The Child Mind BlogBrainstorm

  • Problem Solving, Not Suspension, Sets Kids Up for Success
    July 7, 2015 Caroline Miller

    An excellent piece in Mother Jones this month drives home the point that using suspensions to punish kids who have behavior problems in school doesn't help them learn how to control their behavior. What it does is channel them into the "school-to-prison pipeline." 

    A 2011 study of the records of nearly a million kids found that those suspended or expelled—even for minor infractions like small scuffles, using phones or making out—were three times as likely as other students to end up in the juvenile justice system within a year. And kids with diagnosed behavior problems like ADHD are the most likely to be disciplined.

    As the writer, Katherine Reynolds Lewis, asks: "Are we treating chronically misbehaving children as though they don't want to behave, when in many cases they simply can't?"

    The article chronicles successes in schools that have reoriented their disciplinary approach to helping kids solve their behavior problems instead of punishing them. By recognizing that many kids are struggling with anxiety, learning disabilities, ADHD, or trauma, school staff can help kids identify why they are acting out and teach them techniques to manage their emotions more effectively.

    Problem solving strategies are being tried by several hundred schools around the country, from public and private elementary schools to juvenile detention centers. One youth correctional center in Maine found that not only did disciplinary write-ups and injuries of both students and staff decline dramatically; the recidivism rate also dropped from 75 percent to 33 percent. 

    That's what Ross Greene, who pioneered this skills-based approach, sees as the big win: not just to reduce behavior problems in school, but to set kids up for success on their own. 

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  • What Kids (and Parents) Will Learn From 'Inside Out'
    June 23, 2015 Harold Koplewicz

    What's going on inside the brain is a mystery to many of us. The brain doesn't come with an owner's manual, and it's up to each of us to figure out how to work with what we've got. Learning how to navigate our emotions is one of the major lessons of childhood, in fact, and something that nearly all children struggle with at some point. So I was overjoyed to see Disney's latest Pixar movie, Inside Out, which takes place almost entirely inside an 11-year-old girl's brain. For all of the criticism directed at the movie industry for its questionable moral standards, Hollywood is at its best when it creates compelling, engaging content about complex topics. Inside Out does exactly that.

    The movie is about a girl named Riley who moves from Minnesota to San Francisco because of her dad's job. Moving is hard for everyone, but for a child a change like that can feel catastrophic—Riley is leaving behind her house, her friends, her hockey team, even the pond where she skates every winter. We see Riley and her parents struggling to adapt to their new surroundings, but in a novel twist the characters getting most of the screen time in Inside Out are Riley's personified emotions—Joy, Fear, Disgust, Anger, and Sadness. We watch as her emotions try to run the control center in her brain—they call it Headquarters—and see the chaos that ensues when different emotions take over. Part of the charm of the movie is that it takes some of the mystery and fear out of our emotions and imagines what a stressful moment might look like inside our brains.

    Kids will enjoy the movie, which is partly an unlikely buddy comedy and road trip starring Joy and Sadness. But if you're a parent you'll appreciate the wonderful lessons that are built into the plot. We tend to think of childhood as a mostly happy time, but of course children experience an intense range of emotions. Inside Out lets kids—and adults—know that all of our feelings are okay, even the ones that don't feel very good at the time. In fact, the unexpected hero of Inside Out is Sadness. When Riley is struggling to cope with the move everyone at Headquarters assumes that Joy will come to the rescue, but it isn't until Riley is allowed to face her sadness that things begin to improve. And perhaps most importantly, the secret to feeling better for Riley is speaking up and telling someone how she feels. For most of the movie Riley tries to be brave and hide that she's struggling from her parents, but she eventually learns that keeping her emotions hidden doesn't help.

    In the end Inside Out is a movie about growing up, too. We see the control panel in Riley's brain expand after she learns how to embrace her emotions and talk about how she's feeling. We can see that she is maturing, and ready for the new demands that she will be facing. Parents will find it reassuring and poignant. Kids will laugh at the joke about her newfound interest in boy bands and the looming prospect of puberty. With Inside Out everyone will walk away happy—but know that feeling sad is okay, too.

    Harold Koplewicz, MD, is the founding president of the Child Mind Institute. This piece was originally published on Parents.com

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  • 'Infinitely Polar Bear': The Ups and Downs of a Dad With Bipolar Disorder
    June 23, 2015 Allison Baker

    The title of the film Infinitely Polar Bear comes from something funny a small child says about her father: "Dad has polar bear." What dad actually has is bipolar disorder, and while that isn't funny, it isn't tragic either in this movie that is warm and sweet as well as realistic about some of the darker aspect of life with the disorder. 

