Teaching Students How to Deal With Stress

Edutopia

Strategies to help upper elementary and middle school kids who have experienced trauma understand and control their emotions.

December 3, 2018
Middle school students in a classroom, talking with each other in pairs
©iStock/SeventyFour

When people feel stressed because of toxic levels of adversity—such as experiencing or witnessing physical or emotional abuse, or substance abuse—they find it very challenging to step back from a negative experience, pause, and calm their nervous systems. When this happens during adolescence—as the influence of peers is increasing and young people cope with the challenges of a developing sense of self—the stress can be very challenging.

Fortunately, there are some emotion regulation strategies that educators can build into their instructional practices, routines, bell work, and so on that help students pause and reflect a bit on their choices and dilemmas. I’ve been implementing these brain-aligned strategies in the upper elementary and middle school grades in the Indianapolis Public Schools.

These activities are not to be implemented in the heat of the moment, when students are extremely agitated or dysregulated. These are preventative and reflective. A previous article highlights more strategies that can be used to create an atmosphere that feels safe for traumatized students.

SEEING THAT PEERS HAVE HAD SIMILAR EXPERIENCES

We may think of adults as the go-to or point people for helping young students regulate negative emotions and experiences, but peers can be of great assistance to one another if we teach and model how to be present for one another.

There are many times in our middle school classrooms when students are surprised to learn that one of their friends has experienced adversity like their own. We can use these moments to build cooperation and collaboration within our schools and classrooms.

In a morning meeting or when small groups are meeting, have students discuss questions that will show them what they have in common. You can start with a silly question like, “How many of you have two eyes (or two thumbs, or hair)?” Students might laugh, but this will drive home that they have things in common.

You can then move on to more fraught questions: How many of you have ever broken a bone? How many of you have ever been afraid? How many of you have ever not eaten breakfast? Dinner?

As the year goes on and students build trust with each other, the questions can become more intense: How many of you have ever had something scary happen to your parents or brothers or sisters? How many of you have been in the hospital with an injury or illness? How many of you have ever had someone you love arrested? How many of you have experienced the death of someone you care about?

Many of us have experienced some of these situations. If we keep them to ourselves, they may grow to feel overwhelming, taking up so much space in our minds that the only things we think about are the negative experiences and problems we have. If we see that others have experienced these things also, that can help us come to terms with them.

A FRAMEWORK FOR TEACHER INTERVENTION

When a student begins to become agitated, irritated, or upset, teachers can try to co-regulate with them if they have not reached that point of no return where the anger or sadness overrides their ability to talk or share concerns or challenges. When adolescents bring significant adversity to their schools and classrooms, they often need a trusted adult to listen, to gently probe, and to share possible solutions and improved outcomes.

The following questions are meant to spark a discussion and show empathy while helping the student calm their nervous system—they can begin to repair and heal with an adult who sees them, feels their pain, and listens to learn.

  • Is there anything you need right now that would ease your mind and feelings?
  • Is there another way you’d like to address this other than with words? I have some paper, pens, and crayons, or you can work with some clay.
  • If you could list three or four people you need right now, who would they be? How would they help you?
  • Is there a place here at school that feels safe to you where you can rest until you feel a little better?
  • Are there any objects or belongings here that would comfort you?
  • When you’re ready, I want you to know I’m right here, ready to listen.

A GARDEN OF WELL-BEING

For this strategy based on a metaphor and focused on the development of students’ minds and emotions, I start by bringing a bouquet of flowers and several types of fruit and vegetables to a morning meeting. As a class, we discuss how they’re similar and different, and what it takes for them to grow and flourish. Then we make connections between the students’ mental and emotional development and the flourishing of a garden.

We discuss questions like: What makes each of these fruits, vegetables, or flowers unique? What ingredients and environments do these plants need to grow? Are any of these ingredients the same for your own mental and emotional development? What would be your sunlight? What would be similar to water for your mental and emotional health?

If you think of your mind or emotions as a garden, do you have a protective fence? Do you have boundaries, routines, and structures that keep you safe and comfortable?

This strategy can be useful in helping students to analyze their own feelings and to realize which people, places, and experiences in their lives act as nutrients for their well-being.

