Advice & Support

Dr. Alan Ravitz, a child and adolescent psychiatrist at the Child Mind Institute, is an avid movie watcher who has a keen eye for the pleasures and insights to be found in all genres, from action flicks to intimate character studies. Each week Dr. Ravitz recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

I saw What Maisie Knew last weekend. It's a contemporary update of a Henry James novel. Most of the reviews have focused on what it's like for young Maisie to experience her parents' divorce. In my clinical practice I've seen hundreds of divorcing families. Maisie's parents are the most narcissistic, self-centered parents I've ever experienced, and I've experienced quite a few. I think the movie is less about divorce and more about narcissism. Poor Maisie. The acting is great; the art direction is even better. This is a sad story, but it's entertaining.

We were distressed to read about Paris Jackson's hospitalization last week after what is being officially called a suicide attempt. The daughter of an extraordinarily talented and self-destructive father, we can imagine that Paris might be in a very precarious situation emotionally. But she is also a 15-year-old girl not unlike the thousands of other 15-year-old girls from the most ordinary families in the world who make suicide attempts every year. Teenage girls experience very volatile emotions, and they lack the skills and experience to put them in perspective—a risky combination.

In Paris's case, fortunately, her suicidal behavior didn't result in her death. But it did result in an outpouring of the worst possible responses from gossip sites pretending to be news outlets. Coverage at TMZ, for instance, reads like a list of what not to do when a teenager expresses suicidal feelings or behavior. (The ellipses, by the way, are theirs.)

Law enforcement sources familiar with the situation tell TMZ ... based on the information the L.A. County Sheriff's Dept. has gathered ... "She wanted attention."  One source involved in the case tells us ... her call to a suicide hotline is compelling evidence "she wanted to be saved."  The source added, "It makes no sense if you really want to die to call a hotline, where the person on the other end will get an ambulance over to your house.

You couldn't invent a worse message to send to other vulnerable teenagers: that we trivialize your pain and desperation, that we don't take your actions seriously, and that calling a hotline means that you aren't truly suffering. Unbelievable.

Just as bad was the endless speculation about what prompted her action, from being bullied at school to being upset over having to testify in the wrongful death lawsuit involving her father to being told she couldn't go to a Marilyn Manson concert. And then Marilyn Manson got into the act in a concert Thursday, dedicating a song to Paris, and miming cutting himself with a huge knife.

Marilyn Manson isn't exactly a role model for probity, but even for him this lapse in judgment is shocking. For a very thoughtful description of what it's like to feel suicidal I recommend an interview last week with comedian and actor Stephen Fry, who admits that he made a suicide attempt last year that would have been fatal but for a producer who found him unconscious in his hotel room.

"You may say, 'How can anybody who's got it all be so stupid as to want to end it all?' " Frye said in the interview. "That's the point, there is no 'why?' That's not the right question. There is no reason. If there was reason for it, you could reason someone out of it."

Fry, who is on the record about having bipolar disorder, said he often feels suicidal. "Sometimes it's the expression I imagine on my mother and father's face—both of whom are alive and happy—that stops me," he said. "But there are other occasions when I can't stop myself, or at least I feel I can't."

We hope that the caring adults around Paris Jackson will make sure that whatever pain led her to this act gets serious attention, as well as the love and support she deserves. 

In the 1967 classic To Sir, With Love, Sidney Poitier plays an innovative teacher who helps some tough East London kids succeed both in school and at home by taking a personal interest in their lives.

Fast-forward some 50 years and this type of positive approach remains the exception, not the rule. Middle and high schools are doling out suspensions at ever-higher rates; according to two recent reports, 2 million students were suspended during the 2009 school year, and boys of color and children with disabilities were suspended at much higher rates.

So it's encouraging to learn about Lincoln High School in Walla Walla, Washington, which is bucking the trend with policies that keep kids in school and enjoying great success doing so. How great? Suspensions have dropped a whopping 85 percent. Given that Lincoln is an alternative school that takes on at-risk students whose behaviors have gotten them kicked out of other settings, its success rate is that much more remarkable.

