Advice & Support

The New York Times has a provocative and compelling story on the front page today about the use of ADHD medications. It will be widely shared—and widely misinterpreted. 

The story is about the growing use of ADHD medications to help kids struggling in school—kids, that is, who don't have ADHD. A lot has been written about middle class kids cribbing Adderall to help them score better on tests, or scoring their own prescriptions to enhance their chances of making it into an Ivy League college. But this is about a different set of kids: those whose schools are underfunded and whose parents can't afford the non-pharmaceutical support they need to enhance their school performance.

In the story we hear a lot from Dr. Michael Anderson, a well-meaning pediatrician near Atlanta who routinely prescribes ADHD meds to kids essentially because they're struggling in school.  "I don't have a whole lot of choice," he tells the Times reporter. "We've decided as a society that it's too expensive to modify the kid's environment. So we have to modify the kid."

Dr. Anderson sees it as an issue of social justice, of "evening the scales a little bit" for these kids who would otherwise almost surely be failing in school—in schools, that is, that he perceives as clearly failing them.  

Whoa. We need to establish some facts here. Kids who are failing in or behaving badly in school don't necessarily have ADHD. It does a serious disservice to both kids who do have ADHD and kids who don't to prescribe it as a fix for bad schools.

ADHD isn't a disorder that just happens in school—to qualify for a diagnosis, a child must exhibit extreme inattention, hyperactivity and impulsivity in several settings, not just the classroom. It's what we call a global impairment, and it's not responsible or competent to see stimulant meds simply as a tool to improve school performance—or to compensate for a lousy school.

We know it happens, and we worry that it happens much more to kids whose families don't have the resources to get other kinds of support they might really need—tutoring, behavioral therapy, smaller classrooms, better-trained teachers, consistent structure.

We worry along with one school superintendent who speculates that what's happening is a doctor who "sees a kid failing in overcrowded classes with 42 other kids and the frustrated parents asking what they can do. The doctor says, 'Maybe it's ADHD, let's give this a try.' "

This story also fuels the myth that ADHD medication is dangerous.  The unsubstantiated suggestion that these meds can lead to lifelong addiction is irresponsible. There is a clear body of evidence that taking ADHD meds in childhood and adolescence does not increase the risk of addiction or abuse, and in fact they are among the safest, most effective, best-studied, and least easy-to-abuse psychotropic medications we have.

So what we have here is a sympathetic pediatrician arguing that when a kid is struggling in school, trying ADHD meds might be the most cost-effective thing he can do to help. "I am the doctor for the patient, not for society." It may be cost-effective, but we'd argue that it's not good either for the patient or the society.

Royce White, the NBA rookie recently drafted to play for the Houston Rockets, is catching attention again because of his anxiety, this time after he requested permission to travel to close road games by bus due to his fear of flying. While White has already gotten on several planes with his new team over the summer, flying is stressful for him, and he says he'd prefer to avoid it whenever possible as part of a "more healthy work environment."

White, who has generalized anxiety disorder and OCD, explained, "It's honest to just say, 'I have some anxiety.' It's a whole different level of honesty to say to the Rockets, 'I have anxiety, and this is what I need to do to be healthy and can you accommodate me?' I felt that it was necessary to take that step."

White's skill is undeniable—people are already speculating that he'll have a spot on the NBA All-Rookie team—but he's always been upfront that he brings his anxiety along with his talent. This makes him a fascinating figure in sports, since athletes are often conditioned to mask their fears and weaknesses. But White does his best to be candid, both because he says he wants to be a role model for kids and because he believes getting the support he needs will make him a better player. Fortunately it looks like he has found a team that thinks the same way. The Rockets knew about White's anxiety and fear of flying before they drafted him, and they have agreed to let him drive to games whenever possible. Here's wishing them luck.

Learn more about Royce White and his anxiety here.

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

This one's very dark (maybe the blackest black comedy I've ever seen) and very funny. A social misfit, who acts as if he hates his father, unexpectedly dies. Robin Williams stars as the boy's single father, who through a strange twist of fate, becomes The World's Greatest Dad. All about how memorialization takes on a life of its own.

For adults and teens—but dark.

I attended the premiere of Bell Rung, a provocative documentary co-produced by retired football player Dorsey Levens about concussions in the NFL. Mr. Levens interviewed several players and friends of his who experienced multiple concussions and now, several years later, are feeling the ill effects of these injuries. Many complained of persistent headaches, problems with attention and memory, and heightened emotionality and mood swings in their personal lives.  

To many kids, Dorsey Levens and the players featured in Bell Rung are heroes and their words and actions carry an enormous amount of influence. This is important, because all too often they hear their favorite NFL players minimizing concussions as "dings" or "just part of the game." And when an idol talks nonchalantly about routinely playing through his injuries, this approach to the game can easily become internalized. In contrast, the players in Bell Rung were not shy opening up about their experience with concussions—some claimed to have suffered 20 to 30 over their NFL careers—and talked introspectively about their decisions to play through injuries, their limited awareness of risks, and the toll it may have had on their health. One of the players discussed his reaction to the suicide of NFL star Junior Seau and wondered if he might be heading down a similar path. The film provoked a strong reaction in the audience, many of whom had questions about how to safeguard their own children. 

