Category Archives: Mental Health

More young children with ADHD could benefit from behavior therapy, CDC

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Behavior therapy recommended before medicine for young children with ADHD

More young children 2 to 5 years of age receiving care for attention-deficit/hyperactivity disorder (ADHD) could benefit from psychological services – including the recommended treatment of behavior therapy.

ABC blocks stacked in a pyramidThe Centers for Disease Control and Prevention’s (CDC) latest Vital Signs report urges healthcare providers to refer parents of young children with ADHD for training in behavior therapy before prescribing medicine to treat the disorder.

ADHD is a biological disorder that causes hyperactivity, impulsiveness, and attention problems. About 2 million of the more than 6 million children with ADHD were diagnosed before age 6.

Children diagnosed with ADHD at an early age tend to have the most severe symptoms and benefit from early treatment.

The American Academy of Pediatrics recommends that before prescribing medicine to a young child, healthcare providers refer parents to training in behavior therapy.

However, according to the Vital Signs report, about 75% of young children being treated for ADHD received medicine, and only about half received any form of psychological services, which might have included behavior therapy. Continue reading

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Opioid treatment model spawns imitators

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Two white tabletsBy Christine Vestal
Stateline

BALTIMORE — Dr. Kenneth Stoller held court on the sidewalk outside the Broadway Center for Addiction on a sunny afternoon last week, chatting with a troop of lingering patients.

He beamed as he patted a young man on the shoulder and said he’d see him tomorrow.

“It’s important for patients to see this as a place that’s safe and accepting,” he said. “For some, it’s the first place they’ve gotten positive reinforcement in their lives.”

Operated by Johns Hopkins Hospital and located two blocks from its main campus, the Broadway Center — or “911” as it’s called because of its address at 911 N. Broadway — has provided methadone maintenance therapy for people with opioid addiction for more than two decades.

But unlike most of the roughly 1,400 methadone clinics across the country, the Broadway Center offers not only methadone, but the two other federally approved addiction medications, buprenorphine and naltrexone, and a full complement of mandatory addiction counseling and group classes. In most other places, addiction treatment is fragmented, leaving patients to shop around for the care they need or settle for whatever is offered at their local opioid treatment clinic.

Unlike most of the roughly 1,400 methadone clinics across the country, the Broadway Center offers not only methadone, but the two other federally approved addiction medications, buprenorphine and naltrexone, and a full complement of mandatory addiction counseling and group classes.

“If you went to a doctor for any other disease, you’d expect to be offered all available treatment options,” said Dr. David Gastfriend, scientific adviser at the Philadelphia-based Treatment Research Institute, which studies substance abuse treatment. “Addiction treatment should be no different.”  Continue reading

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As fentanyl deaths spike, states and CDC respond

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DeafentanylBy Christine Vestal
Stateline

ATLANTA — When Ohio tallied what many already knew was an alarming surge in overdose deaths from an opioid known as fentanyl, the state asked the U.S. Centers for Disease Control and Prevention to investigate.

The rash of fatal overdoses in Ohio — a more than fivefold increase in 2014 — was not an isolated outbreak. Fentanyl is killing more people than heroin in many parts of the country. And the death toll will likely keep growing, said CDC investigators Matt Gladden and John Halpin at the fifth annual Rx Drug Abuse and Heroin Summit here.

At least 28,000 people died of opioid overdoses in 2014, the highest number of deaths in U.S. history. Of those, fentanyl was involved in 5,554 fatalities.

Fentanyl, used in its legal pharmaceutical form to treat severe pain, represents the latest evolution of an epidemic of opioid addiction that began with prescription painkillers and moved to heroin, as users demanded cheaper drugs and greater highs.

At least 28,000 people died of opioid overdoses in 2014, the highest number of deaths in U.S. history. Of those, fentanyl was involved in 5,554 fatalities, a 79 percent increase over 2013, according to a December CDC report.

Unpublished data for the first half of 2015 indicate an even steeper spike in fentanyl deaths, Gladden said.

Cheap and Lethal

Continue reading

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President’s task force aims to help end discrimination in mental health coverage

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headacheBy Jenny Gold
Kaiser Health News

Tucked in remarks the president made Tuesday on the opioid epidemic was his announcement of a new task force on mental health parity — aimed at ensuring that people with mental illnesses and substance abuse problems don’t face discrimination in the health care system.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

Despite a landmark 2008 law intended to do just that, enforcement has been paltry, and advocates say discrimination has continued.

