The Child Mind BlogBrainstorm
Rep. Tim Murphy on Plan to Reform Mental Health Care
Jan. 22, 2016 Child Mind Institute
As part of its regular briefing series, this morning the Child Mind Institute welcomed to its New York City headquarters Representative Tim Murphy (R-PA), who provided an update on the Helping Families in Mental Health Crisis Act of 2015, H.R. 2646. The Act, introduced by Reps. Murphy and Eddie Bernice Johnson (D-TX), focuses on mental health reform that would help both those with mental illness and families who are struggling to get necessary care for their loved ones. According to Rep. Murphy, the legislation has advanced out of the House Energy and Commerce health subcommittee, and its chances of coming up for a vote in the full House in 2016 are strong.
Rep. Murphy first discussed his view of the deficiencies in the federal government's approach to mental health issues. Among other challenges, he noted the shortage of psychiatric beds, the outsized role of prisons in providing mental health care, the challenges privacy rules present to physicians and family members, and the shortage of child psychiatrists. Rep. Murphy then highlighted a number of provisions of the Act intended to address these and other problems, including:
• A new Assistant Secretary for Mental Health and Substance Use Disorders, with professional mental health training, to elevate the importance of mental health, coordinate programs across different agencies, and promote evidence-based programs
• A new National Mental Health Policy Laboratory to drive innovative models of care and develop evidence-based and peer-review standards for grant programs
• A requirement that the Assistant Secretary recommend a national strategy for increasing the number of psychiatrists, child and adolescent psychiatrists, psychologists, psychiatric nurse practitioners, clinical social workers, and mental health peer-support specialists
• A new early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting
• Advancements in remote tele-psychiatry to link pediatricians and primary care doctors with psychiatrists and psychologists in areas where patients don't have access to needed care
• Dedicated funding for the Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) Initiative
• Reauthorization of the National Child Traumatic Stress Network
Rep. Murphy's remarks were followed by a lively discussion among the attendees, a range of New York City area practitioners and representatives of professional organizations.Read More
Child Mind Institute Depression Service: Rigorous Evaluation and Individualized Care
Jan. 20, 2016 Harry Kimball
Clinicians at the Child Mind Institute regularly treat mood disorders, including depression. But the recently launched Depression Service for children and adolescents brings a complete diagnostic evaluation and a variety of treatment options under one roof so that patients and families can better understand symptoms and how different treatments can help — now and in the future. The result is a thoroughly evidence-based approach that also recognizes the individuality of every child who seeks treatment, ensuring they get the highest quality care and the support they deserve.
Dr. Jill Emanuele directs the service, and stresses the importance of rigorous evaluation before any treatment decisions are made, as mood disorders in youth frequently go unrecognized or are misunderstood. "What happens out there in the world is that people get diagnoses that are wrong or do not explain the whole picture," Dr. Emanuele says. "What we do here is nail down what is happening — effectively diagnose depression and whatever other disorders are co-occurring — so we can formulate a plan and recommend the best treatment."
Within the Depression Service, the primary treatment options include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) and interpersonal therapy (IPT). Mindfulness based interventions, which have a growing evidence base for the prevention and treatment of depression, can be incorporated into treatment sessions when indicated. In addition, when medication may be warranted as part of the treatment, clinicians collaborate with board certified child and adolescent psychiatrists on the service to provide comprehensive care using both therapy and medication.
Overall, the specific treatment that is recommended depends on the specific needs of the child and the family. Every intervention takes into account that depression is often a chronic disorder. "If you have a first episode of depression, especially in adolescence, there is a strong possibility you may relapse and have a second episode. Depression can become a lifelong problem." With that critical understanding in mind — that these disorders often affect the wellbeing of children into the future — focusing on prevention is a central part of the service.