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How to Help Teens Weather Their Emotional Storms

A D.I.Y. snow globe full of glitter is an apt metaphor for the emotional chaos of the adolescent brain.

Trying to help a deeply upset teenager — perhaps one undone by a social slight or flipping out about an upcoming test — is among the most common and stressful challenges in all of parenting. Amid all that stress, it’s easy for well-meaning adults to make missteps.

More often than not, we jump in with earnest questions or suggestions: “Any chance you did something that hurt your friend’s feelings?” or “Would it help if I quizzed you on what you’ve studied so far?” But, despite our best intentions, these efforts often seem to only agitate our teenagers further.

Even though I’ve got years of training and experience as a clinical psychologist, for a long time I more or less muddled my way through the adolescent meltdowns that inevitably arose at my practice. Lately, however, I’ve managed to improve my approach, and I owe it all to a fateful trip to Texas.

I was chatting with the counseling team at a Dallas girls’ school a few years ago when the conversation turned to how we each handle students who become unglued during the school day.

“That,” said one of the counselors in a Texas twang, “is when I get out a glitter jar.” As I tried to conceal my immediate skepticism, she went off to retrieve one. While we waited for her to return, I sat there thinking that whatever she was bringing back, I hated it already.

First, as a parent with a neatness hang-up and kids who love art projects, I have come to loathe glitter. Second, if there was any psychology behind this, it seemed bound to be a little, well, poppy.

The counselor returned holding a clear jam jar. Its lid was glued on and it was filled with water plus a layer of sparkling purple glitter sitting at the bottom. “When a girl falls apart in my office, I do this,” she said, while shaking the jar fiercely, like an airport snow globe. Together we beheld the dazzling glitter storm that resulted. Then she placed the jar down on the table between us and continued, “After that I say to her, ‘Honey, this is your brain right now. So first … let’s settle your glitter.’”

Mesmerized, I watched the swirling glitter slowly fall to the bottom of the jar. Finally getting over myself, I was ready to acknowledge the brilliance behind this homemade device.

Sitting right there was an elegant model of the neurology of the distressed teenager. Early in adolescence, the brain gets remodeled to become more powerful and efficient, with this upgrade retracing the order of the original in utero development. The primitive regions, which are just above the back of the neck and house the emotion centers, are upgraded first — starting as early as age 10. The more sophisticated regions, located behind the forehead and giving us our ability to reason and maintain perspective, are redone last and may not reach full maturity until age 25.

While this process is underway, young people are put in a rather delicate position. Though they tend to be highly rational when calm, if they become upset, their new, high-octane emotional structures can overpower their yet-to-be upgraded reasoning capacities, crashing the entire system until it has a chance to reset.

I have enthusiastically recommended glitter jars to several parents and colleagues knowing that some teenagers will instantly benefit from having a concrete model of emotional distress. That said, I have come to appreciate that a glitter jar’s main utility is in the instructions it provides to those who are caring for the overwrought: Be patient and communicate your confidence that emotions almost always rise, swirl and settle all by themselves.

Not long after I returned from Texas, I ran into a visibly upset sophomore in the lunchroom of the school where I consult each week. She looked stricken, and her eyes were red from crying.

Urgently she asked, “Are you free?”

“Yes,” I replied, turning her toward my office.

Once there, she buried her hands in her face and broke into heaving sobs. Soon, she slowed her breathing and looked at me, even as tears continued to stream down her face. In the past, I would have taken that opening to quiz her about what had gone wrong. In retrospect, I now see this as the verbal equivalent of further shaking the mental glitter jar. Instead, I asked if she wanted a glass of water, or some time alone to let her painful feelings die down. She declined both offers, so we just sat there quietly.

Not a minute had passed before she relaxed completely. Then she volunteered that she had done poorly on a test that morning and had fallen down a rabbit hole of worries about what a bad grade might mean for her future. Now, with her glitter nearly settled and her mind more clear, she regained perspective on the situation. Within moments she decided that the low grade probably wasn’t such a big deal, and if it was, she’d figure out how to make up for it in other ways.

