Mark Bertin's Blog, page 10

If You Could Control Someone's Attention, What Would You Do With It?

Click here to watch the TEDTalk that inspired this post.



Apollo Robbins, the world's greatest pickpocket, quite accurately states in his entertaining TED talk "The Art of Misdirection" that attention steers our perception of reality. We cannot be aware of something unless we choose to attend to it. Misdirected by him, we miss again and again his sleight of hand as he pickpockets and generally befuddles his mark.



Mr. Robbins ends with this question: If you could control somebody's attention, what would you do with it? It is a fascinating idea to ponder. It also makes me wonder, if I can't even control my own attention, what am I supposed to do with someone else's?



Attention is a Limited Resource



Life is here. My attention often isn't. I have a pretty good sense of what I could attend to that would make me happier, and what I would be happier attending to less, but get sidetracked an awful lot. Using the term in its broadest sense, our attention spends much of its time "misdirected" without any need for outside help.



We live in a world full of distraction, and in truth we always have. It's a problem described through the ages. Whether I want it to or not, my mind gets busy and I find myself caught up in not only trying to prevent pickpockets but internally with all my worries, hopes and planning, and around me family, friends, email, phone calls and all the rest.

Lost in distraction, we exist on autopilot and habit. Paying attention creates an opportunity for change. -- Mark Bertin

Several years ago, a Harvard study suggested that the more we attend to whatever we are doing, the happier we feel. The researchers did their best to separate out the fact that we want to focus on the pleasant times, and turn away from the painful. Even considering that, the more attention paid to an activity, the happier people reported being.



As Robbins accurately states, the human brain can only focus fully on one thing at a time, in spite of how often we try juggling more. I'd be less stressed and more productive writing this blog if I paid attention to it and it alone. But I have a phone call to return and by this time next week I'll be on vacation. I wonder if the weather will delay our flight. And I am starting to get antsy because I want to go out and play in the snow with my kids.



Thoughts themselves become deep ruts that draw our attention. In fact, mental patterns reinforce themselves neurologically, making it even more likely we'll head down the same path again. I know I'd be better off focused on the computer, but at any given moment I'm pulled off track again and again by idle rumination, vacation planning, rehashing some conversation or wondering if the snow is good for sledding. I better hope there's not a pickpocket in the room.



If You Don't Attend to Something, You Can't be Aware of It



Everywhere we go, screens reach out too, a crazy mix of entertainment, awful news, and advertising. Precise research determines that all of it grabs our attention. Marketing is a form of misdirection not unlike Mr. Robbins, packaging a message to make sure it seems harmless and fun while subtly grabbing our attention and letting us know: Use this product, watch this show, live this life.



Years ago, an expose on advertising revealed an interesting point about this aspect of attention. Target stores use marketing research and neuroscience quite skillfully. They determine through changed shopping patterns when you are likely to be pregnant, and insidiously alter the weekly flier mailed to your house. Suddenly, a high percentage of products relate to infants. They have determined that once they capture your dollar, as a stressed new parent you are unlikely to attend to that choice again. Target = diapers. Done.



But here's the encouraging part of the article: Simply recognizing shopping as a habit makes it more likely you'll vary your behavior. With that moment of awareness, you remember another store might have lower prices. Drawing attention to any habit makes it more likely to change. That fact applies to marketing, but also to how we think, how we act, and where we choose to place our attention.



Attention Shapes Reality



I may never control my mind with the consistency Mr. Robbins apparently achieves with his unique skills. As a pickpocket, he takes advantage of something I accomplish for myself quite well. I attend for a few moments where I want and then the next thought or emotion crops up and off I go again.



It's not just that the world is distracting. Our minds distract themselves. We know our attention would best be held here in the present, and yet it takes itself somewhere else, over and over again. And it's not only that we get distracted. We also develop mental habits that reinforce themselves over time and hijack our experience. But many of these can be redirected if we're aware of them. Knowing that is an opportunity for change.



We can practice steering our full attention back to our family, our friends and our lives more often. We can also give attention to all our innate (and sometimes inane) habits, and create a better chance for doing something new next time around. Maybe we put down the smartphone, get down on the floor, and play with the children for the next few minutes, nothing more.



It all comes down to this: Lost in distraction, we exist on autopilot and habit. Paying attention creates an opportunity for change.



It still won't stop a skilled pickpocket, though.



Ideas are not set in stone. When exposed to thoughtful people, they morph and adapt into their most potent form. TEDWeekends will highlight some of today's most intriguing ideas and allow them to develop in real time through your voice! Tweet #TEDWeekends to share your perspective or email tedweekends@huffingtonpost.com to learn about future weekend's ideas to contribute as a writer.

The ADHD Blame Game

The first mother to arrive at my office last Tuesday brought me a copy of the latest New York Times article regarding ADHD. She said she was both hurt and angry, as the newspaper heavily suggested that most ADHD results from problems with the educational system. She added, "It took me a while to accept ADHD is real (considering what everyone says about it), and if I had seen this article a few months ago, it would have made me doubt myself again." After reading the Times, she felt she might have skipped getting her son evaluated for ADHD, instead blaming herself and the school system for his academic difficulties.



Meanwhile, her son is thriving this year after diagnosis. "It makes me sad to think of all the parents who might be misled by the article. It seems so reasonable on the surface," she said. Since October was National ADHD Awareness Month, I thought I'd respond online to this common experience for parents and individuals living with ADHD.



ADHD is a medical disorder, not caused by parents or by our increasingly busy modern world. The genetic influence of ADHD has been shown close to that of height: If two tall people with ADHD put their child up for adoption, he (or she) will likely grow up to be tall and have ADHD. Suggesting otherwise alienates people who either have ADHD or are deciding about seeking help.



ADHD does not affect only attention but a part of the brain responsible for self-regulation and management as a whole. Individuals with ADHD may struggle at home, at school and in social relationships. Studies have linked ADHD to car accidents, obesity, sleep problems, and many other daily struggles. Parents of children with ADHD report higher stress levels, anxiety, depression, and marital problems. The cost of treating other medical conditions (such as asthma or diabetes) dramatically rises when an individual has ADHD, making it a public-health concern that we address it well.