“The goal of the task force is to essentially develop a set of tools, guidelines, mechanisms so that it’s actually enforced, that the concept is not just a phrase — an empty phrase,” President  Obama said during a panel discussion at the National Prescription Drug Abuse and Heroin Summit in Atlanta, Georgia. “We’ve got to let the insurance carriers know that we’re serious about this.”

Advocates say parity has long been an “empty phrase” and it has taken the administration far too long to address the problem. They say insurers have been subverting the law in subtle ways, and the government has not aggressively acted to stop them. Continue reading

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Fantasy sports fueling rise in gambling addiction

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Data GlobeBy Ana B. Ibarra
Kaiser Health News

Poison comes in many forms for addicts: Alcohol and drugs usually come first to mind, but gambling — often overlooked — is of increasing concern to state officials and rehab centers.

The number of problem gamblers has grown in recent years with an explosion of betting opportunities available at the touch of a smartphone screen.

That is particularly true during this month’s annual “March Madness” college basketball tournament.

The state’s Office of Problem Gambling, part of the Department of Public Health, recorded 36,000 calls to its hotline last year — the highest number since it began public awareness efforts in 2003, said Terri Sue Canale-Dalman, who heads the agency. The number of problem gamblers in California is estimated to have reached 1 million.

The average gambler loses about $38,000 a year and is $20,000 in debt, Canale-Dalman said. And the damage is not only monetary: Relationships are often lost and some gamblers suffer a decline in mental and physical health. Continue reading

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Primary care doctors often don’t help patients manage depression, study

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Doctor simpleBy Michelle Andrews
Kaiser Health News

Although primary care doctors frequently see patients with depression, they typically do less to help those patients manage it than they do for patients with other chronic conditions such as diabetes, asthma or congestive heart failure, a recent study found.

That is important because research has found that it can be good for patients’ health when physician practices have procedures in place to identify and provide targeted services to patients with chronic conditions and to encourage patients to get involved in actively managing their own care.

But physicians were less likely to use those “care-management processes” with patients who have depression than with those who had other chronic conditions, according to the study in the March edition of the journal Health Affairs. Continue reading

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Saving Amanda: One family’s struggle to deal with a daughter’s mental illness

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Pam and Amanda Lipp on Tuesday, December 15, 2015 (Heidi de Marco/KHN).

Pam and Amanda Lipp on Tuesday, December 15, 2015 (Heidi de Marco/KHN).

By Jenny Gold
Kaiser Health News/Woman’s Day

In March 2010, Pam Lipp received the call she’d been dreading for months. She figured it would come from one of three places: the police, the hospital or the morgue.

Instead, it was her husband, Doug, saying that he’d just received word that their 18-year-old daughter, Amanda, a freshman at Chico State University in California, was being held at a psychiatric crisis center after trying to throw herself in front of a moving car.

Amanda had lost her grip on reality and fallen into a state of psychosis.

Amanda had lost her grip on reality and fallen into a state of psychosis. She’d started selling off her belongings and believed that cameras were following her everywhere.

Doug was away at a speaking engagement, so Pam jumped in the car with a friend and raced to the crisis center two hours away. When they arrived, they found Amanda, curled up in a ball on the floor in a fetal position, sobbing.

“I was hallucinating. I thought I was a doctor. When my mom got there, I realized I was the one in trouble,” says Amanda. “Nothing prepares you for seeing your child in such turmoil. I felt helpless,” says Pam.

Amanda was soon diagnosed with bipolar disorder, a mental illness characterized by manic highs, depressive lows and possible periods of psychosis.

Although the diagnosis provided a new direction to what had been an all-consuming journey for the Lipp family, it was just one stop on the bumpy road to navigating the mental health system.

The Lipps are not alone: Nearly one in five Americans experiences a mental illness in any given year, but fewer than half of them receive treatment.

Early Signs

Amanda first started acting out when she was in middle school in Fair Oaks, California. She had extreme mood swings and explosive arguments with her parents. Pam and Doug, who run a small business together, hoped it was typical adolescent drama that would soon fade. “We never knew which Amanda we were going to get,” Pam recalls — the edgy Amanda looking for a heated debate, or the down, depressed Amanda who would retreat to her room. Eventually, the intensity and unpredictability of her moods made them realize she needed professional help.

