The Child Mind BlogBrainstorm
CDC: Kids With Autism Up 30%
March 27, 2014 Caroline Miller
The Centers for Disease Control released a new survey today finding that one in 68 children in the US has autism, up from one in 88, which the agency reported two years ago. The new prevalence figure, which is based on a sample of 8-year-olds taken in 2010, is a 29 percent increase over the figure for 2008, and a 123 percent increase in the figure for 2002.
• Gender differences: The new figure breaks down into one in 42 boys and one in 198 girls. That ratio has remained constant, though it varies among individual states.
• Ethnic differences: Non-Hispanic white kids were almost 30 percent more likely to be diagnosed than non-Hispanic black children, and 50 percent more likely than Hispanic children.
• Intellectual disability: The number of children diagnosed with autism who do not have intellectual disability has risen to 46 percent, up from 32 percent in 2002.
• Age of diagnosis: The median age of the first diagnosis is 4.5 years, not significantly different from the last survey.
• State breakdown: Prevalence of autism diagnoses varies a great deal among states in the survey—from 5.7 to 21.9 per 1,000 children. The lowest rate is Alabama and the highest is New Jersey.
The survey is based on a sample of kids in 11 sites around the country who have been identified by records from medical providers or school services as having an autism diagnosis. Records are then scrutinized by professionals to check them against accepted diagnostic criteria for autism.
Since it's based on the 2010 survey year, this survey reflects diagnostic criteria for autism-related diagnoses from the DSM-IV-TR, rather than the new criteria in DSM-5 that was released in 2013. Included in the prevalence figures are all children diagnosed with autism, PDD-NOS, and Asperger's Syndrome, which have all been combined more recently into ASD.
The CDC reports that the distribution of children among these subtypes has not changed significantly since 2006.View Comments | Add Comment
Depression, Suicide, and Too Much Sharing
March 25, 2014 Caroline Miller
In an op ed piece in the New York Times today an anthropologist named TM Luhrmann writes about an increase in reported rates of depression and suicide around the world. She notes that the increase reflects changes in how cultures label feelings: "For example, until recently, most Japanese understood intense fatigue as sacrifice for one's work and suicide as an act of reasoned will." Now many Japanese who find themselves drained of energy and beset by suicidal thoughts would call themselves depressed. That's not a bad thing.
But of the factors she mentions, one that's particularly interesting is the change in what she calls "our awareness of other people and where we stand in social space." Studies show that Facebook makes people feel less good about themselves. The constant stream of other people's flattering photos and evidence of fun you're not having, not to speak of accomplishments you haven't achieved, is tough on all of us. But I would suggest that it's probably hardest on teenagers, who are acutely sensitive to, and anxious about, comparisons with their peers.
On a global scale, she's talking about people everywhere knowing, thanks to both television and the internet, how much richer and more powerful others are. On a high school level, it may be addictive to keep up with what everyone is doing and thinking, 24/7, but it's also potentially depressing.View Comments | Add Comment
Autism and Sensory Overload
March 25, 2014 Caroline Miller
In what's called the "intense world theory," a leading neuroscientist is arguing that autism should be seen as a result not of cognitive deficits but of cognitive overload.
Henry Markram's radical rethinking stems from observation of his own son, Kai, who is on the Asperger's end of the spectrum. And his research with rats offers evidence, he argues, for the theory the autistic brain is actually hyper-responsive to stimuli. The rigid and repetitive behaviors associated with autism, not to speak of the meltdowns, are explained as attempt to manage bewildering sensory and emotional overload. And social unresponsiveness is seen as a coping mechanism for a "barrage of chaotic, indecipherable input, a cacophony of raw, unfilterable data."
A story about Markram and his theory on the website Medium is riveting, and it has important implications for treatment. Since children learn social skills in specific windows of development, could it be that "early intervention to reduce or moderate the intensity of an autistic child's environment" might keep kids from shutting down during crucial learning periods and hence protect their development?
Learn about another theory of sensory issues in autism based on brain imaging here, from Dr. Wendy Chung, who reaches a remarkably similar conclusion concerning tailoring learning environments and experiences for young people on the spectrum.View Comments | Add Comment
Avonte’s Brother Thanks New York City
March 24, 2014 Beth Arky
During the desperate search for Avonte Oquendo, the nonverbal autistic teen who went missing after running out of his Queens school last October, his older brother, Danny, emerged as a leader in the unprecedented citywide effort to find him.
