The Child Mind BlogBrainstorm

  • When Stomach Aches Indicate Anxiety
    Aug. 12, 2013 Rachel Ehmke

    A study published today in the journal Pediatrics links childhood stomach aches with future anxiety disorders in adulthood.

    The long-term study followed over 300 children who experienced recurring stomach aches without any apparent medical explanation (called functional abdominal pain) throughout adolescence and young adulthood. Researchers at Vanderbilt University found that the kids with functional abdominal pain were more likely to develop anxiety disorders and depression later in life than the almost 150 control children without stomach aches. In fact, in most cases an anxiety disorder was already present before the children were evaluated for functional abdominal pain. This despite the fact that the study's lead author, Lynn S. Walker, PhD, told the New York Times that the majority of kids "had not seen a mental health professional, ever." Which isn't much of a surprise. Anxiety is often overlooked in kids because it tends to have quieter consequences than some other childhood disorders. Anxious kids are often more introverted and, as Dr. Walker says, preoccupied with doing a good job.

    This new study is a helpful reminder that the mental health disorders that affect adults often begin in childhood, where they are typically overlooked. Not only does that mean that many kids who are suffering don't get support, it also means that families are missing out on the opportunity to help kids when they are younger and treatment can be most transformative.  

    Anxiety tends to grow with us—the more time we spend with overwhelming anxiety, the more we learn to contain our discomfort with maladaptive coping techniques that we devise ourselves. This means that anxious kids learn early to close themselves off from things that make them nervous, so they miss out on many of the academic, extracurricular, and social opportunities that their peers get to experience.

    Recurring stomach aches, something that kids might be more vocal about, can be a good warning sign for families. 

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  • #dearmentalhealthprofessionals Is Trending on Twitter
    Aug. 12, 2013 Caroline Miller

    Amanda O'Connell, a  woman who runs a mental health training business in Scotland, hit a nerve Saturday when she started the Twitter hashtag #dearmentalhealthprofessionals. Given the very negative effect isolation has on people with mood disorders and other mental health challenges (and, of course, everyone else), it seemed like a good idea. We were curious to see what people might have to say, and whether the posts reflected issues we hear about regularly from parents.

    Amanda, who her bio says has experienced some mental health issues herself, wrote, as several others did, about the importance of clinicians treating patients as peers, not condescending to them: "There is no 'them' and 'us.' We can become professionals, and just as easily you can become mentally unwell."

    Of course there were some who voiced criticisms: "When I'm struggling, in crisis and ask for help, don't call me an attention seeker and actually help." But also some thank yous: "... And now because of your persistence, humanity and compassion I am well enough to return to med school."

    Availability is obviously a sore subject, and rightly so. One wrote: "do not prescribe medication that increases suicidal thoughts & then not offer an appointment for 6 weeks." Another "I shouldn't have to beg to be allowed to see you" and finally "There aren't enough of you. Government has failed us all."

    The final word goes to Amanda herself, from a post which may have referred either to the hashtag or to mental health care in general, but applies equally well to both: "Appropriate humour can actually be really helpful. Everything doesn't need to be really serious."

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  • The Ravitz Report: 'The Bad Seed'
    Aug. 9, 2013 Alan Ravitz, MD, MS

    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 recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

    The other day, in a case conference, we discussed the nature/nuture question. Our fearless leader, Harold Koplewicz, mentioned The Bad Seed (directed by Mervyn LeRoy in 1956). It just so happens that I used this film in the film and development course I taught at NYU, since the movie focuses on the question of whether or not children are born "bad."  The interaction between biology and the environment, and the perceived dichotomy between these two forces, is well illustrated in this movie. It's a bit old-fashioned—way Freudian—but Patty McCormick, as the bad seed, is beyond creepy. Available on Amazon Instant.

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  • Asperger's: Out of DSM but Still in the Brain?
    Aug. 6, 2013 Harry Kimball

    The DSM-5 may have done away with the diagnosis of Asperger's syndrome—as distinct from autismbut the conversation (fracas is often a better word) over how to and whether we should differentiate low- and high-functioning autism continues. The latest item to address this thorny issue is a study out of Boston Children's Hospital that aimed to uncover physical brain differences between Asperger's children and children with the wider autism spectrum disorder diagnosis using electroencephalography, or EEG. The results are...mixed.