 Amanda at her high school graduation with her brother and sister. (Courtesy of the Lipp Family)

Amanda at her high school graduation with her brother and sister. (Courtesy of the Lipp Family)

They took her to the family doctor, who agreed that Amanda required more help but said that she didn’t have anyone to refer her to. Instead, the doctor recommended that Pam request a copy of all the therapists in her zip code who worked with her insurance company and call down the list. Pam called dozens of practitioners, leaving message after message. Not only was the list outdated, but most were too busy to even see her daughter and the ones who were highly recommended didn’t accept her insurance anymore.

For her part, Amanda was reluctant about seeing a therapist. She worried about what other people might think, and that it would change the image she had of herself. “I was the popular kid who people looked up to,” says Amanda. “I thought that if my friends saw me as someone to be pitied, they wouldn’t lean on me anymore. Part of me wanted to get help, yet the other part of me didn’t want to admit I needed it.”

She agreed to give therapy a try and Pam found someone Amanda was comfortable with. Yet, at an out-of-pocket rate of $120 per hour, the Lipps just couldn’t afford the amount of care she needed, which was about three sessions per week. She visited a psychiatrist and was diagnosed with depression and put on an antidepressant. Despite the treatment, Amanda continued to spiral downward — staying out late, self-medicating with drugs and arguing with her family.

During those years, Pam says, she and Doug were living one exhausting day to the next. They had three children to raise, but taking care of Amanda consumed their lives. “We felt like we were in prison in our own home with all the hostility and upheaval.”

By the time Amanda headed to college, she was barely speaking to her parents.

Fighting For Care

Amanda’s bipolar diagnosis was a turning point — it meant that she could begin to receive the treatment she desperately needed. But it wasn’t easy to find at first.

The crisis center would only hold her for a maximum of 72 hours, and Amanda needed much more treatment than that. When Pam asked where her daughter would be sent next, the doctor told her Amanda would be discharged and likely end up back in the center.

Amanda Lipp holds up one her art pieces on Tuesday, December 15, 2015. Art helped her with cope with her depression (Heidi de Marco/KHN).

Amanda Lipp holds up one her art pieces. Art helped her with cope with her depression. (Heidi de Marco/KHN)

So Pam spent the next day in the crisis center waiting room, desperately calling one psychiatric hospital after another to find a place to send Amanda. They were all full. She begged them to call her back when they had an opening, but they told her they couldn’t reserve a spot. Instead, they told her to call every half hour in the hope that she’d be able to grab the next available bed. Pam plugged her cellphone into the waiting room wall and repeatedly called each one on speed dial. “You go into mother-bear mode, where you dig in and do what you have to do to protect your cub. I knew I couldn’t stop until Amanda had the help she needed,” says Pam.

After eight hours of continuous dialing, Pam finally found Amanda an open bed at a hospital near their home. For Pam, it was a huge relief that her daughter was safe. “We felt like we were finally entering a new phase of tackling her condition. In the hospital, at least we knew where she was and that she was under a watchful eye. We felt safest knowing she didn’t have a choice to leave.”

But Amanda had a different perspective. She didn’t see her psychosis as a disease — she saw it as a transformation where she was finally able to face her vulnerability and deal with her issues.

“In the hospital, I felt like a prisoner,” she says. “I felt trapped in a space where people were always watching me and monitoring my behavior.” Amanda is an artist who finds solace in creativity, but she says the staff in the hospital was more focused on trying to treat her medically and didn’t seem to value what she was doing with her art. “Trying to express myself and heal felt impossible,” she says.

Figuring Out Finances

While Amanda was in the hospital, Pam was gripped with fear over the coverage of the treatment. “I was terrified that insurance would run out and we’d lose our savings and everything we’d worked for.”

Amanda Lipp (Heidi de Marco/KHN).

Amanda Lipp (Heidi de Marco/KHN)

Fortunately, a federal law passed in 2008 guarantees that mental illnesses be covered “at parity” with any other disease, without special limitations. Her insurer informed Pam that any care Amanda needed would be covered. “I was so relieved,” says Pam.

