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  • 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.

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  • 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.

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  • 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 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.

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  • 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.

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  • Treating Schizophrenia Early, and With More Than Medication
    Oct. 26, 2015 Caroline Miller

    The importance of early mental health interventions got a big boost in a just-published study of 400 young adults with schizophrenia. In the NIMH-funded study of patients who had experienced their first psychotic episode, or break from reality, it was shown that the sooner treatment was started, the better they did.

    Treatment that combined psychotherapy and low doses of antipsychotic medications, along with family education and support, proved more effective than standard care, which usually relies on higher doses of medication alone.

    The program, which was developed at Hofstra University, was implemented at 34 clinics around the country where teams of specialists were trained to coordinate care for each individual. Patients treated at clinics using the program showed more improvement in symptoms, along with better relationships, quality of life, and involvement in school and work than those who got standard community care. They also stayed longer in treatment.

    This news underscores the value of programs designed to catch teenagers exhibiting signs of psychosis before the first full-blown psychotic episode. Again, there's evidence that if they do develop schizophrenia, the treatment and support can delay onset and reduce its impact on their functioning and their families. 

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  • Sesame Street Debuts an Autistic Character
    Oct. 22, 2015 Beth Arky

    There's a new girl on the block over at Sesame Street. Julia has red hair, bright eyes and a big smile. She's also autistic. Julia is part of a new educational and awareness initiative, Sesame Street and Autism: See Amazing in All Children, aimed at building understanding and destigmatizing differences.

    The initiative, which uses the hash tag #SeeAmazing, includes a free app that features new storybooks led by We're Amazing, 1, 2, 3 and more interactive tools and resources like videos and daily routine cards.

    In the storybooks, Julia explains to her friends how she plays a little differently. "If you're 5 years old and see another kid not making eye contact with you, you may think that child doesn't want to play with you. But that's not the case," Sherrie Westin, executive vice president of global impacts and philanthropy, told People. "We want to create greater awareness and empathy."

    Julia's character is a real step forward—but it might be the real-world stories that really hit home for many viewers. We found ourselves touched and impressed by a four-minute video peek into a day in the life of Nasaiah, a young boy with autism. If everyone could see the joys and everyday challenges from his family's perspective, understanding wouldn't be far behind. And with muppet Abby enlisted as a guide, she of the "sparkle-tastic!" catchphrase, the message is calibrated to land where it will do the most good: our kids' ears.

    Sesame Street created the initiative with input from parents of both autistic and typically developing kids, autistic adults and special-needs teachers, including everyone from blogger Frank Campagna of Autism Daddy, who also works on the show, to the Autistic Self Advocacy Network.

    And relatedly, from The Times: What it means to think that Fozzie Bear was already the first autistic Muppet.

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  • On the Shoulders of Giants 2015: Tom Insel on Building the Future of Mental Health Care
    Oct. 16, 2015 Harry Kimball

    The Child Mind Institute welcomed an inquisitive crowd yesterday to the auditorium at the New York Academy of Medicine for its fifth annual On the Shoulders of Giants scientific symposium, celebrating achievement in neuroscience and the strong community that nurtures that success. This year the neuroscience lecture series honored the 2015 Child Mind Institute Distinguished Scientist, Dr. Tom Insel, director of the National Institute of Mental Health, and also featured presentations by Dr. Conor Liston, of Weill Cornell Medical College, and Dr. Nim Tottenham, of Columbia University.

    Dr. Insel laid out a bold and optimistc vision for the future of mental health services delivery, aided by scientific advances. His theme was that while "we have problems with access and problems with quality" in mental health care, the central challenge is to better understand the treatments we have now, and when and with whom they'll be effective. He drew the parallel to the revolution in childhood cancer mortality, which wasn't due to a "magic bullet" treatment. "What really happened is that the way we provided care got better," he said. "We moved practice into research so that every family became a partner in research, and that's what needs to happen here." Dr. Insel hopes that both advances in academic research technology like genomics and imaging, as well as the ubiquity of smart phone tech for data gathering in the everyday world, will contribute to a sea change in service delivery where all the appropriate treatments can be integrated into high quality "network solutions."

    For example, Dr. Insel noted, "many of the projects coming out of the Child Mind Institute, particularly a project like the Healthy Brain Network, are going to give us the fundamentals, the kind of science we need to be able to provide far better services in the future."