"What we're trying to do is not only resolve the symptoms and the illness, but also teach skills to help prevent relapse," Dr. Emanuele says. "These treatments have different components to help people not only recognize and understand their depression but to start thinking about what happens when the symptoms come back. For example, using skills in DBT, challenging your thoughts in CBT and reinforcing personal relationships in IPT — all of these strategies can help people to improve and remain well."
Bringing as many resources as possible into treatment, including the family itself, helps achieve that goal. "One thing we do really well is work with families," Dr. Emanuele says. "The family is an essential component of the process." This is particularly true for more intensive interventions like DBT, where family participation is a structured part of the treatment.
Above all, the clinicians in the Depression Service are attuned to the real pain and disruption that come from the symptoms that children, adolescents and young adults can experience, like persistent feelings of sadness, irritability or explosive anger, and impulsive decision-making, and to designing the appropriate intervention. "The focus on matching the right treatment to the right symptoms and life circumstances doesn't just apply within the service," Dr. Emanuele says, "but throughout the clinical services at the Child Mind Institute." Clinicians constantly tailor interventions to the individual. What does someone get out of the Depression Service? As Dr. Emanuele puts it: "Support, treatment and hope."Read More
New Study Seeks to Unlock Secrets of the Developing Brain
Jan. 20, 2016 Child Mind Institute
In 2015, the Child Mind Institute launched the Healthy Brain Network to pursue a bold goal: to seek out biological markers of mental health disorders in the developing brain. Other fields of medicine have objective tests to diagnose disease, but psychologists and psychiatrists must rely on observation, along with patient and family reports, to identify and treat mental health disorders.
One in five children struggles with a mental health or learning disorder, and objective tests will fundamentally change the way clinicians evaluate these children and design and assess treatment plans. The need for that change inspired the Healthy Brain Network.
Over the next five years, the Healthy Brain Network will provide free diagnostic mental health consultations and treatment recommendations to 10,000 children and adolescents in New York City, all the while collecting brain scans and other data to advance our understanding of the biology of mental illness.
"The scope of this study is unprecedented because the scale of the problem is unprecedented," says Harold Koplewicz, MD, president of the Child Mind Institute. "There are 17 million children in this country who have or have had a psychiatric illness — that's more than the number of children suffering with cancer, AIDS and diabetes combined. We feel a tremendous sense of urgency to advance the science of the developing brain to help these children."
The Healthy Brain Network's community-based research center on Staten Island has begun collecting what will be the largest-ever database on the developing brain. Plans are in motion to open additional research centers in Brooklyn and other boroughs in the coming years to enable the study to reach its ambitious goals. The study will also test new research paradigms while involving the community in a partnership for children's mental health. In addition to the state-of-the-art research center, a mobile MRI lab and research vehicle enables staff to do evaluations and collect data in neighborhoods across the city.
Sharing data with researchers through open science
Freely sharing its data is fundamental to the design of the study. Dr. Cameron Craddock, director of imaging at the Child Mind Institute's Center for the Developing Brain, is leading key aspects of the data collection and sharing process. "We are excited about what the project is doing for children and families, but also what it could mean for the study of children's mental health on a grand scale because of how we'll share our data," he says.
Unlike other research efforts where data is held until papers are published, or longer, the Healthy Brain Network will share its results with researchers around the world using what's called "open science." In addition, the mobile units will take cutting-edge technologies out of the lab and into communities to facilitate data collection and to address the needs of children who may otherwise not have access to care.
Studies such as the Healthy Brain Network that use large data sets and open science are helping drive a fundamental shift in how research is conducted in developmental neuroscience. "These methods are the only way we can answer the mental health questions we want to ask," says Dr. Craddock. "We can look at similarities and differences between disorders, and find answers to some fundamental questions about brain development."
With New York's diverse population and data shared with researchers around the globe, the hope is that these comparisons will uncover the biological factors contributing to mental health and learning disorders in young people, which may one day lead to new treatments, new diagnostic tools and new approaches to prevention.
