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Vol. 19, No. 11, November 2003
1. What's New in Research
Effects of text messaging on adolescent health studied
2. Response and responsibility: New findings in juvenile delinquents -
should it change how we think about crime?

What's New in Research Effects of text messaging on adolescent health studied
Preliminary findings from a crosssectional study suggest that text messaging on mobile phones may be related to sleep disturbances in a growing number of adolescents, who sometimes take the phones to bed so they do not miss any incoming messages. In a letter to the editor published in the Sept. 13 issue of the Journal of Sleep Research, researcher Jan Van den Bulck, Ph.D., associate professor at the Katholieke Universiteit Leuven, reports the results of research examining the effects of text messaging on sleep interruption in adolescents. Van den Bulck looked at the responses of 2,500 children who participated in the first wave of the Leuven Study on Media and Adolescent Health (SOMAH) in Flanders. Participants were asked how often they were awoken nightly by incoming text messages on their mobile phone, and about how tired they felt. Almost half of the 16-year-olds surveyed said they had been awoken at night by incoming text messages on their mobile phone. A quarter of the 13-year-olds reported sleep disruptions related to text messaging. "Too often researchers and [practitioners] only worry about TV use, when they think about the health effects of the media," said Van den Bulck, in an interview with The Brown University Child & Adolescent Behavior Letter. "Mobile phones have a larger potential impact on adolescent health than TV viewing or other media use because those other forms of media use only seem to lead to going to bed later and/or sleeping less." Studies have shown that sleep plays an important role in a child's development and overall well-being. Sleep disruptions have been implicated in some childhood neurodevelopmental disorders, such as ADHD, because the symptoms of sleep deprivation and sleepiness can mimic those of the attentional disorder. Sleep disruptions have also been tied to other deleterious health effects in children, including risk for injury. In addition to losing sleep, Van den Bulck noted that adolescents' quality of sleep is probably affected as well. He said that adolescents are not just awoken by the incoming messages but rather want to be woken up, which may further affect the quality of sleep. In other words, he said the incoming messages are no coincidence; they are meant to be received. "Parents should realize that mobile phones can have a big impact on the lives of their children," said Van den Bulck. "Being aware of what children do with means of communication should not stop at the door of the bedroom." Van den Bulck: Text messaging as a cause of sleep interruption in adolescents, evidence from a cross-sectional study. Journal of Sleep Research 2003;12(3):263. Correspondence to: Dr. Van den Bulck, Katholieke Universiteit Leuven, Dept. of Communication, Van Evenstraat 2A, 3000 Leuven, Belgium; e-mail: jan.vandenbulck@soc.kuleuven.ac.be

What's New in Research
Effects of text messaging on adolescent health studied

Preliminary findings from a crosssectional study suggest that text messaging on mobile phones may be related to sleep disturbances in a growing number of adolescents, who sometimes take the phones to bed so they do not miss any incoming messages.

In a letter to the editor published in the Sept. 13 issue of the Journal of Sleep Research, researcher Jan Van den Bulck, Ph.D., associate professor at the Katholieke Universiteit Leuven, reports the results of research examining the effects of text messaging on sleep interruption in adolescents. Van den Bulck looked at the responses of 2,500 children who participated in the first wave of the Leuven Study on Media and Adolescent Health (SOMAH) in Flanders. Participants were asked how often they were awoken nightly by incoming text messages on their mobile phone, and about how tired they felt.

Almost half of the 16-year-olds surveyed said they had been awoken at night by incoming text messages on their mobile phone. A quarter of the 13-year-olds reported sleep disruptions related to text messaging.

"Too often researchers and [practitioners] only worry about TV use, when they think about the health effects of the media," said Van den Bulck, in an interview with The Brown University Child & Adolescent Behavior Letter. "Mobile phones have a larger potential impact on adolescent health than TV viewing or other media use because those other forms of media use only seem to lead to going to bed later and/or sleeping less."

Studies have shown that sleep plays an important role in a child's development and overall well-being. Sleep disruptions have been implicated in some childhood neurodevelopmental disorders, such as ADHD, because the symptoms of sleep deprivation and sleepiness can mimic those of the attentional disorder. Sleep disruptions have also been tied to other deleterious health effects in children, including risk for injury.

In addition to losing sleep, Van den Bulck noted that adolescents' quality of sleep is probably affected as well. He said that adolescents are not just awoken by the incoming messages but rather want to be woken up, which may further affect the quality of sleep. In other words, he said the incoming messages are no coincidence; they are meant to be received.