Doubt about ADHD continues in spite of accumulating evidence about its medical basis. So much in print and online fans flames of distrust around global problems such as misdiagnosis and medication misuse. In reality, we have to separate the needs of individuals who have ADHD from societal concerns about people without ADHD ending up diagnosed or abusing prescription medications.



First , there is a difference between diagnostic rate and the actual occurrence of any disorder. Worldwide studies have shown that the actual rate of ADHD is around 4 to 8 percent. If somewhere the rate is far lower, ADHD is probably under-diagnosed. Anywhere the rate is significantly higher suggests misdiagnosis is rampant and needs addressing... but that doesn't change the fact that around 1 in 15 children actually have ADHD and would benefit from compassionate, objective care.



As for medication, no single intervention changes everything, so strong ADHD management typically draws from a wide range of supports. Parent training, behavioral therapy, educational interventions, discussion of better sleep habits, exercise, the practice of mindfulness and many other options all have potential roles. However, nothing studied to date changes core symptoms of ADHD (such as poor focus or impulsivity) more effectively than medication, another frequently biased area of public discussion.



Personally, I'm neither for nor against medication. Clearly, it is always best not to prescribe a medication when it can be avoided for anything. I also feel people should know the basics before making any decisions: Medications require meticulous adjusting over time to get right and they do not work for everyone, but used appropriately they can be hugely beneficial and without side effects. The fact that medication can be abused by people without ADHD must be addressed but should not affect decision making for an individual who actually has ADHD.



For the benefit of everyone, we need to balance discussion about the impact of ADHD (which is real) from separate concerns about over-diagnosis or medication abuse (which are also real). People end up doubting themselves ("This is all my fault!") and their family members ("They just have to work harder!") and miss out on opportunities to change a lifelong path through intervention. Instead of sowing seeds of doubt and pointing fingers of blame, individuals with ADHD need compassionate and open-minded support along with ongoing discussion about how to further progress in this complex field.



For more by Mark Bertin, M.D., click here.



For more on ADHD, click here.

The Brain-Boosting Product You Already Have in Your Home

Did that tag line grab your attention? As parents, we're under constant pressure to do whatever we can to give our children a leg up. Millions of dollars are spent marketing to us, most of it without a whole lot of grounding in reality. For example, claims are continually made, yet there is scant evidence to date that "educational" software has much (if any) benefit for children.



What "new" product does promote brain development? Apologies if you find it a stretch, but new books come out every week. That may not sound flashy, but more than any other "product," time with books has been shown to build language and cognitive abilities. There is evidence to show that:



Exposure to books in early childhood has been linked to improved language development.



Exposure to books in early childhood has been linked to improved academic performance.



And, there is also evidence to show that:



Hours spent in front of a screen in early childhood predict similar screen use later in life.



Increased screen time correlates with poorer academic scores, shorter attention spans, obesity and other less than ideal outcomes.



Laying the Foundation for Success



For parents of young children, a vital fact to know is this: Habitual behaviors hard-wire themselves. The brain develops across our entire lives through a concept called 'neuroplasticity.' Anything we repeat enough reinforces itself by creating brain connections to support that specific behavior. Routines built early in childhood neurologically sustain themselves around nutrition, exercise, reading, technology and countless other aspects of life.



There's nothing wrong with well-managed computer use for entertainment, and technology can be a powerful tool when well-utilized. Someday, a specific product may even be proven to educate. Yet, screen habits develop early and built-in marketing is highly influential. In order to raise a generation of children able to manage media without allowing an intrusion on other vital activities or a push towards less healthy habits, we must promote and model a balanced lifestyle from the start.



Most parents want to encourage children to skillfully and willingly spend time with peers, reading and in physical activity, and to be able to fill down time with self-created imaginative play. If you teach a child to depend on constant screen entertainment at the first sign of fussiness and boredom, that pattern may continue through all of childhood. There may even be particular value to time spent daydreaming.



We need to go out of our way to emphasize activities such as reading, open-ended play, outdoor play and family time, all of which have been shown to promote healthy child development. For example:



Families exposed to books early are more likely to value reading (which improves language abilities and builds background knowledge).



Social, imaginative play has been linked to strong executive function (self-management) abilities, which correlates with academic success later in school.



Contrary to claims, educational products have not been shown to build language or cognitive skills in young children. Screens have been shown, however, to disrupt and shorten social interactions with parents and caretakers.





Build a Better Brain



It is national literacy month in the United States. Get on board by going back to the basics. No one is going to spend millions of dollars to convince you that the most important product for your child's development may simply be a pile of books. Lots of people are going to try to sell you other stuff. Take special effort this month to bring books into your home, emphasize reading as a joint activity and make reading fun.



Reach Out and Read is a national organization that promotes early literacy by giving out books to low-income children during well-child visits with their pediatrician. Here are tips selected from its website for building a young child's relationship with books:



Make reading part of every day.

Have fun. Talk about the pictures. You do not have to read the book to tell a story.

Let your child turn the pages.

Run your finger along the words as you read them.

Choose books about events in your child's life such as starting preschool, going to the dentist, getting a new pet or moving to a new home.

Make the story come alive. Create voices for the story characters.

Ask questions about the story. What do you think will happen next?

Let your child ask questions about the story.

Talk about the activities and objects depicted in the story. Make connections with your child's day to day experience.

If someone you know cannot read, encourage them to share books through activities such as describing the pictures and prompting children to do the same.

Visit your local library often -- you do not even need to spend money on this particular brain-building product at all!

Mindfulness Means Nothing: Lose the Word, Find a Habit

I am on my way to a Mets game and my friend Ken asks, "What is mindfulness?" It's not an uncommon question for me. It's in my writing, my medical practice, the classes I lead, and my everyday life. So you'd think I'd have a pithy answer that perhaps would last less than the hour we'll be stuck in ballpark traffic, but I don't. Mindfulness has become harder and harder for me to define the more I know about it.



