Treating Anxiety in Children

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What does the child who can’t say goodbye to a parent without breaking down have in common with the child who is cripplingly terrified of dogs and the one who gets a bad stomach ache reliably on Monday morning?

Anxieties and worries of all kinds are common in children, necessarily part of healthy development, but also, when they interfere with the child’s functioning, the most common pediatric mental health problems. From separation anxiety to social anxiety to school avoidance to phobias to generalized anxiety disorder, many children’s lives are at some point touched by anxiety that gets out of hand.

“I often tell parents, anxiety and fears are totally a normal and healthy part of growing up,” said Dr. Sabrina Fernandez, an assistant professor of pediatrics at the University of California, San Francisco, who has written about strategies for primary care doctors to use in dealing with anxiety disorders. “I worry that it’s becoming something more when it interferes with the child’s ability to do their two jobs: to learn in school and to make friends.”

Children whose lives are being seriously derailed by their anxieties often get psychotherapy or medication, or both. And a meta-analysis published in November in JAMA looked at the two best-studied treatments for anxiety disorders, cognitive behavioral therapy and psychotropic medication. The technique of a meta-analysis allows scientists to pull in a whole range of different studies, weight the results according to the size and rigor of the research, and then consider the wider array of data gleaned from multiple investigations.

“We included panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder and separation anxiety,” said the lead author, Zhen Wang, an associate professor of health services research at the Mayo Clinic College of Medicine and Science (they did not include children with post-traumatic stress disorder or obsessive-compulsive disorder). The study looked at the effectiveness of treatments in reducing the symptoms of anxiety, and at ending the anxiety disorder state. And they also looked at any reports of adverse events associated with the treatments, from sleep disturbances to suicide.

The authors examined 115 different studies, for a total of 7,719 patients, and concluded that certain kinds of antidepressant medications — especially the selective serotonin reuptake inhibitors, or S.S.R.I.s — were effective in reducing anxiety symptoms in children; the mean age of the children in the study was 9.2 years, with a range of 5 to 16.

There were only a few studies that directly compared them, but they suggest that cognitive behavioral therapy may be even more effective at reducing symptoms and at resolving the anxiety disorders, and that the combination of medication and C.B.T. may be better than either was alone. The drugs were associated with a variety of adverse events, though they did not find the association with suicide attempts that has led to a black box warning on S.S.R.I.s. Still, they have not ruled out those dangers: “The difference may be due to underreporting and monitoring of suicide attempts in clinical trials,” Dr. Wang said.

Dr. Stephen P.H. Whiteside, the director of the Pediatric Anxiety Disorders Clinic at the Mayo Clinic, who was one of the authors of the meta analysis, said, “if your child has difficulties with anxiety, first of all, it’s treatable. There are a variety of interventions that can be helpful.”

So which of those children — the parent-clinger, the dog-fearer, the school-avoider — needs psychotherapy or psychopharmacology?

“Anxiety happens in kids,” said Dr. Christopher K. Varley, a professor in the department of psychiatry at the University of Washington School of Medicine in Seattle. “It does not always need treatment.” And it does not always look exactly like what adults think of as anxiety, he said. Kids can have physical symptoms, or become disruptive; headaches and stomachaches and tantrums can all mean that a child is anxious.

“The important questions to me are, is this a problem, is it getting in the way of functioning, is it creating stress for the child and the family, is it causing pain and suffering?” he said.

“A big thing for families is that sometimes anxiety can lead to avoidance behavior in social settings and in school,” Dr. Fernandez said. But staying away from school is only going to make the problem worse, she said. “As a parent, all you want to do is make your child feel safe and feel comfortable, and if they’re saying, I only feel safe and comfortable home with my door shut, that can only exacerbate the problem.”