"Parents should realize that mobile phones can have a big impact on the lives of their children," said Van den Bulck. "Being aware of what children do with means of communication should not stop at the door of the bedroom."

Van den Bulck: Text messaging as a cause of sleep interruption in adolescents, evidence from a cross-sectional study. Journal of Sleep Research 2003;12(3):263. Correspondence to: Dr. Van den Bulck, Katholieke Universiteit Leuven, Dept. of Communication, Van Evenstraat 2A, 3000 Leuven, Belgium; e-mail: jan.vandenbulck@soc.kuleuven.ac.be

Response and responsibility: New findings in juvenile delinquents - should it change how we think about crime?

Hans Steiner, M.D.

A series of new studies regarding the mental health of juvenile delinquents is raising questions regarding how we should think about juvenile crime - and maybe all crime.

Studies carried out most recently by our group in California found that six to nine months into incarceration, a majority of both female and male incarcerated youth suffer from significant mental disorders. Moreover, these disorders rarely occur in isolation. Some children suffer from as many as nine comorbid disorders, and three to six are common. These disorders affect the teenagers' ability to think and learn, to use their emotions as an accurate navigation system for everyday life and to be aggressive in an adaptive way. The sheer number of disorders (not the type) was found to negatively affect their overall level of emotional distress and their ability to act in a measured, restrained fashion, especially when stressed and threatened. Only a minority of these disorders would qualify as meeting the current legal standard for exculpability (the M'Naghten rule, which stipulates that one essentially needs to be out of touch with reality to be excused from the responsibility for one's actions). Yet, to all of us working with these youth as physicians, psychologists and caseworkers, it is also clear that they are not in full control of themselves.

Our findings parallel those from other research groups in New York, Chicago, The Netherlands, Russia and Austria to name a few, using different instruments at different times during the judicial process - e.g., before and after adjudication, at times before criminal conviction, and after some time spent in prison. There is little doubt in our minds that this is a real phenomenon and one that has grave implications for these youth and their future. As an immediate question, one has to wonder what is wrong with our mental health system, that it permits this level of psychiatric morbidity to go undetected? Many of these youth never saw a mental health professional before their crime. Secondly, even if they were diagnosed, why are so few of them treated properly and effectively? This is not a question of the mental health sciences not having the wherewithal to make a difference. Like at no time prior to the last 5 to 10 years, we now have at our disposal new diagnostic and therapeutic tools, which are efficacious and cost effective at the same time. We are simply not bringing them to bear on the mental health care of these juvenile delinquents. Thirdly, how is it possible that we pay between $35,000 and $64,000 per year per child for incarceration and still we do not provide the mental health services needed after they are detained and the problems are identified?

These are all questions that clearly need an answer, and urgently so, if not for humanitarian reasons, then certainly from the point of view of society's self interest. Virtually all of these incarcerated youth will be released, usually after two to three years, and their criminal records will be closed. They will become our neighbors, our daughter's boyfriends, our children's babysitters. Having them healthy and functioning is in everyone's best interest. Moreover, I for one would like my tax dollars be put to work more efficiently than to support simplistic, "just say no" types of superficial campaigns.

Finally, it seems that it is time to rethink the boundary between those actions for which one is fully responsible and those that can be excused on the basis of one being impaired. The temporary insanity rule needs revision, especially in the light of these new findings of widespread psychopathology.

It is a fact, demonstrated in many different cultures, that most juveniles (up to 95%) commit antisocial acts of one form or another sometime during their adolescence - most minor but some of them serious. It is also clear that only a small percentage do so repeatedly, and even fewer persist in a lifetime career of crime. It appears that those who do, have some mental health issues, usually multiple diagnoses and problems. It is likely that the sheer accumulation of problems (not just their impact on reality testing and knowledge of the wrongness of one's actions) is sometimes sufficient to cause severe deviations in developmental pathways, which in the long term then become insurmountable.

A national discussion between legal and mental health experts is needed to review and redraw the line that defines juvenile responsibility in light of our burgeoning knowledge about psychopathology in the young. As mental health sciences progress, we need to redefine agency, intentionality and free will. Even troubled youth are too precious to relegate to a life of symptomatic crime and incarceration without treatment.

Dr. Steiner is Professor of Psychiatry and Director of Education in the Division of Child Psychiatry and Child Development at the Stanford University School of Medicine.