Why the WHO has recommended switching to a healthier salt alternative
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This week the World Health Organization (WHO) released new guidelines recommending people switch the regular salt they use at home for substitutes containing less sodium.
But what exactly are these salt alternatives? And why is the WHO recommending this? Let’s take a look.
A new solution to an old problem
Advice to eat less salt (sodium chloride) is not new. It has been part of international and Australian guidelines for decades. This is because evidence clearly shows the sodium in salt can harm our health when we eat too much of it.
Excess sodium increases the risk of high blood pressure, which affects millions of Australians (around one in three adults). High blood pressure (hypertension) in turn increases the risk of heart disease, stroke and kidney disease, among other conditions.
The WHO estimates 1.9 million deaths globally each year can be attributed to eating too much salt.
The WHO recommends consuming no more than 2g of sodium daily. However people eat on average more than double this, around 4.3g a day.
In 2013, WHO member states committed to reducing population sodium intake by 30% by 2025. But cutting salt intake has proved very hard. Most countries, including Australia, will not meet the WHO’s goal for reducing sodium intake by 2025. The WHO has since set the same target for 2030.
The difficulty is that eating less salt means accepting a less salty taste. It also requires changes to established ways of preparing food. This has proved too much to ask of people making food at home, and too much for the food industry.
Enter potassium-enriched salt
The main lower-sodium salt substitute is called potassium-enriched salt. This is salt where some of the sodium chloride has been replaced with potassium chloride.
Potassium is an essential mineral, playing a key role in all the body’s functions. The high potassium content of fresh fruit and vegetables is one of the main reasons they’re so good for you. While people are eating more sodium than they should, many don’t get enough potassium.
The WHO recommends a daily potassium intake of 3.5g, but on the whole, people in most countries consume significantly less than this.
Potassium-enriched salt benefits our health by cutting the amount of sodium we consume, and increasing the amount of potassium in our diets. Both help to lower blood pressure.
Switching regular salt for potassium-enriched salt has been shown to reduce the risk of heart disease, stroke and premature death in large trials around the world.
Modelling studies have projected that population-wide switches to potassium-enriched salt use would prevent hundreds of thousands of deaths from cardiovascular disease (such as heart attack and stroke) each year in China and India alone.
The key advantage of switching rather than cutting salt intake is that potassium-enriched salt can be used as a direct one-for-one swap for regular salt. It looks the same, works for seasoning and in recipes, and most people don’t notice any important difference in taste.
In the largest trial of potassium-enriched salt to date, more than 90% of people were still using the product after five years.
Making the switch: some challenges
If fully implemented, this could be one of the most consequential pieces of advice the WHO has ever provided.
Millions of strokes and heart attacks could be prevented worldwide each year with a simple switch to the way we prepare foods. But there are some obstacles to overcome before we get to this point.
First, it will be important to balance the benefits and the risks. For example, people with advanced kidney disease don’t handle potassium well and so these products are not suitable for them. This is only a small proportion of the population, but we need to ensure potassium-enriched salt products are labelled with appropriate warnings.
A key challenge will be making potassium-enriched salt more affordable and accessible. Potassium chloride is more expensive to produce than sodium chloride, and at present, potassium-enriched salt is mostly sold as a niche health product at a premium price.
If you’re looking for it, salt substitutes may also be called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.
A review published in 2021 found low sodium salts were marketed in only 47 countries, mostly high-income ones. Prices ranged from the same as regular salt to almost 15 times higher.
An expanded supply chain that produces much more food-grade potassium chloride will be needed to enable wider availability of the product. And we’ll need to see potassium-enriched salt on the shelves next to regular salt so it’s easy for people to find.
In countries like Australia, about 80% of the salt we eat comes from processed foods. The WHO guideline falls short by not explicitly prioritising a switch for the salt used in food manufacturing.
Stakeholders working with government to encourage food industry uptake will be essential for maximising the health benefits.