After a month in the hospital, two months of a full-time outpatient program, the temporary help of an antipsychotic medication and years of therapy with a new psychologist, Amanda made an impressive recovery, learning to manage her condition.

A key point for her was a change in perspective. She went from seeing her symptoms as evidence of illness to seeing them as strengths that she could use to her benefit. For example, she could turn a period of introspection that she might have previously seen as “depression” into a piece of art.

Living Out Loud

Many families end up running into similar obstacles — they don’t know where to go for proper care or they’re worried about the cost. But there’s also the stigma of mental illness that prevents people from reaching out because they fear judgment or worry that it might affect their jobs.

“When you break a leg, you get a cast and people sign it and put smiley faces on it. When you’re given a mental illness diagnosis, you’re cast out,” says Amanda, who is now a 24-year-old college graduate and member of the board of California’s National Alliance on Mental Illness, an advocacy group.

It truly took a village and a community of friends to help Amanda heal.

Pam Lipp

Fortunately, Pam wasn’t afraid of the stigma, having learned from her own family’s mistakes. “I grew up in an environment where everything was pushed under the rug,” she says. “People were suffering from mental illness, but they blamed it on other things like migraines. In reality, they needed therapy. I wasn’t going to let that happen with Amanda.”

Pam faced the stigma head-on and was completely open with her friends about what was happening. While this didn’t help the Lipps crack the code on their daughter’s illness earlier, it gave them strength when they needed it.

“Mental illness is not usually a casserole disease — when you tell your friends that a family member is suffering from a mental illness, they don’t deliver a lasagna. But in our case, our friends did because we were open about it,” says Pam.

People rallied around her. In particular, Pam was already part of a monthly mothers’ group that got together to make care packages for their children in college. The other women urged her to keep coming to the group and making care packages for Amanda throughout her illness. “They were my rock of friendship. It truly took a village and a community of friends to help Amanda heal,” says Pam.

Pam's Book of Appreciation, which she used when Amanda was in high school to list positives about the day. She would then leave it on Amanda's pillow for her to respond. Even though Amanda often didn't write back, she now says it meant a lot to her. (Heidi de Marco/KHN).

Pam’s Book of Appreciation, which she used when Amanda was in high school to list positives about the day. She would then leave it on Amanda’s pillow for her to respond. Even though Amanda often didn’t write back, she now says it meant a lot to her. (Heidi de Marco/KHN)

Finding Hope

Hard-won strides in the area of mental illness like the parity law helped Pam and her family get through the crisis intact, but it was a difficult road.

“We’re so proud of Amanda and everything she’s overcome,” says Pam. That doesn’t mean she’s stopped worrying. “We experienced a mental health emergency, an illness and a recovery, and now we’re stable. But every day I wake up and worry, could she relapse?” For anyone with a history of psychosis, another breakdown is always a possibility.

Now armed with knowledge and experience, Pam feels more confident. And in the meantime, both mother and daughter are dedicated to raising awareness and helping other families find the hope and the care they need in a system that often seems to be working against them.

For women facing similar situations, Pam has this advice: “Treat mental health concerns like you would any condition. Don’t let the stigma be a roadblock to getting yourself and your family the care that’s needed. If your gut tells you there’s something going on with your child, look the issue in the face and get the help you need.”

This article is part of an editorial partnership between Woman’s Day and Kaiser Health News and is the first in a series focusing on mental health.

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Managing depression a challenge in primary care settings, study finds

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By Shefali Luthra
Kaiser Health News

Often referred to as the “common cold of mental health,” depression causes about 8 million doctors’ appointments a year.

Often referred to as the “common cold of mental health,” depression causes about 8 million doctors’ appointments a year. More than half are with primary care physicians. A new study suggests those doctors may not be the best to treat the condition due to insurance issues, time constraints and other factors.

The paper, published Monday in the March issue of Health Affairs, examines how primary care doctors treat depression. More often than not, according to the study, primary care practices fall short in teaching patients about managing their care and following up regularly to track their progress. That approach is considered most effective for treating chronic illnesses. Continue reading

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Bridging the gap between medical and mental health care

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Tracy Young, 50, gets her ears checked by Brian Schlesinger, a physician’s assistant, during her physical exam at the San Fernando Mental Health Center in Granada Hills, Calif., on Monday, February 8, 2016. (Heidi de Marco/KHN)

Tracy Young, 50, gets her ears checked by Brian Schlesinger, a physician’s assistant, during her physical exam at the San Fernando Mental Health Center in Granada Hills, Calif., on Monday, February 8, 2016. (Heidi de Marco/KHN)

By Anna Gorman
Kaiser Health News

Even on her worst days, Tracy Young goes to her appointments at the San Fernando Mental Health Center. The counseling and medication, she says, keep her depression and schizophrenia at bay.