So how does it work? Let's say a student behaves negatively—maybe he hurls curses at a teacher. The go-to consequence in this time of increasing "zero-tolerance" is suspension; according to a 2011 report by the National Education Policy Center, 95 percent of kids are kicked out of school not for weapons or drugs but for categories including "disruptive behavior" and "other," which includes being "defiant"—a vague, highly subjective term—cell phone use, dress code violations, displays of affection.

But this is not the case at Lincoln High; instead, teachers and administrators act quickly to stem escalation and try to find out what's going on in the student's life that might be causing him to act out. So principal Jim Sporleder might ask a student, "Wow. Are you OK? This doesn't sound like you. What's going on?" He gets even more specific: "You really looked stressed. On a scale of 1-10, where are you with your anger?"

Sporleder did his about-face after he learned the theories of John Medina, the best-selling author of Brain Rules. Medina writes, "Severe and chronic trauma (such as living with an alcoholic parent, or watching in terror as your mom gets beat up) causes toxic stress in kids. Toxic stress damages kid's brains. When trauma launches kids into flight, fight or fright mode, they cannot learn. It is physiologically impossible."

"It sounds simple," Sporleder says about the new approach. "Just by asking kids what's going on with them, they just started talking. It made a believer out of me right away."

This is not about giving kids a pass. There are still consequences, just not punishment, which many consider less effective as a way to shape behavior. Instead, Lincoln uses ISS—in-school suspension, "a quiet, comforting room where the student can talk about anything with the attending teacher, catch up on his homework, or just sit and think about how maybe he could do things differently next time." Sporleder and his staff also give kids the tools to recognize their reaction to stress and how to self-regulate their response to it.

The approach is in stark contrast with traditional suspensions, which don't work well for kids who are already at-risk. "Studies show that one suspension triples the likelihood of a juvenile justice contact within that year," California Chief Justice Tani Cantil-Sakauye told the California Legislature last spring. "And that one suspension doubles the likelihood of repeating the grade." Meanwhile, according to the NEPC report, "research shows being suspended even once in ninth grade is associated with a 32 percent risk for dropping out, double that for those receiving no suspensions." 

Given the cost to students, parents, and society at large when kids aren't encouraged to stay in school, Lincoln High offers an important lesson: When students are treated as individuals, when teachers and administrators take time to find out what's behind their behavior, what's happening in their lives that's affecting them in school, the results can be stunning. 

When I'm shopping for presents for young children, toys from the Melissa & Doug company stand out. Melissa & Doug toys don't do anything—they don't light up, they don't moo, and they definitely don't have an on/off switch. What you see is what you get—dress up costumes, a child-size toolbox, plastic kitchenware and groceries. As far as I know, their only toys that make noise are the musical instruments. Melissa & Doug aren't the only company making toys like this—an article in Sunday's Times profiling the company also mentions Haba and Alex, for example—but their brand might be the most recognizable.

In 2013, toys like this are decidedly retro. Handing kids the iPad or iPhone to play games is reflexive for many parents and these days even Lego has a line of video games. One mother interviewed in the Times story says she buys Melissa & Doug products as a kind of "rebellion against digitized toys," and acknowledges that they probably appeal more to her than her son. "The thing about Melissa & Doug toys, the problem with them, is they encourage you to be creative, which is great, but they also, speaking of it kind of concretely, are relatively one-dimensional," she explains. These toys are open-ended and require more work from kids. And without flashing lights and sound effects that provide constant feedback, they run the risk of being boring.

Melissa Bernstein, the Melissa half of Melissa & Doug, is okay with that. "Parents are so scared of having their kids say, 'I'm bored.' It's synonymous with, 'I'm a bad parent,' and so they never allow kids to feel boredom, which equals frustration, and so kids don't get to the point where they have to dig deeper and figure out what to do." Which is really too bad because the inventiveness that comes from figuring out how something works or how to keep yourself entertained is an important childhood lesson that our kids are increasingly missing out on. Open-ended play teaches children how to think critically and creatively—it's how most of us learned how to solve problems, work together, and control our impulses. Contrast that with the hyper-structured modern idea of play, where kids follow rules to complete a task and are rewarded with a "level up." As Bernstein tells the Times, "When you're using a computer or an app, it's giving you all the information you need. It's a completely reactive experience."