    Dad, played rather irresistibly by the cuddly Mark Ruffalo, is Cam Stuart, a blueblood Bostonian who is the principal caregiver for two adorable little girls, while their mother is in New York working on her MBA so she can get a higher-paying job. We see him in both manic and depressed periods as well as periods when he's in between, and really has his stuff together.

    In manic mode he's this fun-loving, high-energy, fast-talking, creative dad who invites the neighborhood kids to the house to jump on an indoor trampoline and listen to jazz and learn to make a chocolate soufflé. The girls are embarrassed to invite their friends over because their home is so chaotic but their friends think it's super cool; they get to do zany things and have more fun than they do in their own homes.

    When he's depressed and irritable, he sometimes uses explosive language in front of these tender-aged girls. And he sometimes goes out drinking at night leaving the girls alone—something that's nervous-making to watch and in real life could certainly get the attention of child protective services.

    You see the mixed relationship Cam has with his medication. He takes lithium—on and off, that is. This, too, is fairly typical. On medication, people with bipolar disorder can achieve mood stability—that middle ground we psychiatrists call euythmia—and stay there for years, for decades. But this is less the norm. People go through their own processes of accepting their illness and the fact that it requires maintenance, having to take medication, and having to tolerate some side effects of the medication or the euthymia you may not care for.

    It surprised me that, unlike Silver Linings Playbook,  there was no relationship with a psychiatrist in the movie—his only treatment seemed to be the lithium in the huge brown bottle in the bathroom cabinet.

    What felt most honest about the movie is that living with these chronic illnesses can be messy, and families that are loving and supportive tolerate the mess, hang in there through seasons of good and bad and in between.

    There's a sweet moment when mom is in town for the weekend and she and the older girl are talking about daddy and his illness.

    Mom says: "When we got together I didn't know about all this stuff. I fell in love with his charisma."

    Daughter asks: "Are you sorry you married and had kids with him?"

    Mom says: "Absolutely not!"

    That was a neat moment of acceptance, of someone accepting this person and loving him for all that he has to offer, his illness notwithstanding.

    Allison Baker, MD, is a child and adolescent psychiatrist at the Child Mind Institute.

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  • What SPD Is to Me
    June 16, 2015 Putting Socks on Chickens

    This is a guest post from Putting Socks on Chickens, a blog about sensory processing issues.

    By Erin

    At 18 months of age, my son starting showing signs of "odd" behavior and aggression. I heard from others "the terrible twos actually start at about 18 months." So I thought...ok, other parents go through this too! The twos came. Then we heard..."you think the twos are bad, wait till he turns three." Then, I'm thinking to myself, "oh boy...it's going to get worse." The threes came and this time others said "wait till he starts school, it'll get better then." Finally, the day for him to start school had arrived. Guess what, it didn't get better.

    It all started with my son biting his hand. He was a pacifier baby and still had the pacifier at the time this started, so I wondered what it was about. At first, I paid little attention to it, but then he started biting his hand all the time and so hard that his hand was callused. Concerned, I asked his pediatrician and she reassured me to not worry about it.  As time went on, we tried various tactics to help him break this habit. We started with ignoring it, then bringing it to his attention. We also tried wrapping it, putting a yucky tasting rub on it, and basically anything else that we could think of. To this day, my son still bites his hand.

    He also became extremely aggressive around 18 months of age. I can remember him pulling my hair with such force that I actually had to have medication because of an infected hair follicle. When he'd pull my hair, it would take both my husband and myself to get my hair out of his tiny little grasp. We would tell him no, slap his hand, time-out, all of the "parenting" recommendations. Whatever we did, he just seemed to smile, laugh and pull harder. Hair pulling soon turned to hitting and throwing things.

    As he got older and the violent outbursts continued, it prompted me and my husband to seek outside help. Starting with his pediatrician, she recommended that we see a child psychologist. After only a couple sessions with a psychologist, he suggested we have him evaluated for Sensory Processing Disorder (SPD). I looked it up after his recommendation and was in shock. This was my son. We went on to have him evaluated to find that he does in fact have SPD. While we are still learning about his condition, I most definitely am not an expert. I cannot tell you all the facts about SPD, but I can tell you what it means to me.

    SPD is never having a full nights sleep because your kid wakes up all the time. I finally gave up and let him sleep in my bed because honestly, I am too tired to get up with him every 30 minutes and put him back to sleep.

    It's not knowing what set your kid off, but being so distraught that you can't do anything because he is jumping, screaming, biting and having a meltdown. It's constantly telling him "No, don't do that. Get off of your sister!" It's a constant battle until he has overcome his "fit."