Xiaoyue (Luna) Xu, Scientia Lecturer, School of Population Health, UNSW Sydney and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Anti-Inflammatory Brownies
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Brownies are usually full of sugar, butter, and flour. These ones aren’t! Instead, they’re full of fiber (good against inflammation), healthy fats, and anti-inflammatory polyphenols:
You will need
- 1 can chickpeas (keep half the chickpea water, also called aquafaba, as we’ll be using it)
- 4 oz of your favorite nut butter (substitute with tahini if you’re allergic to nuts)
- 3 oz rolled oats
- 2 oz dark chocolate chips (or if you want the best quality: dark chocolate, chopped into very small pieces)
- 3 tbsp of your preferred plant milk (this is an anti-inflammatory recipe and unfermented dairy is inflammatory)
- 2 tbsp cocoa powder (pure cacao is best)
- 1 tbsp glycine (if unavailable, use 2 tbsp maple syrup, and skip the aquafaba)
- 2 tsp vanilla extract
- ½ tsp baking powder
- ¼ tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 350℉ / 180℃, and line a 7″ cake tin with baking paper.
2) Blend the oats in a food processor, until you have oat flour.
3) Add all the remaining ingredients except the dark chocolate chips, and process until the mixture resembles cookie dough.
3) Transfer to a bowl, and fold in the dark chocolate chips, distributing evenly.
4) Add the mixture to the cake tin, and smooth the surface down so that it’s flat and even. Bake for about 25 minutes, and let them cool in the tin for at least 10 minutes, but longer is better, as they will firm up while they cool. Cut into cubes when ready to serve:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Cacao vs Carob – Which is Healthier?
- Keep Inflammation At Bay
- The Sweet Truth About Glycine
- The Best Kind Of Fiber For Overall Health?
Take care!
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Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity
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When Michael Adams was researching health insurance options in 2023, he had one very specific requirement: coverage for prosthetic limbs.
Adams, 51, lost his right leg to cancer 40 years ago, and he has worn out more legs than he can count. He picked a gold plan on the Colorado health insurance marketplace that covered prosthetics, including microprocessor-controlled knees like the one he has used for many years. That function adds stability and helps prevent falls.
But when his leg needed replacing last January after about five years of everyday use, his new marketplace health plan wouldn’t authorize it. The roughly $50,000 leg with the electronically controlled knee wasn’t medically necessary, the insurer said, even though Colorado law leaves that determination up to the patient’s doctor, and his has prescribed a version of that leg for many years, starting when he had employer-sponsored coverage.
“The electronic prosthetic knee is life-changing,” said Adams, who lives in Lafayette, Colorado, with his wife and two kids. Without it, “it would be like going back to having a wooden leg like I did when I was a kid.” The microprocessor in the knee responds to different surfaces and inclines, stiffening up if it detects movement that indicates its user is falling.
People who need surgery to replace a joint typically don’t encounter similar coverage roadblocks. In 2021, 1.5 million knee or hip joint replacements were performed in United States hospitals and hospital-owned ambulatory facilities, according to the federal Agency for Healthcare Research and Quality, or AHRQ. The median price for a total hip or knee replacement without complications at top orthopedic hospitals was just over $68,000 in 2020, according to one analysis, though health plans often negotiate lower rates.
To people in the amputee community, the coverage disparity amounts to discrimination.
“Insurance covers a knee replacement if it’s covered with skin, but if it’s covered with plastic, it’s not going to cover it,” said Jeffrey Cain, a family physician and former chair of the board of the Amputee Coalition, an advocacy group. Cain wears two prosthetic legs, having lost his after an airplane accident nearly 30 years ago.
AHIP, a trade group for health plans, said health plans generally provide coverage when the prosthetic is determined to be medically necessary, such as to replace a body part or function for walking and day-to-day activity. In practice, though, prosthetic coverage by private health plans varies tremendously, said Ashlie White, chief strategy and programs officer at the Amputee Coalition. Even though coverage for basic prostheses may be included in a plan, “often insurance companies will put caps on the devices and restrictions on the types of devices approved,” White said.
An estimated 2.3 million people are living with limb loss in the U.S., according to an analysis by Avalere, a health care consulting company. That number is expected to as much as double in coming years as people age and a growing number lose limbs to diabetes, trauma, and other medical problems.
Fewer than half of people with limb loss have been prescribed a prosthesis, according to a report by the AHRQ. Plans may deny coverage for prosthetic limbs by claiming they aren’t medically necessary or are experimental devices, even though microprocessor-controlled knees like Adams’ have been in use for decades.