But first, the data needs to be collected. "10,000 in 5 years — that's pretty aggressive," says Dr. Craddock. A recent visit showed the Staten Island research center humming with activity, and the work well underway.
As the mobile collection efforts gain momentum, lessons from the project should have an impact far and wide in experimental neuroscience. The work starts with demonstrating the dependability of the mobile scanner, a newer tool in a time when most neuroimaging studies are conducted at university medical centers. "There's a lot of discussion in the field about collecting data using mobile labs," Dr. Craddock explains. "We're seeing terrific results so far, and the implications for discovery are very exciting."
The most exciting outcome of the study may be its potential to transform the lives of children who struggle with mental health or learning disorders every day.
"Based on our research and the children we see, we know that mental health and learning disorders are real, common and treatable," says Dr. Koplewicz. "But we must do more — too few children have access to care and too many lives are held back by mental illness. We believe that accelerating the rate of discovery is essential to helping our children reach their full potential, and to find meaning and joy in their lives."
Learn more about the Healthy Brain Network at healthybrainnetwork.org.Read More
The ADHD Women's Palooza
Jan. 11, 2016 Rae Jacobson
Women with ADHD will be subject of an online extravaganza this week festively named ADHD Women's Palooza. The free Palooza, which runs through Jan. 16, features over 30 speakers, panels, community message boards, as well as real-time opportunities to ask questions of top experts on women with ADHD.
Speakers include big names like Dr. Patricia Quinn, one of the foremost writers and thinkers on women with ADHD, Sari Solden, author of Women with ADHD and Dr. Stephen Hinshaw, vice-chair of the psychology department at UC Berkley and author of the bestselling book The ADHD Explosion.
Session topics cover a wide range of issues facing women with ADHD, including career and life planning advice, motherhood and ADHD, tips on finding the right medication, ideas for managing procrastination, new research on girls with ADHD, and in-depth talks on relationships, sleep, exercise and more.
Tickets are free, when you register at adhdpalooza.com and all sessions and events are viewable online. Check their website for a full list of panels and topics.
All the presentations are in EST, but the website includes a time zone converter to help ensure you don't miss important sessions — which as a woman with ADHD myself, I must say is a nice touch.Read More
2015 Child Advocacy Award Dinner
Dec. 10, 2015 Caroline Miller
The Child Mind Institute held its sixth annual Child Advocacy Award Dinner at Cipriani 42 Street on December 9th, and it was an evening of high emotion and high spirits that raised $6.85 million dollars.
Fifteen-year-old Jackie Rodriguez set the tone with a compelling story about her battle with crippling anxiety, and the Child Mind Institute team that stepped in after a series of other clinicians who just wrote prescriptions—and essentially washed their hands of her. "One doctor actually said, 'There's nothing I can do for you,'" she recalled. She was 13 years old.
By the time Jackie got to the Child Mind Institute, she said, "I honestly didn't think I could get better." But the team that helped her work through her anxiety with behavioral therapy made it clear from the outset that "we're in this together. We're not gonna stop until you're okay."
Katie Couric, the evening's host, applauded the "poised and articulate" Jackie for being a great example to other teenagers. "The message is that anyone with any kind of mental illness or emotional challenge should know they're never alone," said Couric. "And they should never be ashamed about what they're going through."
Child Mind Institute president Dr. Harold Koplewicz picked up on the theme of adults essentially telling children with mental health issues that they're out of luck.
"I want you to join me in refusing to accept 'there's nothing I can do' as an answer," Dr. Koplewicz said to the audience of more than 600. "Help us make this the political issue it is, and give a voice to all of the families who struggle."
The evening's honorees were Dr. John Rubenstein, professor in the Department of Psychiatry at the University of California, San Francisco, who received the 2016 Child Mind Institute Distinguished Scientist Award, and Andreas C. Dracopoulos, director and co-president of the Stavros Niarchos Foundation, who accepted the Child Advocacy Award.