The most helpful form of therapy, Dr. Whiteside said, according to the evidence, is exposure-based cognitive behavioral therapy, which involves helping kids face their fears in a supportive environment. “If they’re afraid of dogs, they have to practice petting dogs; if they’re afraid of talking to people, practice talking to people.” That seems to be of greater value for children with these problems than, for example, therapies based on changing thought patterns, or distractions, or even therapy aimed at deeper insight into the fears.

The message of exposure therapy, Dr. Whiteside said, is that the situations the child is avoiding are not as dangerous as the child’s anxiety would suggest, and that the child can cope with the anxiety. “It’s an uncomfortable feeling that you can handle,” he said, and the more the child handles it, the more proficient the child will become.

But this takes skill and experience on the therapist’s part, and an investment of time and resources by the family. “We found that C.B.T. reports the most consistent outcomes compared to placebo, but it’s time-consuming and sometimes in rural areas it’s not available,” Dr. Wang said.

The question of medication may arise for children with moderate to severe anxiety, and perhaps ideally for a child who is already getting psychotherapy. But of course, not everyone has access to the experts, or to the recommended forms of therapy. Psychotropic medications are often prescribed by primary care doctors, pediatricians or family physicians, doing their best to help their patients, sometimes getting guidance from a psychiatrist by phone.

“Even though it’s a common problem and there are treatments that work, there are still profound problems in the United States with access to psychotherapists who are versed in psychotherapy techniques that have been demonstrated to help,” Dr. Varley said. “And there clearly is a paucity of child psychiatrists.”

In an editorial accompanying the recent meta-analysis, researchers hailed the large numbers of children included, but warned that many children don’t respond fully to treatment, and that children who suffer from one form of anxiety disorder are often at high risk to develop another.

“The good news is I’ve had lots of patients who’ve had much better experiences and were able to deal with those ups and downs of life, who went to therapy and learned tools to deal, or needed a little help with medication,” said Dr. Fernandez.

The Science of Adolescent Sleep

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Why do children wake up early when they are young but want to stay in bed till noon as teenagers?

Experts say it’s biology. Adolescents’ bodies want to stay up late and sleep late, putting them out of sync with what their school schedules demand of them. So kids have trouble waking up, and they often find themselves feeling drowsy in morning algebra class.

But that chronic sleepiness can affect their health and well-being, their behavior, and even their safety; it becomes genuinely dangerous when sleepy teenagers get behind the wheel.

At a recent conference on adolescent sleep, health and school start times, at which I gave a brief keynote, several experts made compelling arguments supporting the idea that middle and high school start times should shift to 8:30 a.m. or later, as recommended by the American Academy of Pediatrics and the American Academy of Sleep Medicine.

Brian Tefft, a senior researcher with the AAA Foundation for Traffic Safety, talked about “drowsy driving.” He cited an annual study that asks, “In the past 30 days how often have you driven when you were so tired that you had a hard time keeping your eyes open?” Over the past five years, on average, a quarter of the 16- to 18-year-old licensed drivers reported driving in that condition at least once, and 2 percent said fairly often or regularly.

The argument is that teenagers who face very early school start times are at risk of regular sleep deprivation. Driving after sleeping only four to five hours a night is associated with a similar crash risk as driving with an alcohol level at the legal limit. Sleeping less than four hours puts you at the same risk as driving with double the legal alcohol limit. (This is not only true for adolescents, but for all of us.)

Drowsy driving may not be the only risk that tired teenagers take. Wendy Troxel, a clinical psychologist and senior behavioral and social scientist at RAND, talked about the “adolescent health paradox,” that teenagers, who are in a developmental period of physical strength and resilience, face disproportionately high mortality rates. Unintentional injury (especially car crashes) is high on the list of causes, followed by homicide and suicide.