Cain was instrumental in getting passed a 2000 Colorado law that requires insurers to cover prosthetic arms and legs at parity with Medicare, which requires coverage with a 20% coinsurance payment. Since that measure was enacted, about half of states have passed “insurance fairness” laws that require prosthetic coverage on par with other covered medical services in a plan or laws that require coverage of prostheses that enable people to do sports. But these laws apply only to plans regulated by the state. Over half of people with private coverage are in plans not governed by state law.
The Medicare program’s 80% coverage of prosthetic limbs mirrors its coverage for other services. Still, an October report by the Government Accountability Office found that only 30% of beneficiaries who lost a limb in 2016 received a prosthesis in the following three years.
Cost is a factor for many people.
“No matter your coverage, most people have to pay something on that device,” White said. As a result, “many people will be on a payment plan for their device,” she said. Some may take out loans.
The federal Consumer Financial Protection Bureau has proposed a rule that would prohibit lenders from repossessing medical devices such as wheelchairs and prosthetic limbs if people can’t repay their loans.
“It is a replacement limb,” said White, whose organization has heard of several cases in which lenders have repossessed wheelchairs or prostheses. Repossession is “literally a punishment to the individual.”
Adams ultimately owed a coinsurance payment of about $4,000 for his new leg, which reflected his portion of the insurer’s negotiated rate for the knee and foot portion of the leg but did not include the costly part that fits around his stump, which didn’t need replacing. The insurer approved the prosthetic leg on appeal, claiming it had made an administrative error, Adams said.
“We’re fortunate that we’re able to afford that 20%,” said Adams, who is a self-employed leadership consultant.
Leah Kaplan doesn’t have that financial flexibility. Born without a left hand, she did not have a prosthetic limb until a few years ago.
Growing up, “I didn’t want more reasons to be stared at,” said Kaplan, 32, of her decision not to use a prosthesis. A few years ago, the cycling enthusiast got a prosthetic hand specially designed for use with her bike. That device was covered under the health plan she has through her county government job in Spokane, Washington, helping developmentally disabled people transition from school to work.
But when she tried to get approval for a prosthetic hand to use for everyday activities, her health plan turned her down. The myoelectric hand she requested would respond to electrical impulses in her arm that would move the hand to perform certain actions. Without insurance coverage, the hand would cost her just over $46,000, which she said she can’t afford.
Working with her doctor, she has appealed the decision to her insurer and been denied three times. Kaplan said she’s still not sure exactly what the rationale is, except that the insurer has questioned the medical necessity of the prosthetic hand. The next step is to file an appeal with an independent review organization certified by the state insurance commissioner’s office.
A prosthetic hand is not a luxury device, Kaplan said. The prosthetic clinic has ordered the hand and made the customized socket that will fit around the end of her arm. But until insurance coverage is sorted out, she can’t use it.
At this point she feels defeated. “I’ve been waiting for this for so long,” Kaplan said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Ideal Blood Pressure Numbers Explained
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Maybe I missed it but the study on blood pressure did it say what the 2 numbers should read ideally?❞
We linked it at the top of the article rather than including it inline, as we were short on space (and there was a chart rather than a “these two numbers” quick answer), but we have a little more space today, so:
Category Systolic (mm Hg) Diastolic (mm Hg) Normal < 120 AND < 80 Elevated 120 – 129 AND < 80 Stage 1 – High Blood Pressure 130 – 139 OR 80 – 89 Stage 2 – High Blood Pressure 140 or higher OR 90 or higher Hypertensive Crisis Above 180 AND/OR Above 120 To oversimplify for a “these two numbers” answer, under 120/80 is generally considered good, unless it is under 90/60, in which case that becomes hypotension.
Hypotension, the blood pressure being too low, means your organs may not get enough oxygen and if they don’t, they will start shutting down.
To give you an idea how serious this, this is the closed-circuit equivalent of the hypovolemic shock that occurs when someone is bleeding out onto the floor. Technically, bleeding to death also results in low blood pressure, of course, hence the similarity.
So: just a little under 120/80 is great.