This is not to say that letting glitter settle is the solution to all teenage problems. But I have found it to be a better first response than any other. Every time I stop myself from trying to figure out what made a teenager upset, and focus instead on her right to just be upset, I find that doing so either solves the problem or helps clear the path to dealing with it.

It’s critical to recognize that when we react to psychological distress as though it’s a fire that needs to be put out, we frighten our teenagers and usually make matters worse. Reacting instead with the understanding that emotions usually have their own life cycle — coming as waves that surge and fall — sends adolescents the reassuring message that they aren’t broken; in fact, they’re self-correcting.

So, when you next encounter a young person in full meltdown, take a deep breath and think to yourself (Dallas accent optional), “First … let’s settle your glitter.”

Lisa Damour is a psychologist in Shaker Heights, Ohio, and the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood” and “Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls.”

How Parents’ Good Intentions Can Inadvertently Increase Girls’ Anxiety

Many tweens and teens struggle with anxiety and perfectionism, and parents often bemoan that “she puts so much pressure on herself.” Rachel Simmons, an expert on girls’ development and the author of Enough As She Is, however, says that perception puts even more pressure on kids. “The very phrasing of the statement — ‘on herself’ — lays blame for distress at the feet of our teens, rather than a culture that is stoking the flames of their anxiety,” she writes. “It puts the onus for change on kids — just chill, we seem to be saying, and you’ll be okay!” With a recent study finding a 33 percent spike in the number of teens who feel they have to be perfect to win approval, including from their friends and parents, it’s more important than ever to acknowledge what teens are going through and help them develop strategies to deal with perfectionism.

Perfectionism includes both excessively high standards for success and significant self-criticism, and while it can drive teens to achieve great heights, it can also cause anxiety, depression, and in extreme cases, high blood pressure and thoughts of suicide. Since the early 2000s, studies show that increasing numbers of young adults report feeling pressure to be perfect in every domain, including schoolwork, extracurricular activities, social life, and appearance. Simultaneously, parents are feeling greater pressure to raise high-achieving children; researchers even have a name for this phenomenon: “child-contingent self-esteem” or, as Simmons describes, “the tendency for a parent to base their own self-worth on the success of their child.”

When teens feel that their parents’ approval is dependent on high performance, Simmons explains, they “are plagued by the feeling they’ve let others down, whether it be by bottoming out on a test score, missing a shot on goal or getting a ‘no’ from a first-choice college…. Students perform successfully online while struggling in silence, quietly fearing everyone is smarter and more competent than they are.” Then when parents tell teens not to put so much pressure on themselves, their advice often backfires: “When we then tell teens that their wellness is in their own hands, something they might fix if only they relieved themselves of the burden… it has the opposite effect. We only add to their sense of shame that they have failed to measure up.”

Fortunately, there are a few steps that parents can take to start helping their teens reduce their stress and anxiety. Changing the language you use to discuss this topic is a helpful way to start a conversation. Instead of telling teens not to put pressure on themselves, Simmons suggests saying something like “It’s so hard right now to feel like anyone is successful enough… I hope you’ll tell me if I can do anything to make things easier.” Along these lines, recognizing that teens live in a stressful environment, with demands from school, activities, and friends, and validating how difficult that can be goes a long way as many teens crave greater empathy and understanding from their parents about these challenges. Parents can also help teens develop strategies to address their perfectionism with the help of age-appropriate resources like those highlighted below.

Finally, Simmons asserts, “make sure your actions match your words.” She reports that “many teenagers I’ve talked to call their parents’ bluff when told that they just ‘want you to be happy.’ They suspect what their parents secretly want is a high GPA.” One study found that a strong parental emphasis on achievement, particularly when associated with perceived parental criticism, actually led to lower school performance. In the end, Simmons reminds us, “most parents have more in common with their teens than they realize. Let’s retire the bootstrap mentality and stop telling our teens that their stress is self-imposed.”

I Ran 4 Experiments to Break My Social Media Addiction. Here’s What Worked.

 

Social media can connect us to new ideas, help us share our work, and allow previously unheard voices to influence culture. Yet it can also be a highly addictive time-sink if we’re not careful about our goals, purpose, and usage.