    It is having everyone tell you how wonderful your child is and how he is the best-behaved kid in class while you look at them in disbelief. And then for them to look at you in disbelief when you tell them about problems at home. It is the constant assurance from others that just don't get it, that you just need to reinforce your parenting skills. "Give him a swat on the butt. You should try watching Super Nanny. Read this parenting book. Have you tried this?"

    SPD is watching your child jump up and down and bite his hand in frustration because that wall hit him. It is not getting him to understand that objects don't hit people, that we run into them. And hitting the wall because it "hit" you is not going to make anything better.

    SPD is smelling everything. It doesn't matter what it is, if it's in the same room as him, he wants to smell it. It's dealing with those burnt chins because his need to smell the cookies fresh out of the oven is so intense. It's getting those looks from people, as if though they are saying with their eyes "what is this weird thing that your child is doing?"

    It is knowing that as soon as he is home and in his comfort zone, those underwear are coming off and making sure to ask if he has underwear on when you leave the house. It is constantly having to "fix" his glasses because they aren't fitting right and then having his 3rd pair for the year break again because he is putting them on with such force so that they will feel right. It's asking people to not buy your son clothes because he probably won't wear them.

    SPD is the constant worry that I won't be able to teach my child how to control himself and his fits will start happening in school and he will then be considered a "problem" child. SPD is the constant worry that at some point kids will start to bully him. SPD is the constant worry that I am not a good parent. It is the love of my child and his quirks. It is the joy of a great day when he can express what is bothering him with words rather than actions. SPD is a constant learning game and me taking on the role of an OT. But above all else, SPD is unconditional love and making sure my son knows that I love him NO MATTER WHAT.

    Erin is a mother of two children and part-time fundraiser for a nonprofit. Erin blogs about having a child with sensory processing issues at Putting Socks on Chickens. You can also follow her on Facebook and Twitter

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  • Celebrating Diversity at the Tony Awards
    June 9, 2015 Jessica Kashiwabara

    The biggest winner at the Tony Awards on Sunday night was diversity, as the Broadway theater's top honors went to two shows that evoke the challenges of coming of age (and in one case coming out) of people who are different. Both shows (which collected seven other Tonys between them) are brilliantly staged and acted, and neither of them is conventionally commercial fare.

    The Tony for best musical went to Fun Home, the stage adaptation of Alison Bechdel's graphic memoir about the search to understand her closeted gay father, in the wake of his suicide, as well as her own sexual identity as a lesbian.

    The Curious Incident of the Dog in the Night-Time, which won for best play, is the adaptation of the novel of the same name by Mark Haddon, which follows Christopher, a 15-year-old boy with Asperger's, as he tries to solve the mystery of the suspicious death of a neighbor's dog. Curious Incident is an exploration of what autistic activists call neurodiversity, as it moves from the neighbors' comic misunderstanding of Christopher's eccentricities to plumbing the intelligence and the courage he discovers as his family unravels. 

    Alex Sharp, an actor just one year out of Julliard who won a Tony for his portrayal of Christopher, used the spotlight to speak out to other kids: "This play is about a young person who is different and who is misunderstood and I just want to dedicate this to any young person out there who feels misunderstood or who feels different."

    Sharp ended the speech with a teaser about the play: "And to answer that question at the end of the play for you, does that mean I can do anything? Yes it does."

    Michael Cerveris, accepting the best actor Tony for playing the father in Fun Home, noted: "Our show is about home, it's about finding who you are." Cerveris added a plug for same-sex marriage, saying he hoped the Supreme Court justices were watching. But champions of diversity also have to be hoping that other theatrical producers were watching, and gaining encouragement for what Variety called "opening up Broadway to greater diversity in both form and subject matter." 

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  • Real Men (and Women) Deserve Real Mental Health Treatment
    June 8, 2015 Caroline Miller

    The Upshot blog at the New York Times uses data to detect political trends, but it also uses data to debunk stereotypes, and this weekend the stereotypes they targeted involved mental health. And the result was a dramatic snapshot of the need for more access to treatment in the parts of the country comprised of the red states.

    The piece starts with the observation that the number of Google searches for therapists and therapy is 54% higher in blue than in red states. But it isn't because the need is higher in urban than rural areas.

       • Red states have 20% higher rates of major depression than blue states.

       • Red states have 30% higher rates of suicide.

       • Red and blue states have roughly the same rate of use of antidepressant medication.

    In looking for an explanation for the lack of interest in therapy, the author, Seth Stephens-Davidowitz, notes that red states have, on average, lower incomes and a lower percentage of people covered by insurance. They have fewer mental health professionals. And he notes that 30% of Americans who have mental health problems but are not in treatment cite stigma as a factor.