“The onset of new cases of depression skyrockets when kids become teens,” Dr. Troxel said. And we spend a great deal of time, money and energy on programs to prevent adolescent violence and suicide, to counsel against substance abuse and unsafe sex — and not always successfully. Given the vulnerability, and the dramatic changes happening with development, researchers are looking for other ways to support adolescent brains and general well-being. “Sleep loss problems are linked with brain areas that control emotional processes and risk taking,” she said. “Sleep problems and behavioral and mental health problems are linked.” (She recently gave a TED talk on why school should start later for teens.)

The vision of those who organized the conference, led by Dr. Judith Owens, director of sleep medicine at Boston Children’s Hospital and Jim Healy, a retired investment banker who is a parent activist in Greenwich, Conn., on this issue, was to bring together scientists, doctors and community members and address an audience that included school officials and legislators.

Dr. Daniel Buysse, professor of sleep medicine at the University of Pittsburgh Medical Center and the author of a 2014 article on sleep health, spoke about what regulates sleep. There’s a sleep drive that builds up according to how long you’ve been awake, he said, and then dissipates as you sleep. Your 24-hour rhythm and your level of arousal and engagement from moment to moment also regulate sleep.

“How are these things affected in adolescents?” he asked. Their sleep drive takes longer to build up than it did in childhood, he said. “They don’t reach that critical level of sleepiness till a later time at night.”

A student who could handle elementary school starting at 9 a.m. may have to contend with middle school starting at 8 a.m. just as social demands and his or her own sleep cycle shift later, putting development, biology, social connections and academic expectations into conflict.

The brain needs sleep to replenish energy sources, said Dr. Charles A. Czeisler, a professor of sleep medicine at Harvard Medical School. “Sleep is critical to maintain focus and alertness, to repair and maintain brain cells, to clear out toxic metabolites,” he said.

Dr. Mary Carskadon, a professor of psychiatry and human behavior at Alpert Medical School of Brown University, spoke about the variety of developmental alterations that take place in adolescence, from changes in the brain to different patterns in metabolism, and the ways that sleep patterns are affected. Those same children who were once eager early risers, she said, begin staying up later and become, as many parents know, hard to rouse in the morning.

“Some people don’t get it, that this is biology,” she told me. “Adolescent sleep delay is not just in human teenagers; it’s seen in other juvenile mammals.”

And when they do wake up and get to school, their brain function is not at its best. Amy R. Wolfson, a professor of psychology at Loyola University in Maryland, and the co-editor of The Oxford Handbook of Infant, Child, and Adolescent Sleep and Behavior, said that high school students tend to perform better in courses that meet later in the day, and perform better on cognitive tests when they are given in the afternoon.

The adolescent response to chronic sleep loss may be to consume a great deal of caffeine, Dr. Troxel said, leading to a “tired but wired” state in which risk-taking becomes more likely, in a setting where adolescent biology is in conflict with academic expectations and school schedules.

The Banned Books Your Child Should Read

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A selection of “frequently challenged” children’s books. CreditTony Cenicola/The New York Times

More than 40 years ago, my seventh grade English teacher began the year by telling us that we were definitely not allowed to read “The Catcher in the Rye because we weren’t “ready” for it. So naturally we all went out and read it immediately.

I told this story to my son when he was a seventh grader. I meant it as a funny story, and I pointed out that it had taken me years to appreciate that teacher’s pedagogic strategy. But then my son read the book himself right away. The mere long-ago echo of a possible ban was enough to make it interesting.

Adults have been known to worry a great deal about the possible corrupting influence of the printed word on children. If you look at the list of “frequently challenged children’s books” maintained by the American Library Association Office of Intellectual Freedom, you will see a wide range of touchy topics. (A book is “challenged” when someone tries to get it removed from a library or a school curriculum.)

Books can get challenged because they involve magic (Philip Pullman, J.K. Rowling), or because they offend religious sensibilities. “A Wrinkle in Time, by Madeleine L’Engle, has been challenged as both overly and insufficiently religious. Some books are challenged because they depict children behaving, well, childishly (Junie B. Jones, the heroine of a series of books by Barbara Park, gets in trouble for using words like “stupid.”) So adults worry that books may be bad for children’s morals and for their manners.