Over the last two years, I conducted four different experiments to monitor my own behavior, implementing trackers and blockers in order to better understand how social media usage affected my productivity. My goal was to see if by interrupting my daily behavior I could change my “default settings” and have more time for deep, focused work.

In the end, these four experiments opened my eyes about my relationship to social platforms, and taught me effective strategies to maximize the benefit of these social tools while limiting the downsides.

The first step was collecting data. Before beginning my experiments, I tracked my daily behavior to better understand where my time and energy was going, which gave me insight into what I could change to produce more satisfying deep work. I used RescueTime for tracking my computer usage, and Moment to track my cell phone behaviors.

Experiment #1: Complete Removal of Social Sites For 30 Days

My first experiment was a complete removal of all social aspects from my routine: no Facebook, Instagram, Twitter, YouTube, or LinkedIn for 30 days. Leading up to it, I raised objections—“but I need Facebook for my work!”, my brain sputtered, in a testament to the addictive power of the apps.

I logged out of each site and deleted all the apps from my phone. Then, I used Freedom, a website blocking tool, to restrict the social sites from my browser and phone. Finally, I had my partner take over my phone and install parental restrictions on browser sites with a password unknown to me. (I wasn’t taking any chances.)

The Results. Once I decided to go all-in, it was surprisingly easier to do than expected. There was a relief in being offline and deciding, once and for all, to do it. Here’s what I learned:

  • There were a few technical hassles: Facebook, in particular, is embedded in a lot of other applications, which created a problem any a tool required Facebook as a login. Going forward, I’ll create email-based logins only (which is also better for security).
  • My book-reading skyrocketed. In a month, I read more books than I had in the combined three months prior. Whenever I craved a break, I turned to my Kindle, instead of social or news sites.
  • I used social sites a surprising amount for research and discovery—when I’m thinking of a person I want to connect with, or a project I want to follow-up on, I would quickly type the social site for ease. Not having access created more friction in the short-term, but didn’t ultimately delay the work I was doing. There was a tension between instant access and carving out boundaries for deeper creative work that I found useful, albeit annoying.

After the experiment was over, I went back to allowing myself unlimited social media access and continued to track my usage using RescueTime. With a fresh perspective after a month away, I was able to more clearly see a pattern emerge around how I used the various sites, both for better and for worse. My key finding was the marked difference in my behaviors across devices: My laptopwasn’t the biggest culprit for addictive behavior: when I was at my desk, working, I spent the majority of my time actually working. My phone was the biggest culprit for addictive behavior.

Further, it was very clearly time-based. My social media usage (or cravings) clearly spiked at certain times. Most of my bad habits were tied up in late-night tiredness, early-morning mindlessness, and craving “The Scroll” whenever I was tired. It also became fairly predictable that I wanted a mid-morning break (around 11am) and an afternoon break (around 3 or 4pm). By far, the worst time was late evening, after dinner, when my brain felt like complete mush.

By all-out blocking the social feeds for thirty days, I saw where in the day my tiredness emerged and when I wanted to use the platforms for research or actual connection.

Experiment #2: Carving Out Daily Time Blockers

I wanted to learn whether or not I could limit, but not eliminate, social media and have equally effective results. This next experiment involved a daily restriction on websites based on the known “tired times” I’d identified in the first experiment.

For two weeks, I limited social access during certain periods of the day using the blocking app like Freedom. I allowed social sites on my computer in the afternoons only — not in the mornings, or after dinner. I also blocked all news websites, television sites, and installed Newsfeed Eradicator for Facebook, a social plug-in that helps prevent the scrolling nature of the newsfeed.

Results: Keeping the mornings social-media and news free was a game changer. I got so much more done on my biggest projects by having dedicated focus hours, and also knowing that there was a scheduled break in my day coming up.

  • The long-term effects of this change became apparent by day four or five. In the mornings, if I succumbed to impulsivity (a quick check here, an Amazon purchase there, firing off a couple of emails), it was far more difficult for me to throttle back into the realm of deep work.
  • By carving out chunks of the day to focus on specific work projects (moving one big project forward before 11am), I radically improved my personal productivity.
  • Temptation was strong, but waned over time: by overcoming the biggest pull to check first thing in the morning, I was much more focused and clear throughout the rest of the morning.