Board member Mike Fascitelli applauded Dracopoulos for being an early and avid supporter of the Child Mind Institute's neuroscience research. Most recently his foundation made a $1 million gift in support of the Healthy Brain Network, specifically for the Mobile Research Vehicle, which was parked outside during the dinner.
"The vehicle is a model for research and mental health care delivery," Fascitelli said, "and through his support, Andreas will continue to have a significant impact on our understanding of children's mental health for many years to come."
In accepting the award, Dracopoulos explained that the well-being of children is a focal point of his foundation's grant-making efforts, and that the Child Mind Institute's efforts are leading towards concrete results in that area. "The Healthy Brain Network will provide necessary data to help accelerate the identification of biological markers of mental illness in children," he said, "and the development of objective clinical tools for better diagnosis and treatment."
The evening ended with a lively auction for the Child Mind Institute's financial aid program, led by Lydia Fenet of Christie's, with a surprise assist from Jets wide receiver Brandon Marshall and his wife, Michi, who encouraged spirited bidding for the opportunity to invite friends to their box for a New York Jets game.
"Doesn't matter if you're black or white, rich or poor," Brandon Marshall concluded, "mental health affects all of us."Read More
Mass Shootings Aren't Inevitable
Dec. 8, 2015 Caroline Miller
In the wake of the San Bernardino shootings, we are again obsessing over what drives people to commit horrifying acts of mass murder, and how we can identify these killers before they strike.
Against a background of political candidates ranting provocatively about declaring war and closing borders comes a thoughtful and, in a very different way, also provocative essay by Mary Ellen O'Toole, PhD, the editor-in-chief of Violence and Gender, the journal founded by the Avielle Foundation. Avielle, you may recall, was the 6-year-old daughter of Jeremy Richman and Jennifer Hensel who was one of the 20 children murdered at Sandy Hook Elementary School 3 years ago.
In her article, Dr. O'Toole takes on some of the misconceptions about what she calls "mission-oriented shooters," those whose goal is to kill as many people as possible. She notes that these shootings are anything but impulsive. "The planning is strategic, complex, detailed, and sufficiently secretive to minimize the risk of being detected and maximize the chances for success, " she writes.
While it's appalling to think of this kind of cold-blooded preparation, it also means that there are many points in which planning behaviors might be observed, by parents, fellow students, coworkers, retailers, and innumerable others who come in contact with them while they prepare for their mission.
And even before the planning, she notes, there is a stage of evolution in the shooter's personality and habits, development over time of anger, resentments, enmities, obsession with weapons, devotion to extremism. This, too, she writes, "provides first observers with opportunities to intervene as long as this preplanning behavior is not ignored, rationalized, or explained away as something expected, typical, or ordinary."
Dr. O'Toole is an FBI profiler, so identifying risk factors is her specialty. What's provocative here is the notion that it's not just a matter for professionals. All of us are part of communities that, by closer observation of those around us, could do much more to identify red flags. She wants all of us to be "first responders," willing to step up and call attention to signs that someone is in distress or a danger to others.
It's scary—the notion of friends and neighbors being on the alert for danger signs from each other. But a tragedy like the one that happened in San Bernardino or in Newtown is long in developing, and we need to get better at recognizing and responding to signs of trouble. Close attention to behavior may offer more opportunity than drones and closed borders to keep weapons out of the hands of people who intend to do great harm.Read More
5 Things I Learned at CHADD’s 2015 Conference on ADHD
Nov. 19, 2015 Rae Jacobson
Last week I had the chance to attend CHADD’s annual conference on ADHD in New Orleans. I figured I’d leave with some new information but my true takeaways were a lot more valuable, and personal, than I could have expected.
1: There's nothing quite like being with your (ADHD) people.