Unable to remain on the sidelines while they hoped the police would find Avonte, the family went public. Avonte's mother, Vanessa Fontaine, and the family lawyer appealed to traditional media, while Danny took to twitter, Instagram and Facebook. At first, there was only a small band of volunteers, but then something surprising happened.
"We went from a small family searching night and day for our loved one," he writes, "to a large operation with thousands of volunteers ready and willing to help in every possible way."
Danny says in the blog that while New Yorkers have a reputation for being "rude, impatient, aggressive and unsympathetic," the city showed its true compassionate colors, much as it had in the aftermath of 9/11. "His disappearance sparked a city-wide search and an autism awareness campaign came right along with it."
Danny explains that his brother engaged in running or bolting, a common autistic trait that too often ends in drowning, requiring constant supervision on the part of whoever's responsible for the child. In the aftermath of the 14-year-old's death, Senator Charles Schumer introduced a bill called Avonte's Law to fund the voluntary distribution of tracking devices to parents of autistic and other special-needs children. The Justice Department responded that it would make grants available for the devices.
Danny, who aims to go to law school so that he might represent special needs students, expresses the hope that his brother's death will focus efforts to improve security in schools for kids like him. "The city was behind us when we were attempting to find Avonte,' he writes, "and now the city is behind us as we make efforts to reform our school system's security protocols."
The family has also taken steps toward a lawsuit against the city.
Blogger Jill Smo has set up a virtual candlelight vigil on April 1, the first day of Autism Awareness Month, to honor and respect the memories of children like Avonte who have lost their lives to wandering.View Comments | Add Comment
Static Over Smartphones and Parenting
March 11, 2014 Beth Arky
Electronic devices seem to be on everyone's minds, as well as in everyone's hands.
Today's New York Times features an article titled "Parents, Wired to Distraction" by Dr. Perri Klass, in which she cites a new study in yesterday's Pediatrics. The object was to observe caregivers eating with children in Boston-area fast-food restaurants to see how much they were engaged with their charges vs. their smartphones and tablets. While the researchers had no way of knowing if the caregivers were parents, as Klass writes, the adults' behavior does help pinpoint "what kinds of questions we should be asking about how digital devices relate to parenting."
Unfortunately, the results don't surprise me in the least. Of the 55 caregivers observed by researchers eating with one or more young kids, 40 used devices during the meal, with a high degree of absorption. Even more troubling was the study's finding that "Highly absorbed caregivers often responded harshly to child misbehavior."
Klass's piece comes on the heels of a controversial blog in The Huffington Post, in which pediatric occupational therapist Cris Rowan serves up "10 Reasons Why Handheld Devices Should Be Banned for Children Under the Age of 12."
She claims that children's use of technology, including cell phones, tablets and electronic games, can cause everything from delayed development to aggression to mental illness. While most of the connections are a stretch, it's true that too much technology can be bad for kids. But calling for a total ban is a pretty extreme (and extremely unrealistic) move.
Our gadgets are here to stay, and thankfully they can do a lot of good, too. Blogger Jo Ashline was eager to point out that handheld devices like iPads actually assist special-needs kids like her nonverbal autistic son in their communication efforts (something an OT ought to be familiar with).
Dealing with encroaching technology might feel new, but it isn't really. I grew up in a family that watched TV at dinnertime, which didn't allow for much engagement, either. I suppose that's at least subconsciously why I don't allow devices at the dinner table.
These two stories do share one common theme: We need to be mindful of the fact that by plugging in, we're in danger of plugging out of family life. When it comes to electronics, there is no doubt that some parents and kids know no limits. I myself have been guilty of checking in on Facebook and email while my son is in the room.
But there's no putting the genie back in the bottle. It seems to me it's a question of moderation and making smart choices. And isn't that what parenting is about?View Comments | Add Comment
What Kids Actually Think About Sheryl Sandberg, Leaning In, and 'Ban Bossy'
March 9, 2014 Harold S. Koplewicz, MD
Most of us have heard of Facebook COO Sheryl Sandberg's "Lean In" campaign to encourage women in all professions to follow their ambitions and transform the idea of a woman's character and capabilities. Now, with the Girl Scouts, she has launched a new initiative: "Ban Bossy." The aim? Correcting a common (and false) dichotomy: when a man acts like an assertive leader, he's the boss; when a woman does, she's "bossy."
Sandberg wants to eradicate the word from boardrooms and on the playground, because it's toxic to girls and forces them to step back, rather than lean in and get branded as "bossy." I was interested in what kids actually think about "bossy," and what they actually think about each other. So ABC Nightline anchor Cynthia McFadden and I took a trip to New York's Hunter College Elementary School and sat down with 1st and 6th grade boys and girls, in 4 groups.