I often say that if mindfulness seems odd or inaccessible, I've done a poor job explaining it. I generally start with Dr. Jon Kabat-Zinn's definition, since he created the original mindfulness program in the 1970s. He has said mindfulness is "paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment."



That sentence is accurate, but fails my Bronx test. If I ask any average person on the street what that means, I'd be at risk for a dismissive shrug. And who wants to be nonjudgmental anyway? Dr. Kabat-Zinn's definition starts the discussion, but does not necessarily reveal enough about tangible, day-to-day value. That's because mindfulness is a word trying to translate an experience, something common sense and accessible but not easy to encapsulate.



Mindfulness: A Dictionary Definition

Mindfulness According to Oxford:

The quality or state of being conscious or aware of something



Dr. Kabat-Zinn created his "mindfulness-based stress reduction" (MBSR) program to introduce centuries-old Buddhist concepts into the secular West. Mindfulness is not a spiritual practice unless you want it to be. Whether you're an intense business leader, an inner-city kid from Baltimore or living on a mountaintop in Tibet, mindfulness builds skills and perspectives that cultivate a larger sense of equilibrium around basic facts of life such as everything is always changing, nothing stands still, and uncertainty rules.



The concept behind the entire MBSR program can be unintentionally misleading. Give us eight weeks and we can fix your stress problem. It can sound very... advertising driven. As any MBSR teacher would say, in reality stress is going to continue whatever we do. And even when your stress level does improve (as research suggests it may), MBSR does not immediately alter anything for some people or eliminate stress forever for anyone; it is not cure-all or a quick fix.



The eight-week program is an introduction to a lifelong training. Stick to it, even when practice is difficult and not much seems to happen, and your experience changes. Mindfulness is more analogous to long term physical fitness than anything more immediate such as knee surgery or a dose of antibiotics.



The Language of Mindfulness

Mindfulness According to Grandma:

Learning how to "be in the moment" and familiar with what you are experiencing so that you become more focused and less reactive in your behavior.



There's often confusion about the relationship between various related concepts such as "mindfulness" and "mindfulness meditation" and "mindfulness-based stress reduction." Are they all the same or different? Do they all depend on each other? If I take a mindfulness class do I have to sit quietly for hours on end and pretend to be happy about it?



First, what is meditation? Mindfulness meditation is a particular type of meditation that breaks a habit. We all live much of life distracted and not quite paying attention to what's actually going on. We exist on autopilot, generally relying on habitual and often reactive behaviors. Through meditation we aim to build a capacity to attend fully to real life, as it is, for better or worse, without any escapism or striving for a totally still mind. Not only can you meditate if you have a busy mind, it's expected that you'll have one.



How does the MBSR program relate to mindfulness? Dr. Kabat-Zinn's center has created guidelines for MBSR instruction, with the intention that only teachers following the plan call their classes by that name. To attend an MBSR class means someone follows this protocol. Many other programs and interventions formally or informally (but validly) integrate mindfulness.



Mindfulness refers to the whole package, a particular set of cognitive skills we develop that help manage our lives. Mindfulness doesn't require meditation, but it's built through meditation. It does not require a particular program. You can practice mindfulness at any time through the day, bringing your full attention to whatever you're doing, with a particular attitude of openness and acceptance (whatever that means). So mindfulness is not mindfulness based stress reduction is not meditation.



Mindfulness is more than attention training.



Mindfulness According to Siri:

The trait of staying aware

(of paying close attention) to your responsibilities.



Stress results when real life does not fit our idea of what should be. Which might mean something as huge as "I imagined I'd be in a happy marriage forever but now I'm getting divorced" or as simple as "I had my heart set on a cheeseburger but they are out of cheese." Recently back from vacation we may feel particularly magnanimous, accept our disappointment, and move forward. After an awful night sleep and a fight with our boss the no-cheese experience causes a meltdown. A lot of the time, if not all the time, our perspective matters.



When we discuss paying full attention to our immediate experience, it means not only to external forces (no cheese today) but all our internal chatter (this kind of thing always happens to me, what idiot failed to order cheese at a burger joint, my life sucks, why can't I be more mindful and accepting instead of getting angry again). We cannot expect to be happy in any situation, but we increase suffering when fueling our mental fires with self-recrimination (I shouldn't make such a big deal over a missing dairy product), rumination (if only I could stick to vegetarianism this kind of thing wouldn't happen to me), prognosticating (nothing will ever change) or any other common tinder.



Mindfulness may be a proactive version of the traditional serenity prayer, without the God reference. Being open and curious means acknowledging the reality of the moment, however we feel, without excessive wrestling. Equanimity, a sense of peace and ease, often follows. May I develop for myself the ability to change the things I can, to accept the things I cannot, and the wisdom always to see the difference.



Mindfulness is a skill set.

Mindfulness According to Dr. G, Pediatrician/MBSR participant:

Mindfulness is a state where one accepts the past as unchangeable and the future as theoretical, where thoughts are just thoughts

and the present moment is all there is.



So what is mindfulness already? Mindfulness is the ability to live life more fully aware of what's going on both around us and in our minds. Through that awareness, we become more familiar with our ongoing mental habits. That awareness increases our ability to pick and choose (without expecting total success) which ones to continue and from which we might step back at any moment.



We also build a general trait of responsiveness over reactivity. We create a little more space between our experience (no cheese) and whatever we elect to do next. Or maybe for once we allow ourselves to do or say nothing at all, dropping any rumination, planning or compulsion to fix everything. I'm disappointed, I don't have time to go elsewhere, what else can I order today?



Putting our existence under a microscope is not the goal; we instead balance a more gentle focus with a measure of acceptance. We recognize our own cognitive tendencies without self-abuse. We cultivate a sense of compassion for ourselves and others, a recognition than once we pause and attend we may notice that we're all trying to find some peace and happiness in life, even when we appear to be making a mess of it.



Mindfulness for a healthy brain.



Mindfulness According to basketball coach Phil Jackson:

The trick is to experience each moment with a clear mind and open heart. When you do that, the game -- and life -- will take care of itself.