“I think it happens in the U.S. more than in some other countries,” said Leonard Marcus, a children’s book historian and critic. “There’s a squeamishness in the U.S. about body parts I think that goes back to the Puritan tradition, and has never completely died out.” He pointed to the controversy around Maurice Sendak’s 1970 children’s book “In the Night Kitchen,” which centered on the illustrations showing the naked — and anatomically correct — little boy whose nocturnal adventures make up the story.

“Anything with any sexual content is likely to attract attention and hostility,” said Joan Bertin, the executive director of the National Coalition Against Censorship. “Regardless of the nature of its message — whether it is deemed to be helpful or instructive or insightful in some way or just merely titillating — people don’t make that distinction.”

In fact, banned book lists can be a great resource for parents looking for books that teach kids about the world and themselves.

When your children read books that have been challenged or banned, you have a double opportunity as a parent; you can discuss the books themselves, and the information they provide, and you can also talk about why people might find them troubling. Here are a few books that are often challenged, yet present great opportunities for children to learn.

IT’S PERFECTLY NORMAL: CHANGING BODIES, GROWING UP, SEX AND SEXUAL HEALTHBY ROBIE HARRIS. Your children should have age-appropriate books to help them learn about bodies, and you can find plenty of those on any list of banned or challenged books. This book, with illustrations by Michael Emberley has become a classic of information about bodies, development, and sexuality. First published in 1994, it has now gone through several editions and updates. Ms. Harris, who also wrote “It’s So Amazing,” for younger children, and “It’s Not the Stork,” for those even younger, says most of the challenges to her books have revolved around issues of gay sexuality, though masturbation and contraception can also be flash points. (She is also a good friend, and I have helped at times with pediatric questions on some of these and other books.)

CAPTAIN UNDERPANTSBY DAV PILKEY. This series, which has long been legendary for its compelling power over small boys, has sometimes been at the top of the most-challenged list, perhaps in part because (surprise) there are many jokes about undergarments. These books will definitely help children appreciate that bodies and their functions can be profoundly funny and silly (actually, most children seem to know this anyway).

In addition to being attacked for their potty-mouthed humor, the “Captain Underpantsbooks have come under scrutiny because they are full of children playing tricks and disobeying and generally creating havoc; again, as with Junie B. Jones and her big mouth, there is this strange sense that children need stories about obedient model children.

ARE YOU THERE GOD? IT’S ME, MARGARET BY JUDY BLUME. In this widely beloved novel by Judy Blume, originally published in 1970, but still on the most-challenged list, the narrator is deeply preoccupied with the when and how of menstruation. An other Judy Blume perennial, “Deenie,” which came out in 1973, is about a young girl struggling with scoliosis and the brace she has to wear, but it was the most attacked of her books, Ms. Blume says, because it included references to masturbation.

Much of the controversy about Judy Blume’s books centered around information about puberty. “I think the feeling was, if my child doesn’t read this, my child won’t know about it or it’s not going to happen to my child,” said Ms. Blume. “I used to get up there on stage and say, I have news for you, your kids are going to go through puberty whether you like it or not, so why not help them — it’s going to happen whether they read my books or no books or somebody else’s book.”

Ms. Blume said that often when adult tourists come into Books & Books Key West, the independent bookstore that she helped found and where she often works, they want to tell her how much they learned from her novels. “It’s like, thank you, thank you, my mother never told me anything and I wouldn’t have known anything without your books.”

Ms. Blume said she recently sold a copy of “And Tango Makes Three,” the 2005 book by Justin Richardson and Peter Parnell about two male penguins who hatch an egg and raise the baby together (you’ll find it on the list of challenged picture books) to a man who had just adopted a little girl with his male partner. “That’s my new thrill as a bookseller,” she said, “to put that right book into the hands of someone who appreciates what it’s saying.”