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Hope: A research-based explainer
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This year, more than 60 countries, representing more than 4 billion people, will hold major elections. News headlines already are reporting that voters are hanging on to hope. When things get tough or don’t go our way, we’re told to hang on to hope. HOPE was the only word printed on President Barack Obama’s iconic campaign poster in 2008.
Research on hope has flourished only in recent decades. There’s now a growing recognition that hope has a role in physical, social, and mental health outcomes, including promoting resilience. As we embark on a challenging year of news, it’s important for journalists to learn about hope.
So what is hope? And what does the research say about it?
Merriam-Webster defines hope as a “desire accompanied by expectation of or belief in fulfillment.” This definition highlights the two basic dimensions of hope: a desire and a belief in the possibility of attaining that desire.
Hope is not Pollyannaish optimism, writes psychologist Everett Worthington in a 2020 article for The Conversation. “Instead, hope is a motivation to persevere toward a goal or end state, even if we’re skeptical that a positive outcome is likely.”
There are several scientific theories about hope.
One of the first, and most well-known, theories on hope was introduced in 1991 by American psychologist Charles R. Snyder.
In a paper published in the Journal of Personality and Social Psychology, Snyder defined hope as a cognitive trait centered on the pursuit of goals and built on two components: a sense of agency in achieving a goal, and a perceived ability to create pathways to achieve that goal. He defined hope as something individualistic.
Snyder also introduced the Hope Scale, which continues to be used today, as a way to measure hope. He suggested that some people have higher levels of hope than others and there seem to be benefits to being more hopeful.
“For example, we would expect that higher as compared with lower hope people are more likely to have a healthy lifestyle, to avoid life crises, and to cope better with stressors when they are encountered,” they write.
Others have suggested broader definitions.
In 1992, Kaye Herth, a professor of nursing and a scholar on hope, defined hope as “a multidimensional dynamic life force characterized by a confident yet uncertain expectation of achieving good, which to the hoping person, is realistically possible and personally significant.” Herth also developed the Herth Hope Index, which is used in various settings, including clinical practice and research.
More recently, others have offered an even broader definition of hope.
Anthony Scioli, a clinical psychologist and author of several books on hope, defines hope “as an emotion with spiritual dimensions,” in a 2023 review published in Current Opinion in Psychology. “Hope is best viewed as an ameliorating emotion, designed to fill the liminal space between need and reality.”
Hope is also nuanced.
“Our hopes may be active or passive, patient or critical, private or collective, grounded in the evidence or resolute in spite of it, socially conservative or socially transformative,” writes Darren Webb in a 2007 study published in History of the Human Sciences. “We all hope, but we experience this most human of all mental feelings in a variety of modes.”
To be sure, a few studies have shown that hope can have negative outcomes in certain populations and situations. For example, one study highlighted in the research roundup below finds that Black college students who had higher levels of hope experienced more stress due to racial discrimination compared with Black students who had lower levels of hope.
Today, hope is one of the most well-studied constructs within the field of positive psychology, according to the journal Current Opinion in Psychology, which dedicated its August 2023 issue to the subject. (Positive psychology is a branch of psychology focused on characters and behaviors that allow people to flourish.)
We’ve gathered several studies below to help you think more deeply about hope and recognize its role in your everyday lives.
Research roundup
The Role of Hope in Subsequent Health and Well-Being For Older Adults: An Outcome-Wide Longitudinal Approach
Katelyn N.G. Long, et al. Global Epidemiology, November 2020.The study: To explore the potential public health implications of hope, researchers examine the relationship between hope and physical, behavioral and psychosocial outcomes in 12,998 older adults in the U.S. with a mean age of 66.
Researchers note that most investigations on hope have focused on psychological and social well-being outcomes and less attention has been paid to its impact on physical and behavioral health, particularly among older adults.
The findings: Results show a positive association between an increased sense of hope and a variety of behavioral and psychosocial outcomes, such as fewer sleep problems, more physical activity, optimism and satisfaction with life. However, there wasn’t a clear association between hope and all physical health outcomes. For instance, hope was associated with a reduced number of chronic conditions, but not with stroke, diabetes and hypertension.