I don't work out because I want stronger lungs or legs or arms in particular. I want my body as a whole to stay in shape. And I don't practice mindfulness because I expect better focus or less stress or more responsiveness in isolation. I support a general state of mental well-being through ongoing effort. That hopefully improves life not just for me, but for my family and anyone else who deals with me day to day.



As a doctor trained in Western medicine, the science matters a lot to me. Among people practicing mindfulness studies have shown physical changes in the brain including ones potentially related to focus and emotional control. Other research reveals physical and psychological benefits. The brain is malleable, responding to our experience and whatever we mentally practice with concrete, physical growth. So if it clicks for you, feel free to define mindfulness as cognitive fitness training.



In a line or two then, what is mindfulness and why do it? Mindfulness is a word, and a less than perfect one at defining anything in particular. The concepts behind mindfulness matter far more. Try it and find out.



For more by Mark Bertin, M.D., click here.



For more on mindfulness, click here.

Feed Your Brain, Feed Your Life: The Science of Everyday Mindfulness

Practicing "mindfulness" may seem like an abstract or unfamiliar concept, but that's because it is a word used to encapsulate what actually represents a way of living life. We spend a lot of our time lost in distraction, doing one thing while thinking of another, and acting reflexively or out of habit to both our emotional and real-life experiences. Through mindfulness practice, we cultivate cognitive traits that counter these tendencies and promote long-term well-being through building abilities such as focus, responsiveness and compassion.



Our brains continually rewire themselves based on experience throughout our lives, a relatively new and remarkable finding. Analogous to physical exercise and the body, we can take advantage of this plasticity to affect our own basic neurology. Training our brain to be less distracted and reactive, less prone to falling back on ingrained habits, and more flexible in thought unsurprisingly turns out to have lifelong benefits.



Research in mindfulness has exploded exponentially over the last decade, suggesting improvements in both physical and mental health. Among hundreds of positive results, studies have shown better immune function, decreased anxiety, and physical growth of areas of the brain responsible for emotional regulation.[1],[2],[3] While many have been conducted in the adult population, a growing number relate to children.



At the forefront has been Dr. Richard Davidson, founder of the Center for Investigating the Healthy Mind at the University of Wisconsin-Madison, whose pioneering research opened up an entire field of study called "contemplative neuroscience." Dr. Davidson is featured in the upcoming documentary Free Your Mind, which highlights programs working with traumatized military veterans -- and also preschool-age children.



I recently had the opportunity to speak with Dr. Davidson and, separately, to the movie's director, Phie Ambo. Ms. Ambo attended an eight-week mindfulness-based stress reduction program she found life-changing, and "wanted to do a film about the brain for people not likely to enter a meditation study."



Dr. Bertin: There are many different ways of describing mindfulness for people not familiar with it. One from an elementary school age child in the New York Times was something like "getting angry and not bopping someone in the nose." From your perspective, how would you define mindfulness as it pertains to children and family, for people who might not be as familiar with the idea?



Dr. Davidson: The way it has been defined in this context for popular readership has typically been this: paying attention, non-judgmentally, on purpose. Those are the elements that are incorporated to the training that we do. The potential consequences like not bopping your friend on the head are consequences, they are not part of the practice itself.



There is a lot of discussion in the scientific and contemplative literature about just what mindfulness actually means. It's quite complicated, because it also has a component that involves remembering to be aware, remembering to pay attention on purpose non-judgmentally, so that you can actually bring this into everyday life. For a child this may mean remembering they have skills that can be deployed in everyday life where anxiety or conflict may arise.



When you are working with children as opposed to adults, how do you approach them differently?



Well, the strategies and exercises you use are age-appropriate. In the film you see some of them. Various kinds of external prompts and activities are used, like belly breathing with a stone on the belly. We also have kids listening mindfully to sounds, where they have to raise their hands as soon as they hear a bell stop ringing. During the time that the tone is going, you can hear a pin drop in the room. Everyone is very quiet, and they are instructed to raise their hands when they can no longer hear it.



In some cultures where these practice come from, they don't start direct instruction in the practices until children are older. What is your perspective on when and how to start?



What you are referring to in certain cultures, in certain traditional Buddhist contexts, formal practices of mindfulness are not typically begun until adolescence. But there are other kinds of practices that are started early and have the same effects. My own view is that in our culture here in America, and Western countries generally, it may make sense to begin these practices earlier because we don't have those other kinds of activities. (Author's note: Mindfulness, while drawn from Buddhist traditions, is not inherently a spiritual or religious practice.)



There is a lot more specific research about mindfulness and adults, how would you describe the state of the research around mindfulness and children?



To use a single word, I would say it is minimal. There are very, very few good studies that have been done with mindfulness and children. Right now, I would say it is more of a promissory note than anything else. I think the evidence in adults is sufficiently compelling to suggest it is worth exploring in children, but I think anyone who tells you there is good evidence in children is way over-estimating what is out there.



Some people feel that experience of being fully aware and present in many activities of life, if they are lucky, maybe through athletics or a particular hobby. If these activities promote what feels like present-moment, non-judgmental awareness, from a neurological perspective is that the same experience, or is there something unique to the mindfulness practice?



That's a very important question and I'd answer it in a couple of different ways. The first way to answer it is that it is likely there are some elements that are common, although there are no really good studies to compare them directly. There are many activities, as you note, in which we can engage in that type of attention and my suspicion is that if you are looking exclusively at circuits in the brain that are important to the regulation of attention, you might see similar effects.



When mindfulness is taught authentically, rooted in the traditions from which it is derived, the reason we practice mindfulness is to be of benefit to others. We don't normally go out and play tennis to be of benefit to others, we don't normally go out and learn a musical instrument to be of benefit to others. And so when mindfulness is taught within the authentic context from which it derives, it is really very much other-focused and that in itself has some very important neural consequences which are not shared with other activities of focused attention.



Could you comment on those consequences?



There are consequences in circuits of the brain important for empathy and compassion and other-directed focus. That kind of stance ... helps to increase characteristics like humility and altruism and things of that sort. Which are byproducts of mindfulness, if you will, that can occur if taught authentically.



I don't think it was touched on in the documentary, but your lab has come out with those types of study within the last year.



We have done quite a bit of work on that.



