The Child Mind BlogBrainstorm

  • When a Child Doesn’t Speak: Treating Selective Mutism
    Aug. 18, 2015 The Wall Street Journal

    CMI's Brave Buddies program is profiled.

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  • Cook County Jail's New Warden Is a Psychologist
    July 30, 2015 Caroline Miller

    There's an excellent story in the New York Times today about Dr. Nneka Jones Tapia, the clinical psychologist who is now the warden of the Cook County Jail in Chicago. Her hiring underscores vividly the fact that American prisons have become de facto mental hospitals—but largely without appropriate care and treatment. 

    Dr. Jones Tapia is trying to do something about that, with comprehensive mental health screening for inmates and a pioneering transition program that is reducing recidivism. In the program, inmates receive cognitive behavioral therapy and job readiness skills to help them avoid getting into trouble again after release.

    Sheriff Thomas Dart, who appointed her to the post, tells the Times reporter that as many as one-third of the jail's 8,600 inmates are mentally ill. And he explains why many of them should not be locked up, in terms we couldn't agree with more:

    The person isn't choosing to be schizophrenic. The vast majority of mentally ill people are here for nonviolent crimes, like stealing food to survive or breaking into places, usually looking for somewhere to sleep, or getting caught with drugs because they are self-medicating. How is it different than us locking up diabetics?

    Indeed, until we treat mental illness the way we treat diabetes, and get care to kids and young adults before they run afoul of the law, there will be a steady stream of the mentally ill behind bars, and it will continue to be, as Sheriff Dart says in the article, a national disgrace. 

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  • Chirlane McCray's Initiative to Connect New Yorkers to Care
    July 30, 2015 Caroline Miller

    New York First Lady Chirlane McCray has announced her new program, called Connections to Care, aimed at making mental health care more accessible to more low-income New Yorkers.

    The $30-million program includes two initiatives we applaud: to add mental health services to existing community agencies that currently don't offer them, and to train more people, from pre-school teachers to job-placement counselors, to recognize signs of things like depression, anxiety, and substance abuse.

    In the New York Times story about the plan, Gabrielle Fialkoff, senior adviser to Mayor Bill DeBlasio, says something revealing about the work that needs to be done to make mental health an ordinary topic of conversation. People with mental illness, she notes, are most likely already encountering people who could potentially help them. But unless we combat the stigma and misunderstanding about mental health, we would add, people who are struggling aren't likely to be open about it.

    The bottom line: Expanding access to care also has to include making people feel more comfortable asking for help. 

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  • 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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