I AM JAZZ BY JESSICA HERTHEL AND JAZZ JENNINGS. This 2014 picture book about being transgender has been at the center of controversy recently with some schools coming under attack for using it in the curriculum, and others arguing that it can be helpful in teaching tolerance.

Some banned and challenged books upset adults because they teach children that the world is a complicated and sometimes disturbing place, in which good people sometimes behave badly and evil sometimes goes unpunished. This category stretches from modern young adult “problem novels” to great classics of literature. What makes a book “disturbing” often is tied to what makes it interesting or important or worth reading.

If you look over lists of frequently challenged young adult books, you’ll find everything from “The Chocolate Warby Robert Cormier (challenged for violence and for scenes of masturbation) to Anne Frank’s “Diary of a Young Girl” (challenged for sexual explicitness and for depressing tragic outcome). Also on the list — Alice Walker’s “Color Purple (challenged for sexual explicitness and bad language), and of course, Adventures of Huckleberry Finn,which last month was removed from classrooms and libraries in schools in Accomack County, Va., along with “To Kill a Mockingbird,” when a parent complained that the books contained racial slurs.

Those are all books I came across and read on my own, growing up, and yes, they were disturbing, in places, and yes, there were things I didn’t completely understand, and basically skipped over to return to on later readings. (This is a very valuable skill possessed by most precociously bookish children.) I was never forbidden any book by my book-loving parents (we all know what the result would have been), and I don’t think I ever tried to stop my children from reading any book (we all know what the result would have been), though I occasionally said something like, “I think that one may creep you out, so maybe you want to wait.”

One of the jobs — and joys — of parenthood is recommending books at what you think are the right ages. On of the corollaries is that sometimes you get it wrong and your child is not ready — or is much farther along than you thought. Mostly, as a parent, you should be glad and proud if your child is a reader.

In fact, many of the books which are on the most-challenged lists are also frequently assigned as classics (and being assigned may be what gets you challenged). Common Sense Media has a nice list of books on this border between classic and controversial, suggesting parents and kids read them together and discuss why people find them disturbing.

As a parent, I was dazzled when my daughter’s high school summer reading assignment was to choose a book “out of your comfort zone,” however the student chose to define it. Because that is, of course, what literature does, and part of the glorious freedom (and human right) of literacy is the opportunity to journey with words well beyond your comfort zone.

To Help a Shy Child, Listen

The New York Times

By PERRI KLASS, M.D.
Joyce Hesselberth
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Toward the end of the summer, I was seeing a middle-school girl for a physical. The notes from a clinic visit last spring said she was a good student but didn’t talk enough in class. So I asked her: Is this still a problem for you?

I’m shy, she said. I’m just shy.

Should I have turned to her mother and suggested — a counselor? An academic evaluation? Should I have probed further? How do you feel in school, do you have some friends, is anybody bullying you?

Or should I have said: Lots of people are shy. It’s one of the healthy, normal styles of being human.

All of these responses, together, would have been correct. A child who is being bullied or bothered may be anxious about drawing attention to herself; a child who doesn’t ever talk in class may be holding back because some learning problem is getting in the way, making her self-conscious. So you do need to listen — especially to a child who talks less rather than more — and find ways to ask questions. Are you happy, anxious, afraid?

But shyness is also part of the great and glorious range of the human normal. Two years ago, Kathleen Merikangas, a senior investigator at the National Institute of Mental Health, and her colleagues published a study of 10,000 older children, ranging from 13 to 18 years old. “We found that about half of kids in America describe themselves as shy,” she told me.

Common though it may be, our schools — and our broader culture — do not always celebrate the reserved and retiring. “Children who are shy, who don’t raise their hand, who don’t talk in class, are really penalized in this society,” Dr. Merikangas said.