This proved to be a very effective strategy for me. Time-based internet blockers helped me increase my productivity. But now the reverse question came up: instead of blocking out times when I’d never use social, what if I dedicated a particular slot of time to it?

Experiment #3: The Social “Happy Hour”

The next experiment I tried was dedicating a specific hour of my day completely for use on social sites. I set up a calendar invitation from 4-5pm: a “happy hour” at the end of the work day to connect, enjoy, and run across new people and ideas after nearly 12 hours of working or parenting.

Results: Creating a built-in stress relief hour where I know that I can slide into “social research and browsing” (“The Scroll”), helped me avoid temptation at other hours of the day. It was easier to replace a bad habit with a better one than to focus all my energy on eliminating the bad habit.

  • Strangely, consolidating all of my social media use into a single hour made it seem less exciting. I noticed that I’d be finished scrolling within 20 minutes, or 30 minutes on a long day. There’s only so much sustained reading and commenting that I can do.
  • I was much more efficient at responding to all of the requests that come my way—rather than have metered out conversations trickling through the day, I buckled down, opened up new browser tabs for each meaningful mention or request, and whipped through it.
  • My content creation went way down. Instead, I began to plan ahead with a loose Evernote file for social media status updates and things I wanted to share, and the 12-hour delay between composing and pressing “publish” gave me a better chance to reflect on whether instant-sharing was really still necessary.

The biggest insights were that (1) social media usage dripped throughout the day drains the energy and focus I have for writing and other work, and (2) that there’s something insidiously satisfying about pressing publish on a status update, and each time I do it, I get the dopamine hit of satisfaction and response. But each tiny posting saps energy, and that adds up.

Experiment #4: 24 Hours To Break the Cycle

One of my favorite methods for resetting my brain is taking a full weekend day without my phone or my laptop, an idea I originally got from Tiffany Shlain’s “tech shabbat.” Back when I used to train for triathlons and open-water swims, Saturdays were spent largely outdoors, and it’s rather difficult to spend time scrolling the web while biking or swimming. So I used Freedom and a mesh wifi network to block the internet from midnight on Friday evening until Saturday at 3pm from all of my machines.

Results. Having something to do—going on a hike, going to the beach, meeting friends for coffee—helps tremendously.

  • The hardest part is walking out the door without the phone. From there, the freedom begins. The best way to block the internet is to physically leave devices elsewhere.
  • On days when I stay inside, I set my Freedom App to a weekend schedule of “no social media or email” until 3pm on Saturdays. The mornings can be lazy and slow. I’m not a doctor, I’m not an emergency worker, and we can all make it through the day if I’m not on email at 6am on a Saturday morning. By the time 1pm rolls around, I’m usually so involved in some other activity that I don’t notice.
  • I found I needed to be flexible about this experiment. On days when I have article deadlines or want to work a few hours on the weekend, I’ll set parameters for how and when to log on to get a chunk of work done.

Today, even with kids (and no triathlons currently), I still notice the effect of taking a Saturday away each week to disrupt the pattern of connection. A day free of the Internet is a great way to do a pattern reset if you notice (as I have) personal productivity dips by Friday.

Shifting From Subtraction to Addition

By and large, my first experiments were based on control and elimination. Sometimes, instead of focusing on constriction and willpower, however, it’s actually a better strategy to focus on the thing I want more of: more reading, more unplugged time with my family, space to think. One of the reasons diets don’t work very well is because most of them focus what you restrict, rather than what you add. My later experiments opened my eyes to the power of addition: planning ahead for dedicated social time, or a Saturday spent outdoors.

Today, I use Freedom to block social websites and news in the mornings nearly every day. I deleted Facebook and email from my phone, I will manually re-install them from 4pm to 5pm and then delete them again (yes, daily). I take regular 24-hour breaks. And I track my usage with RescueTime, which sends me an alert when I’ve hit 45 minutes of total “distracting” time.