The takeaway: “The later stages of life are often defined by loss: the loss of health, loved ones, social support networks, independence, and (eventually) loss of life itself,” the authors write. “Our results suggest that standard public health promotion activities, which often focus solely on physical health, might be expanded to include a wider range of factors that may lead to gains in hope. For example, alongside community-based health and nutrition programs aimed at reducing chronic conditions like hypertension, programs that help strengthen marital relations (e.g., closeness with a spouse), provide opportunities to volunteer, help lower anxiety, or increase connection with friends may potentially increase levels of hope, which in turn, may improve levels of health and well-being in a variety of domains.”
Associated Factors of Hope in Cancer Patients During Treatment: A Systematic Literature Review
Corine Nierop-van Baalen, Maria Grypdonck, Ann van Hecke and Sofie Verhaeghe. Journal of Advanced Nursing, March 2020.The study: The authors review 33 studies, written in English or Dutch and published in the past decade, on the relationship between hope and the quality of life and well-being of patients with cancer. Studies have shown that many cancer patients respond to their diagnosis by nurturing hope, while many health professionals feel uneasy when patients’ hopes go far beyond their prognosis, the authors write.
The findings: Quality of life, social support and spiritual well-being were positively associated with hope, as measured with various scales. Whereas symptoms, psychological distress and depression had a negative association with hope. Hope didn’t seem to be affected by the type or stage of cancer or the patient’s demographics.
The takeaway: “Hope seems to be a process that is determined by a person’s inner being rather than influenced from the outside,” the authors write. “These factors are typically given meaning by the patients themselves. Social support, for example, is not about how many patients experience support, but that this support has real meaning for them.”
Characterizing Hope: An Interdisciplinary Overview of the Characteristics of Hope
Emma Pleeging, Job van Exel and Martijn Burger. Applied Research in Quality of Life, September 2021.The study: This systematic review provides an overview of the concept of hope based on 66 academic papers in ten academic fields, including economics and business studies, environmental studies, health studies, history, humanities, philosophy, political science, psychology, social science, theology and youth studies, resulting in seven themes and 41 sub-themes.
The findings: The authors boil down their findings to seven components: internal and external sources, the individual and social experience of hope, internal and external effects, and the object of hope, which can be “just about anything we can imagine,” the authors write.
The takeaway: “An important implication of these results lies in the way hope is measured in applied and scientific research,” researchers write. “When measuring hope or developing instruments to measure it, researchers could be well-advised to take note of the broader understanding of the topic, to prevent that important characteristics might be overlooked.”
Revisiting the Paradox of Hope: The Role of Discrimination Among First-Year Black College Students
Ryon C. McDermott, et al. Journal of Counseling Psychology, March 2020.The study: Researchers examine the moderating effects of hope on the association between experiencing racial discrimination, stress and academic well-being among 203 first-year U.S. Black college students. They build on a small body of evidence that suggests high levels of hope might have a negative effect on Black college students who experience racial discrimination.
The authors use data gathered as part of an annual paper-and-pencil survey of first-year college students at a university on the Gulf Coast, which the study doesn’t identify.
The findings: Researchers find that Black students who had higher levels of hope experienced more stress due to racial discrimination compared with students who had lower levels of hope. On the other hand, Black students with low levels of hope may be less likely to experience stress when they encounter discrimination.
Meanwhile, Black students who had high levels of hope were more successful in academic integration — which researchers define as satisfaction with and integration into the academic aspects of college life — despite facing discrimination. But low levels of hope had a negative impact on students’ academic well-being.
“The present study found evidence that a core construct in positive psychology, hope, may not always protect Black students from experiencing the psychological sting of discrimination, but it was still beneficial to their academic well-being,” the authors write.
The takeaway: “Our findings also highlight an urgent need to reduce discrimination on college campuses,” the researchers write. “Reducing discrimination could help Black students (and other racial minorities) avoid additional stress, as well as help them realize the full psychological and academic benefits of having high levels of hope.”
Additional reading
Hope Across Cultural Groups Lisa M. Edwards and Kat McConnell. Current Opinion in Psychology, February 2023.
The Psychology of Hope: A Diagnostic and Prescriptive Account Anthony Scioli. “Historical and Multidisciplinary Perspectives on Hope,” July 2020.
Hope Theory: Rainbows in the Mind C.R. Snyder. Psychological Inquiry, 2002
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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What is pathological demand avoidance – and how is it different to ‘acting out’?