Learning how to be bored or frustrated and then how to self-regulate also helps kids build resiliency, something child psychologists consider essential to becoming a well-adjusted adult. Bernstein can attest to this personally. Growing up she described herself as lonely and miserable. In seventh grade she became anorexic. Her solace was her creativity. She wrote music and poetry and threw herself into arts and crafts. She told the Times that creating things "took me out of what could have been." "When I create it makes me so happy. I'm able to soothe myself." The ability to self-soothe is vital, but kids who are growing up in a constant state of occupation are getting fewer and fewer opportunities to learn how.

Play in general is being threatened for American children, and the movement away from basic, open-ended toys is reflective of that. Recess and gym are disappearing in schools, a casualty of our national obsession over test scores. Our kids have full schedules, with sports, tutoring, and extra-curricular activities filling up their downtime, which has become a dirty word. When kids are at home, they're still kept busy. If parents need to do the laundry or make dinner without getting hassled, they turn on a video or hand kids the iPad. Our desire to have accomplished, well-rounded children (and to get dinner on the table) is laudable, but an important part of being well-rounded is being able to think independently and self-regulate. The lessons learned from imaginative play are real, and it's important that we not discount them.  

Dr. Alan Ravitz, a child and adolescent psychiatrist at the Child Mind Institute, is an avid movie watcher who has a keen eye for the pleasures and insights to be found in all genres, from action flicks to intimate character studies. Each week Dr. Ravitz recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

I was at Film Forum and IFC last weekend. Saw a couple of forgettable films. Found myself so irritated by Frances Ha, in fact, that I walked out on it. I almost never do that, and I'm a big fan of Noah Baumbach. It's gotten fairly good reviews, so maybe I'm just getting old and cranky.

Anyway, while I was at one of those theaters, I noticed that there was a revival screening of The Apprenticeship of Duddy Kravitz, a 1974 film starring Richard Dreyfuss. It's available as a Netflix and Amazon instant download. I watched it again and loved it a second time. The film is based on a novel and has the type of character complexity that I find compelling. It's a rise and fall movie, and both trajectories are driven by Duddy's family experience, historical context, and serendipity. It's going to be a rainy weekend. Do yourself a favor. Watch this one. 

President Obama launched a White House conference on mental health this morning with a surprisingly down-to-earth message. He ticked off some sobering statistics about people suffering from psychiatric illness—for instance, we are losing 22 veterans a day to suicide—and he talked about federal initiatives to do a better job helping them. But his message was mostly to individuals, especially vets, who might be listening to his voice: "Just as you would take care of yourself and those around you in battle, you've gotta do the same thing off the battlefield. You're not alone. You are surrounded by people who will support you and care for you."

He sounded the themes repeated throughout the first session: to anyone out there who is struggling, please seek help. If you know someone who is struggling, please help them get care. Mental illness is treatable. There is hope.

Secretary of Health and Human Services Kathleen Sebelius also addressed the challenge of making it more comfortable for people suffering from psychiatric illness—and here we would add parents of children with psychiatric illness—to ask for help. "Mental health needs to be an issue talked about openly and freely without fear of being judged," she said.

Glenn Close, one of five professionals and activists on the day's opening panel, said some interesting things about stigma. People think there's no longer stigma surrounding mental illness, she said, since most people understand that mental illness is in fact an illness like any other. "But the truth is stigma has hardly budged." As a result there is a surprising amount that we don't know about people we work with and are friends with—even people in our families. She first realized this, she said, when her sister called her up one day and said, "I need help because I can't stop thinking about killing myself." Close was stunned. "I am ashamed at what I didn't know about my own sister," she said.

