autoimmune disease,” he told me recently. “But autism? That’s it! You’ve got to stop this insanity.”

What does stopping the insanity entail? Fix the maternal dysregulation, and you’ve most likely prevented autism. That’s the lesson from rodent experiments. In one, Swiss scientists created a lineage of mice with a genetically reinforced anti-inflammatory signal. Then the scientists inflamed the pregnant mice. The babies emerged fine — no behavioral problems. The take-away: Control inflammation during pregnancy, and it won’t interfere with fetal brain development.

For people, a drug that’s safe for use during pregnancy may help. A probiotic, many of which have anti-inflammatory properties, may also be of benefit. Not coincidentally, asthma researchers are arriving at similar conclusions; prevention of the lung disease will begin with the pregnant woman. Dr. Parker has more radical ideas: pre-emptive restoration of “domesticated” parasites in everybody — worms developed solely for the purpose of correcting the wayward, postmodern immune system.

Practically speaking, this seems beyond improbable. And yet, a trial is under way at the Montefiore Medical Center and the Albert Einstein College of Medicine testing a medicalized parasite called Trichuris suis in autistic adults.

First used medically to treat inflammatory bowel disease, the whipworm, which is native to pigs, has anecdotally shown benefit in autistic children.

And really, if you spend enough time wading through the science, Dr. Parker’s idea — an ecosystem restoration project, essentially — not only fails to seem outrageous, but also seems inevitable.

Since time immemorial, a very specific community of organisms — microbes, parasites, some viruses — has aggregated to form the human superorganism. Mounds of evidence suggest that our immune system anticipates these inputs and that, when they go missing, the organism comes unhinged.

Future doctors will need to correct the postmodern tendency toward immune dysregulation. Evolution has provided us with a road map: the original accretion pattern of the superorganism. Preventive medicine will need, by strange necessity, to emulate the patterns from deep in our past.

Moises Velasquez-Manoff is the author of “An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases.”