Everyone agreed: "bossy" isn't a great word, and it is used more often to refer to girls. The girls disliked the word bossy more than the boys did, sure. But here's what's interesting: when we asked the 1st-graders about the word "leader"—"You're a leader, Harry, how does that make you feel?"—they were more positive but not overwhelmingly so. There's a feeling of wanting to be friends and wanting people to like you, not be a leader. And there was a great equality between the sexes in terms of this.
Things change in 6th grade, but maybe not how you would think. Who are the clear leaders? The girls. The 6th grade boys reported them as much more enthusiastic about student leadership and academic-more ambitious and more interested in being the best. They saw the girls as equals but did admit that they were more likely to call a girl bossy than a boy.
The girls could care less about that. Bossy was a bad word, but not a terrible word, and it meant nothing from a boy. It meant nothing from someone they didn't know. But: if someone they cared about called them bossy they'd try very hard to change their behavior, meaning that they didn't want to hurt someone else's feelings. In terms of socialization, girls are more concerned about how people feel, and have more collaboration, and are more socially minded. Boys at this age have a totem pole hierarchy; they don't really care how other people are doing, as long as they can yank the one above them down and pull themselves up.
What does this mean? I think it means that a pivotal time in development—entering adolescence—we have a great model of successful, social, high-achieving young women. At the very same time, we have relatively under-achieving boys, who even admit this, testing out the sort of dog-eat-dog hierarchy that we often see at the top of any profession. Are these things incompatible in adult life—and is "bossy" the reason?
The girls I spoke to had the same question, and were unsure if Sandberg was right. "Maybe that was old times," they said. Their career choices: Scientist, actress, lawyer, doctor. The major problem I saw was a distinct lack of successful female role models in this country, and around the world. And that's where I think Sandberg is really making waves, encouraging women to "lean in," be assertive, engage their professions and their leadership drives. Hopefully our successful adult role models can help our children build a different world.View Comments | Add Comment
Therapy Goes Bananas
March 4, 2014 Rachel Ehmke
When most people hear the word "therapy" they still picture someone lying on a couch talking while their mostly silent therapist takes notes. While this kind of therapy still happens, the science and art of therapy has evolved a lot since the days of Freud. It's moved so far away, in fact, that one psychologist takes patients out to the street, where the task is to walk a banana on a leash.
In a piece for Scientific American Mind, that psychologist, Jerry Bubrick, who works at the Child Mind Institute, describes the kind of work he does with severely anxious children. It's a form of cognitive-behavior therapy, and Dr. Bubrick gives an interesting history of it, going back to the 1950s, when the first psychologist made the move away from psychoanalysis towards a more active and goal-oriented treatment.
Instead of trying to resolve past childhood issues—how traditional psychotherapists explained anxiety disorders—CBT therapists focus on changing the negative thoughts and behaviors that accompany anxiety. So while anxious kids want to avoid the things that make them anxious, Dr. Bubrick helps them learn to habituate to their anxiety. Enter the pet banana.
For the severely anxious boy Dr. Bubrick was working with, who had been paralyzed by fear of looking foolish around other people, such a thing would have been unimaginable before treatment. But he and Dr. Bubrick worked up to it, getting used to feeling anxious during more mundane things—asking strangers questions, asking strangers questions while in a ridiculous wig, ordering coffee at Starbucks in the wig, and so on.
Dr. Bubrick goes into more detail in the story, explaining how the therapy works and giving several patient case histories. It's a must-read for people who want to know more about what really great therapy—especially for kids—can look like. It's behind a pay wall at Scientific American Mind, but you can read it for free if you use this link.View Comments | Add Comment
John Travolta, Dyslexia and the Oscars
March 4, 2014 Beth Arky
Two days after the Oscars, people are still buzzing about the way John Travolta mispronounced Idina Menzel's name—only now, dyslexia is part of the quickly moving story. We live in a time when social media has made mockery a national pastime, so it's no surprise that the internet was quick to pounce on Travolta's introduction of "Adele Dazim" before Menzel was about to perform the nominated song "Let It Go" from Frozen.
A Twitter account with the mangled name popped up (it's since been suspended) and it wasn't long before Slate had posted a "handy widget" that allowed users to "Travoltify" their own names. (In the name of full disclosure, I am embarrassed to admit that I tried it.)
But now it's Day 2 and the internet is deep into debate over whether Travolta has dyslexia and, if he does, whether the learning disorder caused the gaffe.