With social media, many of us want to reduce our consumption, but we miss an important piece of the puzzle: we’re craving something that we want, and we think that social media has a quick answer. These experiments helped me realize that at the heart of my cravings around the social internet are deep connections with friends, access to new ideas and information, or time to zone out and relax after a hard day. Each of these components can be satisfied with other things beyond social media, and more effectively. As with many tools, it’s not an all or nothing, good-versus-bad conversation. I will continue to experiment in the future, especially now that Apple has introduced it’s “Screen Time” feature. Just because the apps are available, doesn’t mean our current default behaviors are the best ways to use them or get what we want. By limiting my access to social sites, I created a pattern disrupt that allowed me to reach out to more friends, read more books, and go deeper into work that mattered.


Sarah K. Peck is an author and startup advisor based in New York City. She’s the founder and executive director of Startup Pregnant, a media company documenting the stories of women’s leadership across work and family, and host of the Startup Pregnant Podcast.

The Link Between August Birthdays and A.D.H.D.

A new study raises questions about age, maturity and overdiagnosis.

By Anupam B. JenaMichael Barnett and Timothy J. Layton

The authors are health policy researchers.

CreditJackie Ferrentino

The rate of diagnosis of attention deficit hyperactivity disorder among children has nearly doubled in the past two decades. Rates of A.D.H.D. diagnoses also vary considerably across states, with nearly three times as many children getting the diagnosis in Kentucky (where one in five children are said to have the condition) as in Nevada. More than 5 percent of all children in the United States now take an A.D.H.D. medication. All this raises the question of whether the disease is being overdiagnosed.

Diagnosing A.D.H.D. is difficult. Unlike other childhood diseases — such as asthma, obesity and diabetes — the diagnosis of A.D.H.D. is inherently subjective and depends on the assessment of parents, school personnel and health care providers. For a child who is easily distracted, an assessment of normal, inattentive behavior by one could be a formal diagnosis of A.D.H.D. by another.

It turns out that although diagnosing A.D.H.D. requires a subjective interpretation of facts, the month in which a child is born can be a strong, objective predictor.

Most states have arbitrary cutoffs for kindergarten entry, with children who do not reach a given age by a certain date required to wait a year. In 18 states, children who will turn 5 before Sept. 1 can enter kindergarten in the year that they turn 5; children who will turn 5 after Sept. 1 must wait until the next year. So in states with Sept. 1 cutoffs, in any given class, August-born children will usually be the youngest and September-born children the oldest.

These arbitrary cutoffs have important implications for the diagnosis of A.D.H.D. In a study published in The New England Journal of Medicine, we found that among several hundred thousand children who were born between 2007 and 2009 and followed until 2016, rates of A.D.H.D. diagnosis and treatment were 34 percent higher among children born in August than among children born in September in states with a Sept. 1 school entry-age cutoff. No such difference was found among children in states with different cutoff dates. The effects were largest among boys.

We believe these findings reveal just how subjective the diagnosis of A.D.H.D. can be. In any given class, inattentive behavior among younger, August-born children may be perceived, in some instances, to reflect symptom of A.D.H.D., rather than the relative immaturity that is biologically determined and to be expected among children who are nearly one year younger than September-born classmates.

The stakes of additional, potentially inappropriate diagnoses are high, particularly when diagnoses are accompanied by medical treatment, which has side effects. In cases where A.D.H.D. is appropriately diagnosed, we know that behavioral and medical treatments can improve concentration and school performance and other outcomes. And in these instances, the harms of medical treatments are, on average, outweighed by the benefits. But when the disease is improperly diagnosed, the clinical harms and dollar costs of treatment may not be met with commensurate benefits.

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A second-grade classroom in Minneapolis.CreditTim Gruber for The New York Times

Unlike other diseases such as asthma and diabetes, whose diagnosis is more objective and is not based on peer-to-peer comparisons, the diagnosis of A.D.H.D. appears heavily influenced by how children behave in school relative to peers and how those differences in behavior are interpreted by school personnel, parents and ultimately, physicians. Indeed, some evidence suggests that teachers and other school personnel are more likely than physicians or parents to first suggest that a child may have A.D.H.D.