    Of course, "we do have real treatments that work for these developmental brain disorders," Dr. Insel reiterated in answer to an audience question. But often which one will work for which individual is still something of a mystery, "so what care your child receives depends on what door you knock on." A version of this problem motivates Dr. Conor Liston, whose research runs the gamut from stressed-out rodents to depressed human patients. In a freewheeling presentation, Dr. Liston described how his lab's observations about dysfunction at the synaptic level led to measures of  subtypes of depression based on abnormal brain connectivity identifiable in MRI brain scans—in short, biomarkers not only for depression, but for novel subtypes of the disorder.

    That is not what excites Dr. Liston, however. "Bottom line is we don't need a brain scan to diagnose depression," he said. But if it could inform treatment, that would have an impact. "Our treatments do work well for some people, but they typically take a long time and they often don't work on the first try. So it would be great if we could design better treatments based on these observations." One area where he is already seeing promise—both in treatment response and in the predictive power of his research—is called transcranial magnetic stimulation.

    Finishing off the morning, Dr. Nim Tottenham began her presentation by sternly (and jokingly) reminding the audience that "childhood is important." Her research concerning the connection between brain regions responsible for emotion and emotional regulation (the amygdala and the prefrontal cortex, respectively) and how it changes over time allowed her to paint a detailed picture of childhood behavior and offer a convincing explanation of how normal development can go off track.

    Dr. Tottenham showed through her lab's research and experiments that "the caregiver exerts a powerful regulatory influence" on the developing neurobiology of emotion, limiting the power of the amygdala maintaining immature brain processes and relationships for the extended period of human development. In other words, as she put it, "immaturity is a luxury humans were given." And while all of the secrets of childhood may rightly elude us, the complex social, biological, and developmental factors at play conspire together so that there is "something special about events that get under the skin" during our earliest years—bad or good.

    Prior to the presentations, five New York City-area high school seniors were awarded Rising Scientist Scholarships for their already demonstrated commitment to scientific inquiry. "These are five remarkable young ladies who give us hope," said Child Mind Institute president Harold S. Koplewicz, MD, before presenting the awards. In the spirit of On the Shoulders of Giants, Dr. Koplewicz thanked parents and teachers for getting the winners this far, and then read a selection of what their nominators had written about them: "Meticulous. Patient. Responsible. Organized. Extraordinary. Simply outstanding. A natural scientist."

    "I think we can all have hope that these five women will carry the ball," he concluded.

    Dr. Insel took a moment to echo the message of community and lineage at the beginning of his remarks to the general audience. Scientific progress "builds incrementally over generations," he said, "and it's part of the fun of being part of scientific life—you both get to benefit from mentors who care and you get to generate the next group who will in turn also be mentors." Science is "a very social endeavor."

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  • The Oregon Shooting: What's Wrong With Blaming Mental Illness
    Oct. 6, 2015 Beth Arky

    Another horrific mass shooting, another chance to place the blame. For many who are adamant opponents of gun control, that means focusing on the mentally ill. Last week's rampage at Oregon's Umpqua Community College had a number of presidential candidates and other public figures pointing to the role mental illness may have played in the devastation wrought by the 26-year-old shooter, who took nine lives before killing himself.

    As satirist John Oliver pointed out, the sudden political interest in mental health after a mass shooting is not always sincere. During a particularly apt analysis on Sunday's  Last Week Tonight With John Oliver on HBO, Oliver said, "Perhaps the clearest sign of just how little we want to talk about mental health is that one of the only times it's actively brought up, as we've seen yet again this week, is in the aftermath of a mass shooting as a means of steering the conversation away from gun control."

    Besides being disingenuous, pointing fingers at mental illness right now is dangerous, too. As Oliver explained, the aftermath of a mass shooting might be the "worst time" to talk about mental health because "the vast majority of mentally ill people are nonviolent, and the vast majority of gun violence is committed by non-mentally ill people." The reality, Oliver added, is that "mentally ill people are far more likely to be the victims of violence rather than the perpetrators, so the fact that we tend to only discuss mental health in a mass shooting context is deeply misleading."

    Not only is it misleading, it effectively endorses the stigma that keeps many people from getting the kind of care that could transform their lives. What could be a constructive conversation becomes scapegoating.

    Already this shooting has elicited an outpouring of virulent anti-autism chatter on social media, stimulated in part by the fact that the shooter's mother, Laurel Harper, has written in online postings that both she and her son struggled with Asperger's syndrome.