If one good thing has come out in the midst of conflicting reports about possible dyslexia and Travolta's claims that Scientology "cured" him, it's this: The brouhaha has brought the common learning disorder front and center.
As Zanthe Taylor wrote for Psychology Today, while Travolta doesn't need her sympathy, "What about all the dyslexics who aren't rich and famous, who have to stand up in front of a classroom, in front of coworkers, in front of professors and bosses, and suffer the fear of knowing they may screw up just the way he did?"
And screwing up has consequences, even if you're not on stage at the Oscars, she notes: "It's extremely common for a child who can't read, write, or speak correctly in public to be labeled as dumb, while he or she may have normal or even extraordinary intelligence by any other measure."
Taylor points out that one of the most insidious problems with learning disorders is their invisibility. "Would we have made fun of Michael J. Fox for mangling an introduction?" she asks. "Would someone with a physical disability be laughed at for stumbling on stage?"
It's because dyslexics appear "perfectly sound in body and mind," she writes, that "their errors are not met with similar empathy."
According to the Yale Center for Dyslexia & Creativity, about one out of five, or 20 percent of all people, suffers from dyslexia, the most common reading disorder, yet many remain undiagnosed and untreated. And learning disorders like dyslexia can lead to impairing anxiety in children, according to Dr. Matthew Cruger of the Child Mind Institute. This anxiety can, in turn, lead to disruptive behavior and depression.
Whatever happened to Travolta at the Dolby Theatre, one thing is clear: More awareness and acceptance of hidden disabilities like dyslexia are needed to improve both learning and the quality of children's lives.View Comments | Add Comment
Rosie Perez on PTSD and Her Road to Recovery
March 4, 2014 Jessica Kashiwabara
Rosie Perez has been many things in her career —dancer, choreographer, Oscar-nominated actress, and AIDS activist—and now she adds survivor to the list. The Do the Right Thing actress recently spoke candidly with TIME magazine about her difficult childhood and what it felt like to be diagnosed with posttraumatic stress disorder (PTSD). In her words, "It sucked," but only at first. Perez gradually accepted her diagnosis and eventually felt relief, a weight lifted off from the years of fighting back.
In her new memoir, Handbook for an Unpredictable Life, Perez dives into her past and writes about growing up in the rough streets of Brooklyn. Her mother, who struggled with mental illness, first left her with a loving aunt and then abruptly placed Perez (only 2 years old) in a Catholic home for children. There, she was surrounded by vicious fights between girls and abusive counselors. Visits with her mother were not any easier, as she writes, "I was always walking on eggshells, waiting for the insanity to hit. And when it hit, it hit hard and fast—leaving deep emotional and physical scars."
For Perez, accepting PTSD was a struggle because she wanted to believe she was over her childhood trauma. But it was "a big part of my life," she writes. "And I've hated that fact. I'm a forward-moving and positive-thinking person, and it was hard to have that albatross hanging around my neck."
Perez's desire to move forward led her to finally seek professional help, something she admits she resisted for years. Dr. Jamie Howard, an expert on PTSD at the Child Mind Institute, says this is common. "A lot of people who experience PTSD are uncomfortable with it because it seems like a weakness," she says. "But you can still be tough and have PTSD—you can be tough by putting one foot in front of the other and living your life with PTSD."
It is clear writing this memoir has been a huge step in Perez's recovery. "Part of the treatment for PTSD is to face traumatic memories, not to avoid or numb them," explains Dr. Howard. "A lot of people do. When you've had this kind of longterm childhood trauma, the narrative is long."
Though it wasn't easy to write the book, Perez says she felt it was a responsibility. "The point is to get it out, to validate my feelings, to communicate how good it feels to no longer live in fear of what others may think, and to share my journey and move on," she writes.
Dr. Howard is glad to see Perez so open about her experiences and believes her story could help change the perception of PTSD. "I think she's really brave and it could really help people," she says, "especially those who grew up in her community, and communities like hers, where it's really valued to be tough."
Many of us will always see Rosie Perez as that hard-as-nails woman in the opening credits of Do the Right Thing, but now she offers a new view of herself—vulnerable yet fighting back for happiness. Here's how she ends her preface:
After a couple of years of therapy, and I don't know exactly when or how it happened, I noticed my depression wasn't there and the PTSD subsided considerably. I felt joyful, secure, and empowered. My inner strength and sense of self had never been stronger. I guess I allowed time to play its role, and I did my part by working hard on myself to grow past the pain. Gosh I sound so full of shit there. Let me be more honest: I grew past most of the pain and continue to do the work. Every day it gets better. xo.View Comments | Add Comment