I have heard it said that temperament was invented by the first parent to have a second child — that’s when parents realize that children come wired with many of the determinants of disposition and personality. What worked with Baby 1 doesn’t necessarily work with Baby 2. The analysis of temperament has been a topic of discussion in pediatrics and psychology for decades.

“Temperament is the largely inborn set of behaviors that are the style with which a person functions, not to be confused with their motivation or their developmental status and abilities,” said Dr. William B. Carey, a clinical professor of pediatrics at the Children’s Hospital of Philadelphia and the author of “Understanding Your Child’s Temperament.”

Shyness reflects a child’s place on the temperamental continuum, the part of it that involves dealing with new and unfamiliar circumstances. And starting a new school year may be hard on those who find new situations more difficult and more full of anxiety. What most children need is time to settle in, support from parents and teachers, and sometimes help making connections and participating in class.

If a child is not more comfortable after a month or so, parents should look at whether more help is needed, said Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders. Treatment usually involves cognitive behavioral strategies to help the child cope with anxiety.

All ranges of temperament have their uncomfortable, or even pathological, outer zones. Just as there are children whose rambunctious eagerness to participate makes trouble for them in school or signals the presence of other problems, there are children whose silence is a shout for help.

I’m struck by the parallels between the ways we discuss shyness and the ways we discuss impulsivity and hyperactivity. In both cases, there is concern about the risk of “pathologizing” children who are well within the range of normal and worry that we are too likely to medicate outliers. By this thinking, children who would once have been considered shy and quiet too often get antidepressants, just as children who would once have been considered lively and rambunctious too often get A.D.H.D. medications.

But the most important question is whether children are in distress. Dr. Merikangas’s study distinguished between the common trait of shyness and the psychiatric diagnosis of social phobia. Over all, about 5 percent of the adolescents in the study were severely restricted by social anxiety; they included some who described themselves as shy and some who did not. The authors questioned whether the debate about the “medicalization” of shyness might be obscuring the detection of the distinct signs of social phobia.

For parents who simply want to help a shy child cope with, for example, a brand new classroom full of brand new people, consider rehearsing, scripting encounters and interactions. “The best thing they can do is do a role play and behavioral rehearsal ahead of time,” said Steven Kurtz, a senior clinician at the Child Mind Institute in Manhattan. Parents should “plan on rewarding the bravery.”

But don’t take over. “The danger point is rescuing too soon, too often, too much, so the kids don’t develop coping mechanisms,” said Dr. Kurtz.

Cognitive behavioral therapy relies on “successive approximations,” in which children slowly close in on the behaviors they are hoping to achieve. In that spirit, a parent might arrange to meet another parent on the way to school, so a shy child can walk with another and bond. A teacher might look for the right partner to pair up with a shy child for cooperative activities in the classroom.

“Probably the worst thing to do is to say, ‘Don’t be shy. Don’t be quiet,’ ” Dr. Merikangas told me. This is not about trying to change the child’s temperament. It’s about respecting and honoring temperament and variation, and helping children navigate the world with their own instruments.

Early Music Lessons Have Longtime Benefits

Early Music Lessons Have Longtime Benefits

By PERRI KLASS, M.D.

When children learn to play a musical instrument, they strengthen a range of auditory skills. Recent studies suggest that these benefits extend all through life, at least for those who continue to be engaged with music.

But a study published last month is the first to show that music lessons in childhood may lead to changes in the brain that persist years after the lessons stop.

Researchers at Northwestern University recorded the auditory brainstem responses of college students — that is to say, their electrical brain waves — in response to complex sounds. The group of students who reported musical training in childhood had more robust responses — their brains were better able to pick out essential elements, like pitch, in the complex sounds when they were tested. And this was true even if the lessons had ended years ago.

Indeed, scientists are puzzling out the connections between musical training in childhood and language-based learning — for instance, reading. Learning to play an instrument may confer some unexpected benefits, recent studies suggest.