How would you like to wrap up?



I think that the film speaks for itself and I hope it can inspire people to explore the possibility that there are simple types of practice we all can engage in, in everyday life, that promote well-being. The fact of neuroplasticity should give us all hope and encourage us all to take more responsibility for the positive cultivation of a mindful brain in ways I think can make a difference in our own individual lives as well as in those with whom we interact.



---



Regarding what stood out about her experience making the film, Ms. Ambo said she was struck by the warmth of the teachers in the preschool classroom, which utilizes a "Kindness Curriculum" developed at the University of Wisconsin. It integrates games such as one in which when you receive a seed from a friend, you have the privilege of giving one to a friend. One related study demonstrated increased behaviors such as sharing in participating children, distributing stickers more fairly to peers they liked more or less than others.



With the veterans (who engaged in a program emphasizing a type of yoga not part of traditional mindfulness programs), Ms. Ambo was amazed to find that after only one week she could "see that they were very hesitant but had started to smile more ... they softened up and seemed much more alive in a way." Of mindfulness, she said: "Give yourself the possibility. It's free and we all have a brain ... so the raw material is right there to check it out and try. These simple things make changes not only in our own lives but in those around us"



Free Your Mind opens at the Hot Docs Canadian International Documentary Festival on Thursday, May 2nd. It will premiere at the Rubin Museum of Art in New York City on May 3rd.



"Train Your Mind, Change Your Brain" is a particularly accessible book discussing neuroplasticity, mindfulness, and Dr. Davidson's work.





References:



[1] Richard J. Davidson, Ph.D., et. al. "Alterations in Brain and Immune Function Produced by Mindfulness Meditation." Psychosomatic Medicine 65:564 -570 (2003).



[2] Myint, K., et. al. "The effect of short-term practice of mindfulness meditation in alleviating

stress in university students." Biomedical Research 22 (2): 165-171 (2011).



[3] Alexandre Heeren and Pierre Philippot. "Changes in Ruminative Thinking Mediate the Clinical

Benefits of Mindfulness: Preliminary Findings." Mindfulness. DOI 10.1007/s12671-010-0037-y (2010).



For more by Mark Bertin, M.D., click here.



For more healthy living health news, click here.

TV Reality or Reality TV for Children?

Statistician Nate Silver predicted the last two presidential elections through the following logic: Multiple polls were calling the election a toss-up because President Obama's slight lead fell within the margin of error. In other words, it was fairly likely by any individual measure that his lead was no better than chance. However, that same slight lead was present in almost all the individual polls. What were the odds of all of them skewing the same way? Very, very low. Obama wins.



I woke up this Sunday to two different commentaries on media and children. In one, the New York Times published a group commentary from their critics about movie violence. One writer acknowledged that media might actually influence society in some way, another commented on the inappropriateness for kids of many commercials. The other essays didn't seem concerned about the issue much at all.



All of the reporters skirted the large volume of research showing that media content really does influence child behavior. The relatively unconcerned view they took, not in any way unique to the Times, serves as a clear example of a common misperception. While this type of research is inherently challenging to conduct and there may never be a single definitive study, we already have plenty of information about the impact of screen time on children. It's not neutral, and has been shown to be detrimental many times over.



While any individual publication can be picked apart and perhaps even dismissed, it is highly unlikely that dozens would skew the same way. Every month in the medical journals, new papers suggest that without skillful management from adults, media influences children for the worse. Not only behavior but poor sleep, attention problems, obesity and even long-term adult lifespan have been linked to screen time. Much like Nate Silver's view on the elections, the odds are poor that study after study would randomly reveal these negative effects.



Media Management Matters



The second commentary I saw last weekend was from the American Academy of Pediatrics (AAP). A new study showed that simply changing the content of programming for preschool-age children altered their behavior for the better. Alongside that publication was an AAP statement reiterating the fact that in spite of public discussion suggesting there is an open question, a clear body of evidence defines the negative effects of media on children. Since educating parents to cut down on screen time has not made enough of a difference, perhaps the discussion needs to skew towards managing media content instead.



In reality, it is not surprising that a product designed to sell (which includes any device, show, movie or game available) influences our children. The whole point of marketing is to grab attention, hold it and create purchasing habits. While the public view often seems to be that there's no proof media does anything to kids, within the field of pediatrics that is not the understanding at all. There is a clear consensus that media and marketing does, in fact, influence children's behavior and lifestyle. And not for the better.



Two or three generations ago, anyone raising the point that smoking might not be the healthiest activity for people would have been dismissed. Public consensus at that time was that everyone had the right to smoke wherever they chose, and nothing could be done about it anyway because smoking was an entrenched part of public life. That's where we stand with media today: Screen time and unfiltered content seems unavoidable and like an inalienable right, but accumulating science says we need to use it differently than we do to stay healthy... particularly regarding a young and developing brain.



Most of us are going to watch television and use computers and carry smartphones. None of that is going anywhere, and in reality none of it needs to since media on its own is not the cause of any particular ill in society. But at the same time, for almost any measure of well-being screen time shifts the curve for the worse. It may not cause issues for any individual (plenty of people play violent games and live normal lives), but it affects our general health and may influence specific people differently. For example, a small but significant subset of teens could be significantly affected by on-screen violence. Figuring out how to manage screen time and content for children is a complicated issue, but not a non-issue in our world.



Media isn't inherently 'bad' in any way. It's not an exact parallel to smoking (although in fact, exposure to on-screen smoking does impact teen choices), since electronics can actually be helpful in our lives as well as a source of benign entertainment. Yet to raise healthy kids in the modern in the world, both as families and as a society we need to accept that media does in fact have an effect on our children when we do not manage it well. We must recognize that media impacts child development, and set clear limits that protect children and promote their overall well-being.



Some basic media guidelines for early childhood:



- Parents decide how much time is appropriate in front of a screen every day. General guidelines are one to two hours or fewer each day, with none before two years of age whenever possible.