I have ADHD but I spend most of my time around people who don't. I'm well versed in self-advocacy and for the most part have been lucky enough to find friends and coworkers who are already aware of ADHD, or at least open to learning. But when you spend the majority of your life with neurotypical people—no matter how understanding they are—there's nothing like being in a roomful of folks who just get it. No explanations necessary.
2: Managing ADHD isn't just about staying focused.
Finding ways to stay on track is a vital part of managing ADHD, but it's just one aspect of a larger picture. Almost every speaker at the conference talked about the importance of learning to handle the emotional fallout that goes along with ADHD. Some swore by mindfulness, others CBT, exercise, even Facebook support groups, but the same message was there throughout: really managing ADHD goes deeper than learning how to get good grades or stay organized. As one audience member put it, "These days I know how to study, and that's great. But what I'm really working on is figuring out how to be kind to myself."
3: New love for the "extra minute."
Transitioning from one activity to another is hard for people with ADHD. The conference was no exception. When one of our sessions ended, everyone erupted into flurries of frantic packing, myself included.
"SLOW DOWN!" commanded one of the presenters. "This was a test." She pointed at the clock, which showed we still had ten minutes left in the session. "Just hearing 'time to go!' made a lot of you start rushing," she noted, and explained that people with ADHD need extra time to adjust to new situations, so rapid transitions often make us feel anxious. "That anxiety masquerades as the feeling that you need to go fast right now," she told us, "but rushing just leads to more chaos." Instead, she suggested we take an extra minute to pack up, check around our chairs, and put our coats on. "A last look is never a bad idea!" I did and there, hiding in a corner of the seat, was my wallet.
Extra Minute: 1, Rushing: 0.
4: Trying new things is key.
So many of the excellent presentations I saw centered on different ways of managing ADHD. I learned about things ranging from ancient meditation practices to cutting-edge medication advancements and everything in between. As someone who struggles to prioritize information sometimes (always) it almost felt like there were too many choices on the table. But one of the presenters put it in perspective: "The best and worst thing about ADHD treatment is that there is no 'right way' to do things. What works for one person may not work for another. Trying different treatment options is the best way to figure out what works for you, personally."
5: We've got a long way to go
In the three days I spent at the conference I met parents and professionals, coaches and allies, entrepreneurs, doctors, experts, and a lot of people who just came to learn. Listening to all these different voices and perspectives, I was equally struck by how far we've come and how far we still have to go.
I heard so many people ask questions like, "How can I hide my ADHD from my boss?" or "My child feels so behind, can I help her without her teachers finding out?"
After being congratulated for his openness by a presenter one man said, "Thank you, but it's a false impression. I'm open here, with ya'll, because I know you understand and don't judge me but as soon as I step outside this building I'll close back up. This is like a wonderland and that out there is real life."
Many heads nodded along as he spoke. Me too. Me three. The fight to end stigma and shame around learning differences is far from over and even from our privileged vantage point inside our little ADHD wonderland, we all knew that outside there was still hard work to be done.Read More
French Paper to Kids: What Do You Want to Know About Paris Attacks?
Nov. 18, 2015 Harry Kimball
Following the deadly attacks in Paris, we've offered advice to parents trying to discuss the news in a healthy way with children of all ages. It boils down to some pretty basic maxims, including: Be honest. Be reassuring. Be developmentally appropriate. Don't answer questions that aren't asked. In the New York Times Pamela Druckerman, author of Bringing Up Bébé, offers a moving peek at a distinctly French approach. It started when the editor of "the only daily newspaper for children in France" (!) invited some of his readers in to see what questions they wanted answered about the attacks.
Le Petit Quotidien editor in chief François Dufour certainly doesn't mince words. After all, he says, "We are not going to reassure them because there can be another attack." But what emerges in Druckerman's piece is a gruff Gallic approach to talking to children about inconceivable events that hits the mark: bringing the conversation down to earth, where children can begin to make sense of what happened with our help. Kids "don't live on planet Mars," Dufour says, and they need tools for living here. "The idea is to explain, because we cannot lie."