For Close, that was the beginning of her commitment, through her organization, Bring Change 2 Mind, to getting people to tell their stories about living with mental illness. "The way to change somebody's attitude is to have them actually meet someone and hear their story," she said.

I'm with Close on that. It's pretty hard to imagine that people could continue to dismiss children's problems or blame them on parents, as so many do, if you'd met the families I've gotten to know at the Child Mind Institute.

If you are the parent of a school-aged child who plays sports, you've probably been affected by concussion in some way.  Your child may have had one, or perhaps one of his or her friends.  The school might have had you sign a form about concussions or given a presentation about how to identify the signs and symptoms and what to do if you're concerned your child may have been injured.  You may have also noticed changes in how games or practices are run, or what kind of headgear the kids are wearing. This attention to concussion is the result of local activism but also of concerned legislators, and I'm happy that US Senator Jay Rockefeller of West Virginia recently made it a nationwide issue by introducing a concussion safety bill in the Senate.

The history of legislative approaches to the problem of youth concussion really began with the unfortunate circumstances of a young man named Zack Lystedt and the work of an attorney named Richard Adler. In 2006, then 13-year old Lystedt suffered repeat concussions while playing junior high school football, leaving him permanently disabled. Adler supported Zack and his family through his recovery and went on to draft legislation designed to protect youth athletes.  On May 16, 2009, the Lystedt Law was passed in Washington State, requiring that athletes under the age of 18 who are suspected of having sustained a concussion are removed from play and not allowed to return until cleared by a medical professional.  The law also mandates concussion education for athletes, parents, and coaches.  A majority of states have adopted similar guidelines, and we have seen a major shift in how these injuries are understood, recognized, and managed.

Lystedt and Adler have made an enormous impact on youth sports, and no doubt saved lives.  But there is still a tremendous amount of work to be done, especially in educating the public about the different aspects of concussion safety, including prevention. Last month Senator Rockefeller introduced the Youth Sports Concussion Act, which mandates universal safety standards for helmets and clamps down on companies making deceptive claims about their products. As a clinician, one of the most common questions I get from parents is about some new helmet that claims to be "concussion-proof."  My response is generally the same: Show me the data!  In the midst of this concussion craze, some companies are exploiting the fears of parents in an effort to sell products that may actually give a false sense of security and put kids in more danger.  Senator Rockefeller's bill is a timely and essential step towards cementing the legacy of Zack and Richard and, ultimately, keeping kids safe as they play the games they love.

Michael Rosenthal, PhD, is a pediatric neuropsychologist with expertise in the evaluation and treatment of children and adolescents from pre-school through early adulthood, particularly when complex questions exist about autism spectrum disorders and concussion or mild traumatic brain injury.

Many autistic children are prone to unpredictable meltdowns, triggered by everything from transitions to changes in routine to sensory issues, turning something as mundane as a haircut into a stressful experience. When they have them in public, they and their parents are often judged harshly.

Such was the case last week for Ashley Bays and Grayson, her 2-year-old autistic son. As Bays explained in a local TV news interview, Grayson is "terrified of people touching his head and his ears, and the sound of the clippers." So even though the Michigan mom has been bringing Grayson to the same stylist at MSpa for more than a year in hopes of establishing a routine, he cries every time. But during this visit, owner Michelle Mott turned the already difficult situation into a nightmare by yelling at the upset child and distraught mom, forcing them out of the salon.

It could have been just another painful incident for a struggling mom if not for Vanessa Hunt, who witnessed the episode and recounted it in a searing Facebook post. Undoubtedly bolstered by the strong online special-needs community, the update went viral, leading to coverage by national media. A week after Hunt posted, there have been more than 40,000 Facebook shares.

In her post Hunt, who was at the spa getting a birthday manicure with a friend, decried the "severe tongue lashing" the owner meted out, but perhaps more importantly, she expressed empathy for the mom and the little boy. She wrote that the crying child reminded her of her son's first haircut. "It was seriously painful to watch seeing as I have been there more than once myself and it's very hard when your child is having a tantrum in public. The last thing you need is a woman yelling at you for it."