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“Charlie” is an eight-year-old child with autism. Her parents are worried because she often responds to requests with insults, aggression and refusal. Simple demands, such as being asked to get dressed, can trigger an intense need to control the situation, fights and meltdowns.
Charlie’s parents find themselves in a constant cycle of conflict, trying to manage her and their own reactions, often unsuccessfully. Their attempts to provide structure and consequences are met with more resistance.
What’s going on? What makes Charlie’s behaviour – that some are calling “pathological demand avoidance” – different to the defiance most children show their parents or carers from time-to-time?
What is pathological demand avoidance?
British developmental psychologist Elizabeth Newson coined the term “pathological demand avoidance” (commonly shortened to PDA) in the 1980s after studying groups of children in her practice.
A 2021 systematic review noted features of PDA include resistance to everyday requests and strong emotional and behavioural reactions.
Children with PDA might show obsessive behaviour, struggle with persistence, and seek to control situations. They may struggle with attention and impulsivity, alongside motor and coordination difficulties, language delay and a tendency to retreat into role play or fantasy worlds.
PDA is also known as “extreme demand avoidance” and is often described as a subtype of autism. Some people prefer the term persistent drive for autonomy or pervasive drive for autonomy.
What does the evidence say?
Every clinician working with children and families recognises the behavioural profile described by PDA. The challenging question is why these behaviours emerge.
PDA is not currently listed in the two diagnostic manuals used in psychiatry and psychology to diagnose mental health and developmental conditions, the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the World Health Organization’s International Classification of Diseases (ICD-11).
Researchers have reported concerns about the science behind PDA. There are no clear theories or explanations of why or how the profile of symptoms develop, and little inclusion of children or adults with lived experience of PDA symptoms in the studies. Environmental, family or other contextual factors that may contribute to behaviour have not been systematically studied.
A major limitation of existing PDA research and case studies is a lack of consideration of overlapping symptoms with other conditions, such as autism, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, selective mutism and other developmental disorders. Diagnostic labels can have positive and negative consequences and so need to be thoroughly investigated before they are used in practice.
Classifying a “new” condition requires consistency across seven clinical and research aspects: epidemiological data, long-term patient follow-up, family inheritance, laboratory findings, exclusion from other conditions, response to treatment, and distinct predictors of outcome. At this stage, these domains have not been established for PDA. It is not clear whether PDA is different from other formal diagnoses or developmental differences.
When a child is stressed, demands or requests might tip them into fight, flight or freeze mode. Shutterstock Finding the why
Debates over classification don’t relieve distress for a child or those close to them. If a child is “intentionally” engaged in antisocial behaviour, the question is then “why?”
Beneath the behaviour is almost always developmental difference, genuine distress and difficulty coping. A broad and deep understanding of developmental processes is required.
Interestingly, while girls are “under-represented” in autism research, they are equally represented in studies characterising PDA. But if a child’s behaviour is only understood through a “pathologising” or diagnostic lens, there is a risk their agency may be reduced. Underlying experiences of distress, sensory overload, social confusion and feelings of isolation may be missed.
So, what can be done to help?
There are no empirical studies to date regarding PDA treatment strategies or their effectiveness. Clinical advice and case studies suggest strategies that may help include:
- reducing demands
- giving multiple options
- minimising expectations to avoid triggering avoidance
- engaging with interests to support regulation.
Early intervention in the preschool and primary years benefits children with complex developmental differences. Clinical care that involves a range of medical and allied health clinicians and considers the whole person is needed to ensure children and families get the support they need.
It is important to recognise these children often feel as frustrated and helpless as their caregivers. Both find themselves stuck in a repetitive cycle of distress, frustration and lack of progress. A personalised approach can take into account the child’s unique social, sensory and cognitive sensitivities.
In the preschool and early primary years, children have limited ability to manage their impulses or learn techniques for managing their emotions, relationships or environments. Careful watching for potential triggers and then working on timetables and routines, sleep, environments, tasks, and relationships can help.
As children move into later primary school and adolescence, they are more likely to want to influence others and be able to have more self control. As their autonomy and ability to collaborate increases, the problematic behaviours tend to reduce.