    During his show, Oliver cited the shocking ways the mentally ill are dealt with in this country: We've gone from asylums to no treatment; nursing homes, even for the young and middle-aged; one-way bus tickets out of town; and jails and prisons. Some 2 million people with mental illness go to jail every year, and they are estimated to be 10 times more likely to be behind bars than receiving care in a state psychiatric hospital.  

    Oliver noted, as countless families have found, that making the criminal justice system a de facto provider of services to the mentally ill isn't just ineffective, it's dangerous. "Because often, when someone is having a mental health emergency, the police will be called, and that can end tragically," he said. "By some estimates, an incredible half of all incidents involving the police use of deadly force involve a mentally ill person."

    After playing tapes of Donald Trump, Mike Huckabee, and Ben Carson calling for the need to fix a broken mental health system, Oliver summed up this way: "Fine—do it then. Because if we're going to constantly use mentally ill people to dodge conversations about gun control, then the very least we owe them is a f------ plan."

    We can only hope the time will come when it doesn't take shootings to spur this important conversation.

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  • The Basics of Bullying Today
    Sept. 26, 2015 AM New York

    Dr. Jamie Howard discusses what parents need to know about bullying.

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  • SuperBetter, the Game Designed to Improve Your Mental Health
    Sept. 22, 2015 Rachel Ehmke

    Six years ago Jane McGonigal, the game designer and creator of several extremely popular TED talks, had what she calls a "stupid household accident" that changed her life. McGonigal knocked her head against an open cabinet door and sustained a traumatic brain injury, with effects that lasted for a full year. She was in a mental fog—unable to concentrate or remember things—and experienced headaches, nausea, and vertigo. Her doctor put her on cognitive rest to help her brain heal quicker, which meant for months she couldn't read, write, work, run, drink coffee, or play video games. "Obviously there was no reason to live," she joked to the crowd she was telling her story to at the New York Public Library last week.

    But it began to actually feel that way for her. Like many people who experience serious brain injuries, McGonigal was also feeling depressed and anxious, which only increased as she avoided doing the things that made her happy. In a vicious cycle, her doctors warned her that it would be harder for her brain to recover if she stayed feeling depressed. And so McGonigal, who has big blonde curls and was wearing sparkly tennis shoes to her speaking event, disclosed that she starting having suicidal thoughts. "My brain began telling me that I would like to die."

    Jane the Concussion Slayer

    During this time she was supposed to be writing her first book, Reality Is Broken, not that she was able to work on it. The book would argue that games make us happier, more creative, and more resilient. She was surrounded by research claiming this, so she started to think maybe a game could be the answer for her. Working in short bursts, and with the help of family and friends, McGonigal began making a game to help herself get better. She called it Jane the Concussion Slayer, in honor of her hero Buffy the Vampire Slayer. Over time her symptoms began to leave, and while she says she can't totally credit the game, she does know that her mood improved as soon as she started playing.

    She has since renamed the game SuperBetter and turned it into an app that other people can play to help them with things they are struggling with—anything from weight loss and lowering stress to mental health issues like depression or anxiety. The game isn't therapy, and shouldn't be used in place of therapy for people who have real mental health concerns. But McGonigal says it could be considered a good supplement to treatment, and anyone who has participated in cognitive-behavior therapy will see that it has some similarities.

    How the game works

    To play the game you have to identify and then battle "bad guys," or the obstacles or triggers in the way of your goal. There are "power-ups," which are specific positive things that you do to break negative cycles that you are in. For a confidence boost, players get to create a powerful secret persona—a version of yourself that is strong and capable of undertaking heroic quests. And as McGonigal wrote in her blog, "If you can't be yourself (due to your symptoms), why not be someone secret and awesome?"

    You also need to enlist "allies," which are family and friends who will help you on your quest to get better. Supportive family and friends are a big part of getting better for anyone struggling with a mental health disorder, but asking for their support as part of a game is a novel way of helping them understand what you are going through and also helps bust through some of the stigma.

    Gamers are often accused of being lazy couch potatoes more invested in an alternate reality than their own. McGonigal would contest this, and it's clear that SuperBetter requires the opposite of that mentality—to play the game you have to become an active, motivated player in your own life.  

    It seems clear that the game could have a lot of appeal for kids struggling with mental health disorders. If you are interested in checking out the game, you can download it in the app store or check out McGonigal's new book, SuperBetter, which is about the game and some of the research backing it up.  

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