We aren’t talking here about the “Mozart effect,” the claim that listening to classical music can improve people’s performance on tests. Instead, these are studies of the effects of active engagement and discipline. This kind of musical training improves the brain’s ability to discern the components of sound — the pitch, the timing and the timbre.

“To learn to read, you need to have good working memory, the ability to disambiguate speech sounds, make sound-to-meaning connections,” said Professor Nina Kraus, director of the Auditory Neuroscience Laboratory at Northwestern University. “Each one of these things really seems to be strengthened with active engagement in playing a musical instrument.”

Skill in appreciating the subtle qualities of sound, even against a complicated and noisy background, turns out to be important not just for a child learning to understand speech and written language, but also for an elderly person struggling with hearing loss.

In a study of those who do keep playing, published this summer, researchers found that as musicians age, they experience the same decline in peripheral hearing, the functioning of the nerves in their ears, as nonmusicians. But older musicians preserve the brain functions, the central auditory processing skills that can help you understand speech against the background of a noisy environment.

“We often refer to the ‘cocktail party’ problem — or imagine going to a restaurant where a lot of people are talking,” said Dr. Claude Alain, assistant director of the Rotman Research Institute in Toronto and one of the authors of the study. “The older adults who are musically trained perform better on speech in noise tests — it involves the brain rather than the peripheral hearing system.”

Researchers at the University of California, San Francisco, are approaching the soundscape from a different point of view, studying the genetics of absolute, or perfect, pitch, that ability to identify any tone. Dr. Jane Gitschier, a professor of medicine and pediatrics who directs the study there, and her colleagues are trying to tease out both the genetics and the effects of early training.

“The immediate question we’ve been trying to get to is what are the variants in people’s genomes that could predispose an individual to have absolute pitch,” she said. “The hypothesis, further, is that those variants will then manifest as absolute pitch with the input of early musical training.”

Indeed, almost everyone who qualifies as having truly absolute pitch turns out to have had musical training in childhood (you can take the test and volunteer for the study at http://perfectpitch.ucsf.edu/study/).

Alexandra Parbery-Clark, a doctoral candidate in Dr. Kraus’s lab and one of the authors of a paper published this year on auditory working memory and music, was originally trained as a concert pianist. Her desire to go back to graduate school and study the brain, she told me, grew out of teaching at a French school for musically talented children, and observing the ways that musical training affected other kinds of learning.

“If you get a kid who is maybe 3 or 4 years old and you’re teaching them to attend, they’re not only working on their auditory skills but also working on their attention skills and their memory skills — which can translate into scholastic learning,” she said.

Now Ms. Parbery-Clark and her colleagues can look at recordings of the brain’s electrical detection of sounds, and they can see the musically trained brains producing different — and stronger — responses. “Now I have more proof, tangible proof, music is really doing something,” she told me. “One of my lab mates can look at the computer and say, ‘Oh, you’re recording from a musician!’ ”

Many of the researchers in this area are themselves musicians interested in the plasticity of the brain and the effects of musical education on brain waves, which mirror the stimulus sounds. “This is a response that actually reflects the acoustic elements of sound that we know carry meaning,” Professor Kraus said.

There’s a fascination — and even a certain heady delight — in learning what the brain can do, and in drawing out the many effects of the combination of stimulation, application, practice and auditory exercise that musical education provides. But the researchers all caution that there is no one best way to apply these findings.

Different instruments, different teaching methods, different regimens — families need to find what appeals to the individual child and what works for the family, since a big piece of this should be about pleasure and mastery. Children should enjoy themselves, and their lessons. Parents need to care about music, not slot it in as a therapeutic tool.

“We want music to be recognized for what it can be in a person’s life, not necessarily, ‘Oh, we want you to have better cognitive skills, so we’re going to put you in music,’ ” Ms. Parbery-Clark said. “Music is great, music is fantastic, music is social — let them enjoy it for what it really is.”

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