“I come here faithfully,” said Young, 50. “I have to come here or I be feeling I just want to give up.”

Young isn’t nearly as religious about her physical health, despite painful arthritis, a persistent backache and a family history of cancer. Until this month, she hadn’t seen a medical doctor in more than three years.

People with severe mental illnesses are more likely to die prematurely than those without, and it’s often from treatable chronic diseases — in part because many, like Young, don’t receive regular medical care. They may be uninsured or unable to find doctors who take their insurance. They may be reluctant to seek care in traditional medical offices because of stigma or discrimination.

Even when they do have medical appointments, their doctors rarely communicate with their mental health providers. Experts said the lack of coordination can lead to medication problems, higher health costs and gaps in care.

Now, though, providers are beginning to bridge the gap between medical and mental care, forming partnerships aimed at improving patients’ physical and mental health, and reducing costs at the same time. Such holistic projects are underway in numerous states, including California, New York, Washington, and Florida. Continue reading

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Kindergartner’s troubles may reflect trouble at home

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child's abc blocksBy Lisa Gillespie
KHN

Very young children who endure neglect, abuse and dysfunctional home lives go on to struggle as kindergartners, leaving them at risk for more difficult years as adolescents and adults, a new study finds.

Adverse childhood experiences before age 5 were linked with poor academic and behavioral performance in kindergarten, said researchers who examined a sample of about 1,000 urban children. Their study was reported in the journal Pediatrics this month.

Adverse childhood experiences before age 5 were linked with poor academic and behavioral performance in kindergarten.

“Relative to children with no ACEs, children who experienced ACEs had increased odds of having below-average academic skills including poor literacy skills, as well as attention problems, social problems, and aggression, placing them at significant risk for poor school achievement, which is associated with poor health,” the authors said.

The adverse experiences included varieties of maltreatment — psychological, physical or sexual abuse or neglect — as well as household dysfunction — such as maternal depression, substance abuse, incarceration or violence toward the mother.

Forty-five percent of the children in the study had no adverse experiences, 27 percent had one, 16 percent had two and 12 percent had three or more. Continue reading

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Gene’s effect on brain connections may play role in schizophrenia, study

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Suspect gene may trigger runaway synaptic pruning during adolescence

From the National Institutes of Health

Versions of a gene linked to schizophrenia may trigger runaway pruning of the teenage brain’s still-maturing communications infrastructure, NIH-funded researchers have discovered.

“Normally, pruning gets rid of excess connections we no longer need, streamlining our brain for optimal performance, but too much pruning can impair mental function,”

The site in Chromosome 6 harboring the gene C4 towers far above other risk-associated areas on schizophrenia’s genomic “skyline,” marking its strongest known genetic influence. The new study is the first to explain how specific gene versions work biologically to confer schizophrenia risk. — Psychiatric Genomics Consortium

People with the illness show fewer such connections between neurons, or synapses.  The gene switched on more in people with the suspect versions, who faced a higher risk of developing the disorder, characterized by hallucinations, delusions and impaired thinking and emotions.

“Normally, pruning gets rid of excess connections we no longer need, streamlining our brain for optimal performance, but too much pruning can impair mental function.”

“Normally, pruning gets rid of excess connections we no longer need, streamlining our brain for optimal performance, but too much pruning can impair mental function,” said Thomas Lehner, Ph.D., director of the Office of Genomics Research Coordination of the NIH’s National Institute of Mental Health (NIMH). “It could help explain schizophrenia’s delayed age-of-onset of symptoms in late adolescence/early adulthood and shrinkage of the brain’s working tissue. Interventions that put the brakes on this pruning process-gone-awry could prove transformative.” Continue reading

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New Washington State plan outlines impact of suicide, proposes solutions

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teen-in-shadow-light

From the Washington State Department of Health

Suicide is preventable – and everyone has a role in stopping it

More than 5,000 people in Washington took their own lives during the five-year period of 2010 to 2014.