And she expressed that empathy directly: "Jess and I walked outside to see the hairstylist finishing the little boy's haircut on the lawn. The mom still crying and cradling her precious son. We hugged her and cried with her too."

We applaud people like Hunt and Houston waiter Michael Garcia, who refused to serve a patron after he made disparaging remarks about a Down syndrome child eating with his family. They are spreading a message of understanding and acceptance, of standing up and doing the right thing, even if it appears Mott learned nothing; her main reaction to the online firestorm has been to take down MSpa's Facebook page and issue a statement that the matter was handled "appropriately."

But it isn't the anger that's the most important thing here. It's the message that children who can't be counted on to behave typically don't have to be isolated from the community, and that most people (though not all, obviously) have enough generosity and warmth to cut them a little slack. It's one of the most important things we can do for them and their parents, who, you can be pretty sure, are doing their best to make these experiences work for everyone.

Dr. Alan Ravitz, a child and adolescent psychiatrist at the Child Mind Institute, is an avid movie watcher who has a keen eye for the pleasures and insights to be found in all genres, from action flicks to intimate character studies. Each week Dr. Ravitz recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

It's so damn hot today. Reminds me of Walkabout (d. Nicholas Roeg, 1970, one of my favorites). Horrific circumstances strand an urban brother and sister in the Australian outback, where they're found by an aboriginal boy who helps the pair return to their city. As they wander, the siblings survive danger with the help of their new friend. The bond between the three grows, but when they reach civilization, the aboriginal boy finds that he's unwelcome. It's all about the ties that bind us to each other.

An Oregon teenager was charged with aggregated attempted murder today for plotting to blow up his high school. Seventeen-year-old Grant Acord was caught with an arsenal of bombs and bomb-making material secreted under the floorboards of his bedroom, along with checklists and diagrams with which, it is alleged, he hoped to outdo the Columbine killers. 

The already disturbing story took another painful turn today when his mother reported that he was suffering from PANDAS. That's the rare and controversial form of acute-onset OCD that is linked to strep infections. PANDAS—it stands for pediatric autoimmune neuropsychiatric disorder associated with streptococcus—is a syndrome which can come on virtually overnight, after a child has contracted a strep infection. Symptoms include tics and the severe obsessions and compulsions associated with OCD, as well as a host of disorienting behaviors, including intense separation anxiety, sleep disruption, handwriting changes, trouble eating, panic attacks, irritability and emotional outbursts. Parents describe their children as suddenly unrecognizable, and conventional treatment for OCD doesn't work effectively—you can read more about it here.

It's troubling whenever an act of violence is associated with a particular psychiatric disorder, because it's easy for people to stereotype other people with the disorder, wrongly, as prone to violence. In this case it's particularly troubling because parents of kids with PANDAS are already in a very tough spot because of dissent within the mental health community about how to treat PANDAS, and whether, in fact, the disorder actually exists.

Acord's mother's attorney has been quick to use the disorder to build a defense, telling the press that the teenager is "very mentally ill" with PANDAS. As Dr. Jerry Bubrick, the head of the Child Mind Institute's OCD program, puts it, "That statement will do nothing but increase the stigma about a condition that is already so misunderstood."

Dr. Bubrick says that although a small percentage of kids with PANDAS may have explosive episodes in which they are violent, "it tends to be more impulsive and situational, and the child is usually remorseful afterwards. That is very different than premeditating a violent attack, which involves conception, planning and precision. Although both are expressions of anger, their intentions are very different and should conceptualized differently."

Parents of kids with PANDAS already face daunting confusion as well as skepticism from those clinicians and researchers who don't consider the link between PANDAS and strep conclusively proven. Despite efforts to resolve the conflict—including a new broader category called PANS (pediatric acute-onset neuropsychiatric syndrome) that does not specify the link with strep or any other form of infection—the teams are still far apart. The ongoing controversy makes treatment extremely difficult for parents to obtain, and we hate to see any more challenges added to their lives, and those of their children.