The answers are many and promising: New state laws have been passed mandating concussion education for coaches and other school personnel, and rules put in place dictating when a student-athlete should be pulled from play and when he or she is cleared to return. Youth sports organizations are adopting new system-wide policies designed to reduce exposure—Pop Warner has made changes to the way practices are run to limit amount and intensity of contact, US Lacrosse is exploring headgear options for its female athletes, and USA Hockey has eliminated body checking in 12 and under male players. Kevin Guskiewicz and his colleagues at the University of North Carolina are teaching football players at many different levels of play how to tackle safely using proper technique. The CDC has partnered with several organizations to create free tools designed to educate parents, coaches, athletes, and other health care professionals about concussions. And a number of researchers, educators, and clinicians around the country are exploring new technology that could help identify concussions early and treatment techniques designed to shorten recovery times.

With Bell Rung Mr. Levens is certainly playing his part in keeping kids safe, too. I hope more role models step up to influence a younger generation of athletes that it's smart to take care of your brain.

Dr. Rosenthal is a pediatric neuropsychologist who is an expert in identification and treatment of children with concussion or mild traumatic brain injury.

For the past few days the internet has been buzzing over a letter, posted to the social news site Reddit, that a dad wrote to his 13-year-old son after finding pornography on his computer. The gist of the note, left on the son's desk: It's cool. Be careful about computer viruses. I won't tell your mom.

People have been more or less supportive of the anonymous dad, who seems particularly concerned about his investment in the $1800 machine. "I'm not mad or anything," Dad writes. "It's life and I did it too. I just want you to know that most of those sites are places that can and will ruin your computer...There are viruses and other scamware that can completely ruin a computer and I can't afford to buy you another 1800 dollar machine because you went to a site that fried it."

Instead, the dad offers a few suggestions for "safe" porn sites and a tacit offer of an open door, judgment-free. "I won't tell your mom and I'm not gonna make a big deal out of this. In fact I'm not gonna make any size deal out of it. If you don't wanna talk about it that's fine and I completely understand." (Perhaps one of the most contentious parts of the letter, at least to online readers, is the decision to exclude Mom from the discussion. "The husband / father made the unilateral choice for his wife / mother of their child," one Huffington Post commenter protests. "Only she can state whether or not it's important to her." Not so fast, says another. "If a man can't side with his son, who can he side with?")

Another red flag that went up for commenters was the missed opportunity to discuss how far from reality both the sex and the people in pornography are, and how this disconnect can encourage inappropriate sexual attitudes, a point CMI psychiatrist Al Ravitz made yesterday in an appearance on Huffington Post Live. The author responded to this criticism on Reddit. "I also talked to him about porn not being like real life and that women aren't objects like they are portrayed in porn."

It's tempting to focus on the pornography and weigh the response—enlightened? Naive? Unfair? But this misses the point the dad brings up almost in passing at the end of his letter. "I would like you to not be back here so much though. You literally spend all of your time back here." Excuse me?

Let's put aside the issue of pornography for a moment and focus on a larger one: screen time. There are debates over the effects of almost everything a kid—or an adult—can do on a screen: watch frenetic TV shows, play violent videogames, interact on social networks, text, sext, you name it. But we know one thing for certain: when kids are tied up by a screen, they aren't doing other things critical to their development. This includes hanging out with friends, getting physical exercise, and being part of a family.

"I'd like to see you more often," Dad pleads. "I like doing stuff with you and miss it." There are a lot of things going on with a 13-year-old, and this father deserves applause for being open, honest, and practical about sexuality, and for realizing that his son naturally desires some independence and autonomy from his parents. But these words above indicate that Dad also knows—maybe unconsciously—that spending your young life in front of a screen isn't great for his kid or for the family. I hope that this issue comes up in their next conversation. It's not as sexy a topic as porn, and maybe even harder to talk about, but it is a critical one for families to address.

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

Another great film about marriage and divorce is Carlos Reygadas' Silent Light. Set in a Mennonite community in Mexico, it's the story of a married man who has an extramarital relationship with a woman he genuinely loves. Very well received critically, it's on several top ten lists for 2008, and Roger Ebert named it one of the best films of the 2000's.

For adults and teens, especially those interested in divorce. Because it's so deep, it's a bit slow, so many teens may not have the patience for it.

Lady Gaga has put on some weight, and, not surprisingly, she's catching flak for it. The Daily Mail, among others, published a bunch of unflattering photos of her on stage at a recent show in Amsterdam, and quoted a fitness expert who had calculated, from those photos, that Gaga was about 30 pounds "meatier."