    His assumption is that getting pills from your GP is not only cheaper but less stigmatizing than seeking more comprehensive treatment, like one of the many forms of cognitive behavioral therapy that have been proven effective, by themselves and as an addition to medication.

    The author goes to rather creative lengths to demonstrate that stigma is higher in red states than blue states. My favorite is that the celebrities more popular in blue than red states are open about therapy, including Bruce Springsteen, David Letterman, Jack Nicholson, and Howard Stern. Celebrities more popular in red states than blue are more likely to take the position popularized by Dwayne Johnson in a Facebook post: "Heavy iron fights the pain," he wrote. "And it's cheaper than a shrink."

    Johnson, aka The Rock, has in fact been open about the fact that he has had depresson, but he talked about "friends and family" helping him get through it. Lifting weights, not to speak of friends and family, may help, but the evidence is overwhelming that that's not working well enough for a lot of people. Real men (and women) need real mental health treatment, and expanding access to therapies that work to should be a high priority. 

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  • When a Teen Speaks Up ‘About My Depression’
    June 2, 2015 Harry Kimball

    We got a reminder recently about both how insightful young people can be—and how important it is to recognize both their resilience and their vulnerability. A case in point is a New York Times letter to the editor from a 14-year-old girl, with a sad but unashamed title: "About My Depression."

    Emma Rodriguez is writing in response to an opinion piece about depression and dialectical behavior therapy by Will Lippincott, a man some thirty years her senior. And yet his story resonated with Emma. In addition to identifying with the pain of "suicidal thoughts and the false sense that my death would make things better," she finds another sense of alienation to share. "As pointed out by Mr. Lippincott, there is, however, more to it," she writes. "There is a certain stigma to mental illness that I have experienced."

    And that stigma, whether you are a young woman having your first experience of depression or a middle-aged man struggling with a lifetime of mental illness, is disastrous. "I have had serious problems accepting help," Emma writes, "partly because society will not treat me as if I am normal." This kinship between two dramatically different people facing similar struggles, though, is heartening. And even more heartening is the fact that Emma has identified the real barriers of stigma and the power of self-advocacy at an early age.

    We say that early identification and treatment are key to successful development and a happy, productive childhood. Early awareness and advocacy may, in turn, be the key to changing the outlook for everyone who struggles with a psychiatric disorder. As Emma concludes: "If society cannot accept us as we are, while we are attempting to eliminate mental illness, then how can we overcome it?"

    Emma's letter was one of 16 winners chosen out of 1,300 entries in a Times contest aimed at high school students.

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  • Change Maker Awards: Angela Renz, for Being a Local Hero
    May 27, 2015 Rachel Ehmke

    People who work in schools have a unique and lasting effect on children and the adults they will later become. We all remember at least one person who was there for us, who inspired us, who made the school a better place and seemed to make us better, too. For a number of students in New York, that person is Angela Renz, a school social worker who splits her time between the Robert F Wagner Middle School and PS 59, the Beekman Hill International School.

    Angela Renz won the Local Hero award at our inaugural Change Maker Awards ceremony in recognition of work she is doing. She was a natural fit because for decades she's been a hero for at risk children in New York. Renz has a reputation for keeping up with the lives and family situations of hundreds of kids and leads group and individual therapy sessions for students. She has also turned her attention to her fellow educators, advocating for staff workshops on self-care, understanding trauma, and classroom management for teachers who are burning out. In the words of Ali Wentworth, host of the Change Maker Awards, "Angela Renz is the kind of woman you want at your school. She moves mountains for kids every day."

    In her speech at the awards ceremony Renz said, "Too often, we forget that personal development and happiness are at least as important as academic progress and achievement." She acknowledged some of the traditional challenges that kids face, like social or academic issues, and also mentioned some new ones, like cyberbullying and social media. "Because there are so many pressures, it's important that we teach children resilience," said Renz. "Learning how to cope with everyday life is a critical skill, and it's one we can teach if we have the right resources." Thanks to Angela Renz, hundreds of kids in New York City public schools are learning how. 

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  • Mental Health Care: Who Needs It and Who’s Getting It
    May 26, 2015 Caroline Miller

    The New York Times got a lot of attention last week with a dramatic headline: "Severe Mental Illness Found to Drop in Young, Defying Perceptions." The article was a report on a study, published in The New England Journal of Medicine, about trends in kids (6 to 17) getting treated for mental health issues from roughly 1996 to 2012.