- Parents monitor content, using neutral rating systems like those created by Common Sense Media* (as opposed to the industry guidelines, which are self-monitored and not particularly useful)



- Parents model healthy lifestyle themselves -- turn screens and phones off during family meals, play time, down time and in the car. What role do screens play in your home? Actively protect time for imaginative play, social play, reading, exercise and whatever else you value.



- Limit marketing as much as possible. Watch shows without commercials, use digital recorders, buy non-branded products and discuss with children the intent of commercials to influence their choices.



*I am on the editorial board of Common Sense Media, a voluntary position, and have no financial relationship with their non-profit.

Today's ADHD Headline: Misleading Reports Lead to Confusion, Remain Widespread

"ADHD Medications Have Potential Benefits -- But Can Be Misused"



"I Have My Child Back -- A Story of Successful ADHD Treatment"



"Refining Clinical ADHD Diagnosis -- Clarifying an Imperfect Science"



The headline "ADHD Treatments Don't Reduce Symptoms in Most Children" (or similar ones posted on various sites last week) probably is far catchier than any of the above. It is also inaccurate and unfair to both parents and children. It's not what the related study meant to say. While there are many issues to sort out about accurate ADHD diagnosis and appropriate treatment, the endless stream of disturbing headlines about the disorder increases the burden on families working to live with it day to day.



Breaking News: ADHD Stressful For Parents, Children Alike



The major issue around this preschool study is not the report itself, but how it was covered in the media: "Medication Not Helping Kids with ADHD" is a snappy headline but also entirely misleading. This time around, the study was of high quality, but coverage was twisted to make an impression with the public. In other places (such as the New York Times), evidence from less-credible studies (or no study at all) has been presented as fact suggesting, for example, that medications are often prescribed inappropriately or are inherently dangerous. Articles stir up fear and sell newspapers (or increase the number of views online) while fanning the flames around ADHD.



Skewed coverage of ADHD undermines care and amplifies the difficulties for parents. There is still much to refine about how best to diagnose and treat ADHD. There are significant concerns to address about the potential for misuse of the medications as well as their limitations; comprehensive care goes far beyond a prescription. Yet we leave families hanging when we falsely suggest that ADHD is an artifact of a busy society or caused by ineffective parenting, or that treatment is unlikely to help or is unsafe. In fact, ADHD treatment can be remarkably effective -- "I Have My Child Back" is an actual quote I've heard in my office more than once.



Today's Top Story: ADHD Treatment Is Complicated, Often Successful



The paper referred to in the above headline is perfectly well-written. In case anyone out there was discouraged by how the study was reported, here is another interpretation of the actual results:



• ADHD is a chronic medical disorder, so we can't expect resolution of symptoms over time (although a minority of children will outgrow it). As expected, children with preschool ADHD in the study continued to show symptoms as they got older.



• As they are commonly used today, ADHD medications do not always work well. This isn't the first study to suggest that everyday ADHD management by non-experts may be less than ideally effective. One issue is that children are often prescribed specific medications or doses that do not fully address their ADHD or cause side effects that otherwise may be avoidable. Since for any individual, the pluses and minuses of any particular medication are apparent almost immediately, both the formulation and the dose can (and should) be adjusted rapidly if the results are off. That's not what always happens when people are treated in the general community.



In addition, parents and their physicians in the long-term follow up (having left the initial study) were free to do whatever they felt best with the medication over time. Children might have remained on wrong doses or poor fits of medications (for example, continuing to use a type that caused side effects) without even seeing a doctor, or they might not have taken their medication consistently. While the study could turn out to reflect something significant about general ADHD care that would only be the case if follow-up studies tracked appropriately managed medication; specific information about how the families in the study used the medication wasn't available.



• The authors also discussed the need for more research into behavioral therapy, both with parents and in schools. Medication alone is not typically the answer for ADHD, but effective behavioral intervention can be demanding and expensive. It also requires consistent follow-up and long-term maintenance of various plans that must be adapted over time. Behavioral change itself requires observing and adjusting often entrenched cognitive habits for parents and children alike, a feat that is challenging for any of us. Between limited health insurance and the simple reality of a busy life (or classroom), behavioral interventions are therefore hard to implement in a way that addresses all the details.



Clearly, headlines create a buzz when they stir up fear around ADHD. They also lead people to avoid ADHD evaluation, even though it could be helpful in sorting out the "why" of a child's difficulties... separate from making any treatment decisions. Negative headlines also increase stress around an already-challenging choice, without reflecting the reality that while all medications have potential side effects, so does untreated or undertreated ADHD. ADHD impacts individuals, families, schools, and the health care system as a whole. We would all benefit from far more objective and compassionate coverage of ADHD in our modern world.



For more by Mark Bertin, M.D., click here.



For more on ADHD, click here.

That's ADHD again? You Don't Say! Listen Closely and Hear the Effects of ADHD on Communication

Why do I have to repeat myself, I told you ten times already.



Out with it already! You better have a better explanation than that.



How was school today? And don't say 'nothing much,' something must have happened.



Managing ADHD is never about addressing attention or impulsivity alone. ADHD represents a deficit in executive function, a skill set that includes attention, impulse control... and far more. Seen as a disorder of self-regulation, ADHD potentially impacts anything that requires planning and coordination, from sleep and eating habits to laying out a long-term science project all the way to how someone speaks and listens in conversation.



Executive function acts as our 'brain manager' in coordinating our thoughts, actions and ability to plan. It is responsible for sorting through all the complex information we encounter, from paying attention to the right voice in a classroom to organizing responses in the midst of a rapidly-paced discussion. Comprehensive ADHD care requires a broad view of the often subtle effects it has on life, addressing its impact wherever it shows. One of the more commonly overlooked aspects of ADHD is its direct effect on communication.



Talk the Talk



The Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 is the standard diagnostic manual for clinicians in the fields of child development and mental health. Recently updated (although not yet released), the new version divides communication into three components: speech, language and pragmatics. These skills are defined as follows:

Speech comprises everything that goes into producing sounds. Common speech concerns include articulation disorders (unexpected inability to produce specific sounds), stuttering and stammering.



Language is the meaning of words and how we put them together. It includes vocabulary, grammar and narrative discourse along with corresponding receptive language abilities. Under the present system, common diagnoses in this area are expressive language delays (such as using fewer words or sentences than expected) and receptive language delays (understanding less than expected for age).