Our findings aren’t new, but they suggest a continuing problem. Several older studies, both within and outside the United States, analyze rates of A.D.H.D. diagnosis among children born just before versus just after school entry-age cutoffs, similar in design to our study. Nearly all of these studies suggest that younger children within a grade are more likely to be diagnosed with A.D.H.D. than older children in the same grade. One study found that the relative age of a child in a class strongly affects teachers’ assessments of whether a child demonstrates A.D.H.D. symptoms but does not affect parents’ assessments, which suggests that many diagnoses may stem from teachers’ perceptions of students that are based on a child’s age relative to peers.

Our study, which uses recent data, tells us that the problem still exists and that it’s not small. Despite growing awareness that A.D.H.D. may be overdiagnosed and the fact that the medications used to treat it have serious side effects, something as arbitrary as the month a child is born still has a meaningful impact on the likelihood that the child is determined to have the condition.

At a minimum, physicians who frequently diagnose A.D.H.D. in children should be aware of these findings. A simple mental “adjustment” for whether a child is born in August may be sufficient to help physicians reduce overdiagnosis.

School personnel and parents should also be aware of how simple cognitive biases can creep into how important clinical decisions are made. Both our and previous findings suggest that parents of children who are young for their grade could reasonably question whether the initiation of medical treatment for A.D.H.D. should be delayed.

In his 2008 book “Outliers,” Malcolm Gladwell describes the now well-known phenomenon that a disproportionate number of Canadian professional hockey players have birth dates in the beginning of the calendar year. This is explained by the Jan. 1 age eligibility cutoff for hockey programs in Canada, which leads to the oldest hockey players within an age-based division exceeding the age of the youngest players by nearly a year, conferring them a performance advantage. A similar phenomenon is true for A.D.H.D., where a child’s age relative to peers confers a markedly different rate of diagnosis and treatment, but the stakes are higher.

Anupam B. Jena is an associate professor at Harvard Medical School. Michael Barnett is an assistant professor at Harvard School of Public Health. Timothy J. Layton is an assistant professor at Harvard Medical School.

New Federal Exercise Recommendations

The New York Times

Very Brief Workouts Count Toward 150-Minute Goal, New Guidelines Say

New federal exercise recommendations include the first-ever federal activity parameters for 3-year-olds, as well as a few surprising omissions.

CreditJeenah Moon for The New York Times

As of Monday, the United States has new federal physical-activity guidelines. The new guidelines, which represent a scientific consensus about how much and what types of physical activities we should complete for good health, bear a strong resemblance to the existing, 10-year-old governmental recommendations. But they also feature some important updates and expansions, including the first-ever federal activity parameters for 3-year-olds, as well as a few surprising omissions.

And they offer a subtle, admonitory reminder that a substantial majority of us are not moving nearly as much as we should.

The idea that the government might suggest how much we need to exercise is relatively new. The first federal exercise recommendations were released in 2008, after several years of scientific background study.

 

During that time, an advisory board of researchers, most of them from academia, scoured the available scientific literature for clues about the relationships between physical activity and health and how much and what types of exercise seemed best able to lengthen people’s life spans and reduce their risks for disease.

Using that information, they assembled and presented a scientific report to the Department of Health and Human Services, which used it as the basis for the original 2008 guidelines.

Most of us probably know what those guidelines suggested.

In essence, they called for adults who are not disabled to complete at least 150 minutes a week of moderate-intensity exercise, such as brisk walking or other activities that raise people’s heart rates and breathing to the point that they can talk to a companion but cannot, should they be so inclined, sing.

The guidelines also noted that 75 minutes of vigorous exercise, such as jogging, would be equally effective but that the exercise, whatever its intensity, should take place in nonstop bouts of at least 10 minutes at a time and preferably every day.

Adults were urged, too, to do some type of strength training twice a week, while children older than 6 and teenagers were told to exercise moderately for at least 60 minutes a day.

 

That was 10 years ago. Since then, exercise scientists have published a mountain’s worth of new research about the health effects of physical activity — and of sitting — and of how much time we really need to spend in motion.

So two years ago, the Department of Health and Human Services convened a new panel of scientific advisers to sift through this research and provide updated exercise recommendations.