    Over that period of time the percentage of kids getting some kind of outpatient mental health care rose, from 9.2% to 13.3%. So who, wondered researchers, was that care going to?  Was it, as some would argue, going to kids who don't need it?

    To get at an answer, they divided the kids into two groups—more severely impaired and less severely impaired—based on parents filling out scales on 13 kinds of impairment.  And they found, as the Times headline points out, that there was actually a decline over that period in reports of kids in the severe category, from 12.8% to 10.7%.

    What does that mean about who's getting the increased care? Here's where it went:

    • Services to kids with more severe impairment rose from 26.2% to 43.9%.

    • Services to kids with less severe impairment rose from 6.7% to 9.6%.

    So the percentage of kids getting services who have severe impairment is more than four times that of less impaired kids, and the percent increase over the period is greater, 67.5% compared to 43%.

    And here's the thing: The increase in care is impressive, but still, less than half of kids with severe impairment and less than 10% of kids with less severe impairment are getting treatment.

    The Times also notes the fact that the number of kids with severe impairment in this study are lower than other studies which have put the prevalence of severe impairment in kids at around 22%. Here's where it gets confusing, because the scale these researchers used for impairment, called the Columbia Impairment Scale (CIS) is different from the criteria used by other researchers.

    Many other prevalence studies are based on diagnostic criteria—either via parent reports of a diagnosis by a health care provider or direct diagnostic interviews by a professional of a sample population of kids.

    As Kathleen Merikangas, a National Institute of Mental Health researcher who has conducted some of the most significant prevalence studies of children and adolescents, tells the Times, "Right now we have all these different agencies doing surveys, each using a different method. It's a nightmare. We need to do better."

    And what of the decline in severe impairment? The study's lead author, Dr. Mark Olfson of Columbia University, offers several possible explanations for this trend: prevention (maybe parents are doing something that's protecting kids) and increased treatment.

    But here's Dr. Olfson's final conclusion in the study results: "Despite the increase in treatment, many young people with severe mental health impairment received no care. In schools and primary care settings, improvements in the identification and referral of young people in the greatest need of treatment could provide community benefit."

    Speaking of perceptions of mental health, as the Times is, it's important not to ignore the obstacles—including, frequently, stigma—that prevent kids from getting the care they need. Recognizing this would have made for a different and more challenging headline.

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  • Change Maker Awards: Chirlane McCray, for Fighting for Access to Mental Health Care for All New Yorkers
    May 22, 2015 Caroline Miller

    One of the toughest things about mental illness is how lonely it can be. When you're struggling emotionally, you need allies and advocates who will do research, make phone calls, find the most appropriate care, and offer support while you do the work it takes to get better.

    No one knows this better than Chirlane McCray, who is the First Lady of New York. Chirland has been that ally and advocate for her daughter Chiara, and now she's is trying to do it for the whole city.

    Chirlane's daughter Chiara struggled with anxiety, depression, and substance abuse as a teenager. "Our child was in a great deal of pain, terrible pain, but because it originated in her mind, and not another part of her body, there was no established series of steps for us to follow," Chirlane said at the Change Maker Awards ceremony, as she accepted the Activist Award.  

    And Chirlane and her husband, New York Mayor Bill de Blasio, were acutely aware that they had the connections and the resources many other parents in the city don't have.

     "All the time I was looking for someone to help her, all the time I was talking with people, I wondered, what about families who don't have the advantages that we have?  Like, how do they do it?" she said. "And how can we create a mental health system that works for every New Yorker?" 

    So this past January, Chirlane announced that under her guidance the city will be crafting a new "road map" to address mental health issues and create a more inclusive mental health system. City agencies will work with community groups to investigate the scope of the problem, the number of people affected, and their demographics, including race and socio-economic status. Then they will make recommendations that cut through bureaucracy to get children and adults quality mental help faster.

    The mental health road map won't be ready until this summer. So in the meantime, Chirlane and Chiara together have launched NYC Teen Text, an initiative that enables students at high schools throughout the city to to receive confidential help and emotional support via text when they need it. And she's tweeting up a storm, with hashtag #ShatterTheStigma, to open up honest discussions about mental health care needs.

    When the Germanwings flight went down in March, she wrote a letter to the editor of the New York Times. "Mental health care must be as accessible as getting a flu shot," she wrote. "We must seek to change the culture so that people realize that seeking treatment for mental illness is an act of strength, not weakness."

    Chirlane has been both a poet and an activist all her adult life. We applaud her for using the platform she enjoys as First Lady to offer her support to all New Yorkers who struggle with mental illness. And we were delighted to hear her report: "Our family was lucky; we eventually found enough of what we were looking for. And Chiara is now kicking butt at recovery."

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