The stories were obviously, if not surprisingly, crass—"The fat Lady Gaga sings," read one headline—and Gaga countered with some pictures of her own, only slightly more exposed than she is on stage, but appealingly defiant: "This is what I look like off stage and out of costume," they seem to say. " Here's the real thing. Take a good look."

But what got (and deserved) more attention than the photos was the caption: "Bulimia and anorexia since I was 15." Gaga has talked about bulimia before, but what is different this time is the tense: Unlike almost every celebrity who talks about having an eating disorder, she's not talking about something comfortably in the past. She's not telling us that now she feels great about her weight and her healthy relationship with food. Eating disorders don't go away overnight, and by acknowledging her reality Lady Gaga is helping to legitimize anyone who has ever struggled—and is struggling—to recover from one.

In true Gaga fashion she's also launching an offensive against the fat police and asking fans to join her by posting similarly raw photos of themselves. The goal, as she puts it, "is to inspire bravery and BREED some M$therf*cking COMPASSION." Or, to put a little Gaga gloss on it: "May we make our flaws famous, and thus redefine the heinous."

I can't say whether the love fest and outpouring of photos on her site will really help others struggling with negative feelings about their flawed (ie, normal) bodies. But we love Gaga's creative efforts to use her over-the-top celebrity to help her young fans. And, of course, we love her honesty.

On her new talk show yesterday Katie Couric admitted to struggling with bulimia as a young woman. She did it during an interview with Demi Lovato, who has also spoken openly about her bulimia and other mental health struggles. For someone as famously disciplined as Couric to join the more vulnerable young star was winningly candid, and what she had to say will sound familiar to many women:

I wrestled with bulimia all through college and for two years after that. And I know this rigidity, this feeling that if you eat one thing that's wrong, you're full of self-loathing and then you punish yourself, whether it's one cookie or a stick of gum that isn't sugarless, that I would sometimes beat myself up for that.

How do you have a healthy relationship with food, and say, "You know what, I can have one cookie and it's OK?" That is such a huge thing for people who wrestle with this.

It seems to me that not culturally demonizing the cookie—and, of course, ourselves for liking cookies—is part of that healthy relationship with food. It's hard to go a day without hearing someone say they're being "bad" for eating a doughnut (or bread, or anything that isn't undressed raw kale). In our story 13 Ways to Help Build Your Daughter's Self-Esteem Dr. Catherine Steiner-Adair notes that when moms routinely moralize their food intake ("I was terrible today—I had pizza") they undermine their daughters' developing self-esteem by focusing on appearance. After all, cookies aren't unethical. They might not be as nutritious as a salad, but that doesn't make them bad.

Katie Couric's comment reminded me of an anti-obesity ad that you might have read about in The Atlantic or seen if you live in Minnesota, where it's being aired. The ad shows an overweight woman shopping at a grocery story with her overweight daughter, each loading up a cart with soft drinks, snacks, sugary cereal, and pails of ice cream. It's a good ad with a good message: We are passing down our unhealthy eating habits to the next generation. But it's hard not to also get the message that ice cream = fat, which is problematic. When I was a kid my family got ice cream in pails like this, and we ate it occasionally and in reasonable portions. We didn't feel guilty for eating ice cream, nor should we have. We weren't doing anything wrong.

Our society tells women that being fat is just about the worst thing you can be. I guarantee there are young girls out there watching this commercial and telling themselves that skinny girls don't eat ice cream. I wish the message was more overtly about nutrition and exercise instead of about "bad" foods. Otherwise, obesity or not, we're still passing on our unhealthy eating habits. 

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

Part of my job entails dealing with people in the midst of high-conflict divorces. The other day my wife told me that A Separation just came out on DVD. This is a film all about what can happen when divorcing parents just can't stop fighting with each other. It is profound and tragic—a really great movie.

For adults and teens, especially those interested in divorce.

Whether kids are in kindergarten or away at college, it's important that parents have all the knowledge and resources they can get to help guide their children as they grow and develop.

To help prepare parents, we hosted a live event today on Facebook called "A Parent's Guide to Bullying" with Dr. Jamie Howard. The talk included tips on what might put your child at risk for being bullied or bullying others, warning signs that your child might be getting bullied, and what parents can do to stop bullying and cyberbullying. The talk included a Q&A segment at the end, giving parents and teachers the opportunity to write in about their particular obstacles.

If you missed the talk, watch it here:

On Monday, September 17th we also hosted a live Facebook talk called "Is it Depression or Teen Angst?" with Dr. Natalie Weder. As parents of high school students know, it can be hard to tell what is normal teenage moodiness and what might be something more serious. In this talk Dr. Weder discusses the warning signs of adolescent depression, risks associated with depression, how parents and schools might be able to help, and what treatment options are available.

Watch the talk followed by a Q&A session :

Stay tuned for more live Facebook talks!