Pragmatic language represents all the nonverbal nuances that facilitate everyday conversation, and broadly includes anything regarding the social side of communication. It includes all the unspoken aspects of communication, like reading faces and monitoring tone of voice, as well as adapting ourselves to different situations (such as speaking to a teacher versus a peer). Skills such as understanding gestures, non-literal meetings (such as metaphor, irony and sarcasm), and detecting the emotional meaning behind a change in facial expression depend on an intuitive grasp of pragmatics.

Speech and ADHD



Studies show that children with ADHD are at risk for articulation disorders, which affect their ability to produce letter sounds appropriate for their age. Beyond that, they also commonly have differences in fluency and vocal quality when speaking. One study even detected ADHD through these speech differences. Compared to peers with learning disabilities alone, children with ADHD showed increased volume and variability in pitch when talking, along with particular patterns such as increased number of vocal pauses.



Children with ADHD produce more vocal repetitions or word fillers as they try to organize their thoughts, somewhat similar to a stammer. This can lead to impatience and misunderstandings from others, especially children, as they generally don't have the same patience and perspective as adults. A response in the classroom may be along the lines of, "It's a story abou ... um... a story... um... um... it's about ... akidwhofliesakite... um."



Communication and ADHD



Children with ADHD process language differently as well. For starters, they are at increased risk for significant language delays. Even without specific delays, because of distractibility and related ADHD symptoms, they are more likely to get off-topic when speaking. They also frequently struggle to find the right words and put thoughts together quickly and linearly in conversation. Errors in grammar as they compose sentences also may occur, because of planning difficulties present even when underlying skills in this area are intact. All these ADHD- related symptoms, with or without actual language delays, may impact the ability to communicate effectively.



In ADHD, listening comprehension can be impaired directly, in particular because of difficulty handling rapidly-spoken language or managing distracting, noisy environments like a party or a busy classroom. Again, this is true even when a child doesn't have an actual language delay; they have the capacity to understand, but because of ADHD, miss details in both conversation and stories. When listening, they may lose track of conversational threads entirely or miss details, and therefore fail to register vital bits of information. These same gaps frequently come across as oppositional behavior when a request appears intentionally ignored instead of not being heard in the first place. These patterns also relate to the reading comprehension difficulties often found with ADHD.



Paying attention to the thread of conversation can become even more problematic for a child with ADHD in groups or when in a noisy situation.The ability to retain focus on a single speaker and to transition between speakers is challenging. This has social implications, leading some children with ADHD to find it easier to get along one-on-one rather than in a group. Distracting classrooms, when multiple activities occur simultaneously, may make it particularly difficult for a child with ADHD to engage.



ADHD also often makes it hard for a child to manage large clumps of conversation all at once. While another 8-year-old may be able to handle hearing as many as twelve words at a clip with good understanding, with ADHD, seven or eight might be the maximum. Anything larger, and information begins to be dropped.



These types of problems in understanding spoken language are often incorrectly labeled as an 'auditory processing disorder.' There is nothing wrong with the actual auditory pathway; the information gets in, but executive function impairments mismanage it. The brain manager is asleep on the job again, jumbling the details about what's being said.



Pragmatics and ADHD



Pragmatic language, as noted above, encompasses all the social mores related to spoken language and nonverbal communication. Core ADHD symptoms undermine this aspect of communication all on their own. Blurting out answers, interrupting, talking excessively and speaking too loudly all break common communication standards, for example. People with ADHD also often make tangential comments in conversation, or struggle to organize their thoughts on the fly. Even for those with advanced vocabularies and understanding for age, these pragmatic difficulties may get in the way of social success.



These pragmatic difficulties are similar to, but not the same, as found in a child with autism. In autism, the underlying issue is that children do not intuitively grasp the social world -- which includes pragmatic language delays.Unlike those with ADHD, however, children with autism have an intrinsic developmental delay in a far wider array of social and communication skills.



With ADHD, the ability to understand nonverbal language and social interactions as a whole is most likely intact. They recognize nonverbal communication for what it is, and understand basic rules of communication such as 'wait your turn to reply.' Due to distractibility, impulsiveness or other executive function impairments they may fail to follow those same rules at any particular moment, or even notice social cues at all; many will meet criteria for a new DSM-5 category of 'social (pragmatics) communication disorder.' So while autism causes a more pervasive impairment in social judgment, because of lapses in pragmatic skills ADHD can undermine social abilities in children all on its own.



Actions Speak Louder Than Words



What can we do to help with ADHD and communication? Look for potential language delays. Intervene when needed. And as adults, adapt our own communication style as much as possible.



• Evaluate for specific delays through direct testing, and then initiate appropriate interventions when indicated.

• Wait until you gain your child's full attention before making a request or starting a conversation; otherwise, details will likely be missed. Help transition their attention by using a brief marker, such as "Joseph, I have a question for you." If it is helpful, engage them physically through gently touching their shoulder or a similar approach, and then try to maintain eye contact as well. The same technique (perhaps without the physical touch) equally supports adults with ADHD.

• Address pragmatic concerns for kids struggling socially as behavioral intervention alone may not be enough, through working with a therapist familiar with this aspect of communication.

• Offer 'extended time' in conversation, allowing children who may be struggling to pull their thoughts together. Give them ample time to settle themselves and organize their responses.

• Pause often and parse language into shorter segments when speaking to someone with ADHD. Annunciate clearly, and use gesture language such as counting bullet points on your fingers. Without judgment or condensation, rephrase or repeat yourself when needed. Consider having children restate what they've understood from what you've said.



*Many thanks to Dr. Rosemary Tannock, as this posting quotes extensively from her presentation on the same topic at the recent CHADD conference in San Francisco.