Earlier this year, that group delivered a 779-page scientific report to H.H.S., from which the new recommendations were devised.

To the surprise of some scientists and other observers, these guidelines, which were published on Monday in JAMA, are broadly the same as the previous set.

Again, they call for adults to complete at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity every week, along with strength training twice a week.

They also suggest balance training for older people and, for the first time, urge kids between the ages of 3 and 5 to be active for at least three hours a day, an acknowledgment that even small children run the risk of being too sedentary these days.

 

The most substantive change in the new recommendations involves how long each bout of exercise should be. The new guidelines say they do not need to last for 10 minutes.

Any physical activity, no matter how brief, including walking up stairs or from the car to the office, provides health benefits, according to the new guidelines, and counts toward exercise goals.

Using these parameters, “it will be much easier” for people to accumulate the desired 150 weekly minutes of moderate activity, says Adm. Brett Giroir, the assistant secretary for health at H.H.S., who oversaw the development of the formal guidelines.

This idea is captured in a new H.H.S. website cheerfully titled “Move Your Way” that summarizes the latest guidelines.

But despite this expansiveness, the 2018 recommendations do not cover some types or aspects of exercise, including high-intensity interval training. Although these brief, intense workouts are popular and widely studied, the guidelines’ writers felt that more research was needed about their safety and effects.

For the same reason, the guidelines do not set a target for how much — or little — time people should spend sitting or how many steps they should take each day, instead reiterating that the best goal is 150 minutes a week of activity.

Helpfully, the new guidelines do include some practical proposals for increasing exercise, including having health care workers ask people about their exercise habits during every appointment and employers promote physical activity at work.

But such efforts are voluntary, of course, and may be unable to overcome the greatest challenge facing the implementation of the new guidelines, which is us.

Despite 10 years of hearing that we should be moving more, few of us are.

Only about 20 percent of American adults meet the existing recommendations, and a third never work out at all, statistics show.

But Admiral Giroir says he believes that the new guidelines can and should inspire large numbers of people to get moving.

“They are so simple,” he says. “You can walk, dance, mow your lawn, park your car a little farther away. It all counts and could really make an impact on people’s health.”

New Study Finds Positive Correlation Between Team Sports and Mental Health

Women’s Sports Foundation

Researchers, including the team at the Women’s Sports Foundation, have long underscored the positive physical benefits that come with playing sports. A recent study published in the Lancet Psychiatry Journal advanced the conversation by further analyzing the effects of sports on mental health.

Reviewing data from more than 1.2 million responses to a US Centers for Disease Control and Prevention (CDC) survey, the researchers concluded that “physical exercise was significantly and meaningfully associated with self-reported mental health burden.” The report asserts that exercise can ease the burden of a variety of mental health issues, including mild depression, anxiety, panic attacks and stress.

To conduct the research, the authors of the cross-sectional study looked at data from CDC surveys given to adults 18 or over in 2011, 2013 and 2015. The study, which concerns survey responses derived from a one-month period, compares the number of self-reported bad mental health days between individuals who exercised and those who didn’t.

The conclusion? All exercise is good for mental health, but some forms are more beneficial than others.

The report indicates that “individuals who exercised had 1.49 (43.2%) fewer days of poor mental health in the past month than individuals who did not exercise but were otherwise matched for several physical and sociodemographic characteristics.”

“Even just walking just three times a week seems to give people better mental health than not exercising at all,” Adam Shekroud, an author of the study and Yale University psychiatry professor, told CNN. “I think from a public health perspective, it’s pretty important because it shows that we can have the potential for having a pretty big impact on mental health for a lot of people.”

Not all exercise is created equal when it comes to mental health though, the study found. Team sports had the largest association with a lower mental health burden, with a 22.3% reduction. Cycling and aerobic and gym exercises were next, at 21.6% and 20.1%, respectively. The best amount of time to exercise in terms of mental health is approximately 45 minutes three to four times per week, according to the report.

The study was published in August 2018, but has seen the most traction in the media in the last two weeks. In a climate where mental health is becoming increasingly destigmatized — particularly in athletics, where athletes have begun speaking out about their battles with mental health issues — the research is more relevant than ever.