Strategies that build self-determination are crucial. They include opportunities for developing confidence, communication and more options to choose from when facing challenges. This therapeutic work with children and families takes time and needs to be revisited at different developmental stages. Support to engage in school and community activities is also needed. Each small step brings more capacity and more effective ways for a child to understand and manage themselves and their worlds.
What about Charlie?
The current scope to explain and manage PDA is limited. Future research must include the voices and views of children and adults with PDA symptoms.
Such emotional and behavioural difficulties are distressing and difficult for children and families. They need compassion and practical help.
For a child like Charlie, this could look like a series of sessions where she and her parents meet with clinicians to explore Charlie’s perspective, experiences and triggers. The family might come to understand that, in addition to autism, Charlie has complex developmental strengths and challenges, anxiety, and some difficulties with adjustment related to stress at home and school. This means Charlie experiences a fight, flight, freeze response that looks like aggression, avoidance or shutting down.
With carefully planned supports at home and school, Charlie’s options can broaden and her distress and avoidance can soften. Outside the clinic room, Charlie and her family can be supported to join an inclusive local community sporting or creative activity. Gradually she can spend more time engaged at home, school and in the community.
Nicole Rinehart, Professor, Child and Adolescent Psychology, Director, Krongold Clinic (Research), Monash University; David Moseley, Senior Research Fellow, Deputy Director (Clinical), Monash Krongold Clinic, Monash University, and Michael Gordon, Associate Professor, Psychiatry, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Beat Food Addictions!
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When It’s More Than “Just” Cravings
This is Dr. Nicole Avena. She’s a research neuroscientist who also teaches at Mount Sinai School of Medicine, as well as at Princeton. She’s done a lot of groundbreaking research in the field of nutrition, diet, and addition, with a special focus on women’s health and sugar intake specifically.
What does she want us to know?
Firstly, that food addictions are real addictions.
We know it can sound silly, like the famous line from Mad Max:
❝Do not, my friends, become addicted to water. It will take hold of you and you will resent its absence!❞
As an aside, it is actually possible to become addicted to water; if one drinks it excessively (we are talking gallons every day) it does change the structure of the brain (no surprise; the brain is not supposed to have that much water!) causing structural damage that then results in dependency, and headaches upon withdrawal. It’s called psychogenic polydipsia:
But back onto today’s more specific topic, and by a different mechanism of addiction…
Food addictions are dopaminergic addictions (as is cocaine)
If you are addicted to a certain food (often sugar, but other refined carbs such as potato products, and also especially refined flour products, are also potential addictive substances), then when you think about the food in question, your brain lights up with more dopamine than it should, and you are strongly motivated to seek and consume the substance in question.
Remember, dopamine functions by expectation, not by result. So until your brain’s dopamine-gremlin is sated, it will keep flooding you with motivational dopamine; that’s why the first bite tastes best, then you wolf down the rest before your brain can change its mind, and afterwards you may be left thinking/feeling “was that worth it?”.
Much like with other addictions (especially alcohol), shame and regret often feature strongly afterwards, even accompanied by notions of “never again”.
But, binge-eating is as difficult to escape as binge-drinking.
You can break free, but you will probably have to take it seriously
Dr. Avena recommends treating a food addiction like any other addiction, which means:
- Know why you want to quit (make a list of the reasons, and this will help you stay on track later!)
- Make a conscious decision to genuinely quit
- Learn about the nature of the specific addiction (know thy enemy!)
- Choose a strategy (e.g. wean off vs cold turkey, and decide what replacements, if any, you will use)
- Get support (especially from those around you, and/but the support of others facing, or who have successfully faced, the same challenge is very helpful too)
- Keep track of your success (build and maintain a streak!)
- Lean into how you will better enjoy life without addiction to the substance (it never really made you happy anyway, so enjoy your newfound freedom and good health!)
Want more from Dr. Avena?
You can check out her column at Psychology Today here:
Psychology Today | Food Junkie ← it has a lot of posts about sugar addiction in particular, and gives a lot of information and practical advice
You can also read her book, which could be a great help if you are thinking of quitting a sugar addiction:
Sugarless: A 7-Step Plan to Uncover Hidden Sugars, Curb Your Cravings, and Conquer Your Addiction
Enjoy!
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