And what's the best jumping off point for that? Letting children take the lead. The kids' questions to the paper, which appear in the accompanying video, are like a lot of children's questions: innocent, timeless, profound. "Why do they kill themselves?" "Why do they hate things like rock and roll enough to kill people?"
Unfortunately there isn't a daily newspaper for children in America, and parents here need to be vigilant about how their children get information, too. For instance: Let that nice video feature at the top of the story play out, as I did, and it will refresh with harrowing footage of this week's explosive standoff in a Paris suburb. And kids definitely don't need to see or hear that right now.Read More
Brainhack: Where Neuroscience Meets the Internet
Nov. 2, 2015 Harry Kimball
Recently Dr. Cameron Craddock, director of imaging for the Center for the Developing Brain, helped organize a genre-defying event—a scientific conference, convention for academic hacker/neuroscientists, and collaborative brainstorm/barnstorming session on the future of research into the mysteries of the brain, all rolled into one. It was Brainhack Americas, or "Brainhack AMX," and it took place in person and online across 8 cities over the weekend of October 23rd.
Our own web producer, Curt White, was at Mount Sinai School of Medicine to participate, along with many representatives of the Child Mind Institute's Center for the Developing Brain and Healthy Brain Network. He described a lively atmosphere of standing room only talks and "open hacking" sessions where attendees put their heads together to use cutting edge computer technologies of today to anticipate tomorrow's big questions.
Along with Dr. Adriana Dimartino's keynote on using open science tools to accelerate our understanding of autism spectrum disorder through things like her Autism Brain Imaging Data Exchange (ABIDE), Curt was drawn to miniclasses on powerful web-based software tools. These have been pretty alien to academic scientists until now—Amazon AWS for hosting and cloud computing, GitHub for distributed software development.
The fact that academic computer and data scientists and neuroscientists are embracing these tools is telling. GitHub is central to the conception of the modern internet, Curt says. By introducing brain science to that arena, these scientists are trying to "bring a fast-paced, transparent way of software development to academics." And that could mean a faster, clearer improvement in our understanding of the brain and its disorders.
Stay tuned to Brainhack's website for more information on proceedings published through their partnership with Gigascience, a open-access open-date online journal, and to childmind.org for more on how data sharing and open science are revolutionizing the study of the developing brain. And thanks again to Curt for attending Brainhack AMX, and the Child Mind Institute science team for pulling off an amazing event.Read More
Suspending Kindergartners? Really?
Oct. 30, 2015 Caroline Miller
Six-year-olds who have trouble behaving in the classroom are essentially being shown the door at a Brooklyn charter school, according to a disturbing article in the New York Times. The story underscores how important it is to get help—not just punishment—for kids with behavioral issues.
When schools resort to suspending kindergartners—often repeatedly!—it certainly speaks to how frustrated they must be. Who could possibly think suspending a 5-year-old is an effective way to teach him to control outbursts?
Neither is a call to 911, which the article says was another threatened consequence for a young girl who had been "pushing or kicking, moving chairs or tables, or refusing to go to another classroom."
Fortunately a lot of schools, including many charter schools, are beginning to focus on really understanding and getting help for kids who are disruptive, instead of just punishing them. And many are helping teachers acquire more effective skills for managing kids who disrupt their classrooms and undermine learning for everyone.
The good news is that young kids who have problems with disruptive or defiant behavior can very often learn to manage their feelings with the right guidance from teachers, and support from other mental health professionals—especially when it happens in the environment where the problem behavior happens.
At the Child Mind Institute, we know it can work because we're doing it, working with teachers right in the classroom, and we're seeing the results. So are the teachers. As one told me last spring, "You're less stressed, because you're wasting less time getting the kids to follow directions. There's a little more joy to the lessons. And you can actually get through a lesson and maybe do something fun."
And, I'd add, the kids who had been disrupting the class are learning, not being sent home.Read More