Who's Got the Remote? Available Now and Everywhere: Frightening Images and Visual Violence for Children of All Ages

At five o'clock in the morning, a bleary-eyed crowd awaits our Delta flight, immersed in the sounds of a news report on the week-old Newtown tragedy. From 84 to 44 to 4 years old, each person hears the same devastating story blaring from a television, sees the same horrendous images and is forced to process it all right now, whether they'd like to or not. Not that a 4-year-old child has any capacity to do that, nor should he be asked to try. Yet, short of physically turning him away from the screen and covering his ears, there's little for parents to do but concoct a distraction, monitor their child's reactions and cross their own fingers.



Two hours later and at 30,000 feet, Delta Airlines has chosen The Bourne Legacy as the overhead, in-flight entertainment. It has guns and point-blank executions from start to finish. Not even a week after unspeakable disaster, a parent has no way to turn it off, no opportunity to decide whether their child is ready for Bourne.



Over the last few years, televisions and computers have been placed everywhere, without time yet for any specific research about the effects of these constant background images on child development. Personally, I was raised on Clint Eastwood (whose movies were, in retrospect, tame compared with those of today), but my parents allowed me to watch his films only after reaching an age when they felt I could put the violent content into context. Right now, as I write, a woman in the movie cowers behind a table, stalked by a man with a handgun. Only a few weeks ago, several families waited in line with me for Sunday morning bagels while the kids were "entertained" from behind the cash register by a 9/11 documentary showing the collapsing buildings -- a never-ending fabric of visual violence.



Someone is onscreen again, this time stalking his prey with an automatic weapon. Maybe that's OK for me to watch right now, and maybe it is for that teen over there, too. How about that toddler, her parents trying to distract her as her eyes are drawn again to the screen? How about that 7-year-old boy enthralled even though he hasn't been given a headset? We can do better for our children than simply enveloping them in a culture of violence from birth.



Without censorship or sheltering kids from real life, it is time to step back and make intentional choices not just as parents, but as a society. In the midst of countless avenues that potentially influence the incidence of gun violence, basic child development should be considered. What should children see and when is it appropriate for them to see it? And should it be Delta Airlines or the owner of that bagel store who decides?



With effort and decisive action, we can turn away from the path of least resistance and define a more balanced approach. How has it become the norm that televisions are ubiquitous in the public sphere at any time of day, displaying content frequently meant for adults? How do we allow parents some reasonable opportunity to guide their own children? We can allow progress and mature entertainment while still emphasizing healthy experiences that protect the future of our children. We can fashion basic guidelines with intention instead of passivity, honoring freedom of expression while allowing kids to still be kids.

A Holiday Gift to Yourself

The holiday season can be a time of great, uncomplicated joy -- honestly it can. It doesn't have to be an intense, draining, consumer-driven mess. We cram into four weeks a stew of stress-raising ingredients for our families, letting it simmer until New Year's Day. But with a little mindfulness and mental effort, we can keep ourselves grounded and together and help our families find a sense of peace in the midst of it all.



We can start by taking an honest look at what we're doing to ourselves these next few weeks. Forewarned is forearmed. A short list of what the season serves us: Too little sleep; too much food; too little sunlight; too much alcohol; strained budgets; challenging gift purchases; hours of schmoozing with people we see once a year at the same party but never in between; too little exercise; too much travel; extreme weather; and various family crises. And our kids live through the season on sugar and poor sleep and lack of exercise, and probably have become certain that the only path to true happiness is to have the hottest new... whatever fits their vision of nirvana.



It's stressful even writing about it. The holiday season, meant to bring us all together in happiness, consistently accomplishes exactly the opposite for so many people. So what's the point? What can we do instead?



Setting Your Holiday Intentions



There is another option. Instead of letting it all just happen, we can remind ourselves what matters most -- and what we'd like our kids to experience. Emphasize, for our own sanity and for that of our children, the simpler side of the holidays. Find time for fun activities outdoors, at home, in the city or wherever else, without settling for the lowest common holiday denominator of overspending and overscheduling.



In spite of the external pressures, we can value taking care of ourselves. Too little sleep amplifies stress; exercise reduces it. Also helpful is eating healthily, not necessarily at the parties themselves but perhaps the rest of the month. Schedule quiet time alone or with someone who calms you or makes you laugh. Find the humor in the midst of the seasonal insanity. Whatever works for you the rest of the year, instead of letting it slide for a month, protect it, a holiday gift for yourself.



Avoid perfectionism. We sometimes amplify the emotional impact of buying gifts or hosting parties by unconsciously holding them to impossible standards, fitting them to the storybook pictures we've created in our minds. Not only do we invite all our family and friends but we expect angelic behavior from our kids, or stay up late meticulously centering the candy noses on cookie reindeer, or maybe actually expect our parents not to bicker this year, although they have fought fairly consistently over the last few decades. "No bloodshed and a few good laughs" may be more than enough for any given event.



Holiday Self-Care



You also can permit yourself some time to mentally quiet down throughout the day. Left unattended, one stressful thought tends to lead to another (or several), and the cycle ramps up all day long. Eventually, life feels like a crisis even on a relatively ordinary December day. Without disrupting your schedule, without adding another "thing to do," take fifteen slow breaths as needed, focusing as best you can only on the physical sensations related to breathing.



Spend this one moment not doing or planning anything. Don't expect a holiday miracle; your mind will remain busy much of the time. We can't completely stop ourselves from thinking, and there's no need to try. But on the train, in the aisle of the toy store, trying to get the children to the dinner table, or whenever you feel yourself ratcheting up, give yourself a break for a few moments.



As suggested in a 2011 New York Times article, one other trick to lowering stress is to make a practice of gratitude. In spite of the millions spent in seasonal marketing to convince us our long term well-being depends entirely on a massive TV set or a diamond necklace, we know better. Instead of buying into the hype, express appreciation at the end of every day for several things that went well. On an off day maybe simply relish the opportunity to put it behind you and go to sleep. Whatever you discover, small or large, write it down or spend a few moments mentally giving thanks.



We can't eliminate all that the season throws our way. We can't do anything about that or the people around us who may be more wound up than usual. But we can acknowledge the inevitable challenges without getting sucked in. Instead of letting the holiday season run amiss, we can find the opportunity to celebrate and connect with friends and family and create for ourselves and those around us healthier, more relaxing and restorative times.



So really, go for it: Happy Holidays!