Washington’s new Suicide Prevention Plan aims to reduce that toll through unified efforts involving people and groups across the state.

For many years, the state’s suicide rate has been above the national average, prompting Governor Jay Inslee to address the tragedy of suicide in an executive order last week.

“We can stop these tragic deaths, but it’ll take coordination and cooperation,” said Washington’s Secretary of Health John Wiesman. “We know there are ways we can make a difference and this plan maps out strategies to save lives in our state.”

“Suicide is a preventable public health problem, not a personal weakness or family failure,” asserts the first core principle in the plan, which the Washington State Department of Health created in response to 2014 legislation. “Everyone in Washington has a role in suicide prevention. Suicide prevention is not the responsibility of the health system alone.”

Other core principles include:

  • Silence and stigma create harm by isolating people at risk and discouraging help- seeking.
  • Suicide prevention requires changing contributing factors such as childhood trauma, isolation, access to lethal means, and lack of access to appropriate behavioral health care.
  • Suicide doesn’t affect all communities equally, so prevention programs need to address local needs and cultures.
  • People experiencing issues associated with suicide deserve dignity, respect and the right to make decisions about their care.

The plan divides the work of suicide prevention into four strategic directions based on the National Strategy for Suicide Prevention.

Those are:

    • Empowering people, families and communities to understand their roles in preventing suicide “upstream,” before a crisis.
    • Directing suicide prevention programs toward those who need them most, helping identify people at risk and keeping them safe.
    • Making treatment accessible, appropriate and respectful for people at risk.
    • Using research, data and evaluation as a basis for suicide prevention work.

Washington has already made headway in battling suicide with a network of coalitions, student- led clubs, support groups, behavioral health treatment, culturally tailored initiatives, trainers, and community leaders.

The state has groundbreaking suicide prevention training requirements for health professionals. The Department of Health has been involved in youth suicide prevention work for more than two decades.The new plan builds on that base to address a problem that claims an average of three lives in Washington each day.

The intent of the plan is to use data and community input to customize short- and long-term prevention and intervention tactics to best serve specific populations, avoiding a one-size-fits-all approach.

Toward that end, a broad range of contributors and steering committee members participated in drafting, reviewing and completing the plan. As the document makes clear, suicide is a serious public health problem that everyone can play a role in solving.

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Learning soft skills in childhood can prevent problems later

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Pat-a-cake,_pat-a-cake,_baker's_man_1_-_WW_Denslow_-_Project_Gutenberg_etext_18546 (1)By Lynne Shallcross

Academic learning is usually in the spotlight at school, but teaching elementary-age students “soft” skills like self-control and how to get along with others might help to keep at-risk kids out of criminal trouble in the future, a study finds.

Duke University researchers looked at a program called Fast Track, which was started in the early 1990s for children who were identified by their teachers and parents to be at high risk for developing aggressive behavioral problems.

The students were randomized into two groups; half took part in the intervention, which included a teacher-led curriculum, parent training groups, academic tutoring and lessons in self-control and social skills.

The academic skills turned out to have less of an impact on crime and delinquency rates than did the soft skills, which are associated with emotional intelligence.

The program, which lasted from first grade through 10th grade, reduced delinquency, arrests and use of health and mental health services as the students aged through adolescence and young adulthood, as researchers explained in a separate study published earlier this year.

In the latest study, researchers looked at the “why” behind those previous findings. In looking at the data from nearly 900 students, the researchers found that about a third of the impact on future crime outcomes was due to the social and self-regulation skills the students learned from ages 6 to 11.

The academic skills that were taught as part of Fast Track turned out to have less of an impact on crime and delinquency rates than did the soft skills, which are associated with emotional intelligence. Soft skills might include teaching kids to work cooperatively in a group or teaching them how to think about the long-term consequences when they make a decision. Teaching physics is an example of a hard skill.

“The conclusion that we would make is that these [soft] skills should be emphasized even more in our education system and in our system of socializing children,” says Kenneth Dodge, a professor of public policy and of psychology and neuroscience at Duke who was a principal investigator in this study as well as in the original Fast Track project. Parents should do all they can to promote these skills with their children, Dodge says, as should education policymakers. Continue reading

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