    Lead researcher Frank Duffy had already, in a previous study, determined that EEG could differentiate pretty well between kids with autism diagnoses and a typically developing control group. He did this by attaching those familiar EEG electrodes to their scalps and recording the electrical impulses the brain uses to communicate with itself. This paints a picture of connectivity between brain regionsand allows researchers to differentiate between stronger or weaker connections. Using some sophisticated data analysis tools, they were able to show that most kids with autism have similar differences in connectivity when compared to the control group. That is, properly interpreted EEG data agreed with clinical diagnosis.

    Now, to the current study: Let's say that Duffy's earlier work showed EEG could reliably differentiate between apples (kids with autism spectrum disorders) and oranges (typically developing kids). The new study reaches two conclusions that fall neatly on either side of the Asperger's debate. First, in the new study Duffy distinguished three groups of kids: those with Asperger's, those with autism, and those who were typically developing. Duffy found that, physiologically, Asperger's and other forms of autism are much more like each other than they are like the control group. Apples were still grouped with apples, oranges with oranges.

    But! Duffy's second discovery is that if you compare kids with Asperger's and other kids on the autism spectrum, EEG can reliably differentiate them based on brain connectivity. There are brain differences that support the (now passé) clinical separation between Asperger's and autism. So the study shows that Asperger's is on the autism spectrum, but also distinctthey're both still apples, but Asperger's is a Red Delicious and autism is Granny Smith.  

    I detect in Duffy's paper where his affections lie, and it isn't a far-fetched position for anyone who has experience with the incredibly wide range of the autism spectrum. "Although the findings above in many ways agree with the DSM-5 placement of [Asperger's disorder] within the broad autistic spectrum," the study authors write, "they also demonstrate that patients with Asperger's can be physiologically distinguished from those with ASD. Recognition of Asperger's as a separate entity is important from the patients' perspectives of obtaining appropriate medical and educational services as well as of establishing a personal identity." 

    In other words, though the diagnosis has changed, the kids are the same, and need the same personalized supports. This is true whether a child has limited communication and self-injurious behaviors or is highly verbal, intelligent, and socially awkward to the point of impairment. The results of this study could lead to new tools for diagnosis, prognosis, and monitoring of treatment efficacy. But in the meantime, it helps to remember what I've been told by every experienced autism clinician I have spoken with. "You've seen one child with autism," the saying goes, "and you've seen one child with autism."

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  • Kicking OCD's Butt at the International OCD Foundation Conference
    Aug. 6, 2013 Rachel Ehmke

    The International OCD Foundation's annual conference is different from other conferences. Instead of just convening professionals, the IOCDF conference includes people with OCD. A large portion of their programming is aimed at people personally impacted by the disorder—kids and adults with OCD as well as parents, spouses, and siblings. This is because the association includes nonprofessionals in its membership, which gives a unique immediacy to the work being done there. 

    A team from the Child Mind Institute attending this year's conference seized the opportunity to run a workshop for kids with OCD called A Weekend Adventure of Kicking OCD's Butt! Led by Dr. Jerry Bubrick and Dr. Rachel Busman, the team provided what's known as exposure and response prevention—a cognitive behavioral therapy used for treating OCD—to over 30 children over the course of two days. The conference was in Atlanta, but the kids participating came from all across the country—from Seattle to New Jersey, Florida to California. What's more, the kids came with a wide range of experiences with cognitive behavior therapy. Some kids had never received CBT, some received regular CBT back home, others were used to driving several hours for treatment because there aren't any providers near them—an all too familiar story. There was a range of ages in attendance, too—from 9 to 15 years old—but the kids were able to build a supportive community, which is important for the kind of therapy they were doing.

    Exposure therapy works by gradually exposing people to things they are afraid of, with the idea that our anxiety over something diminishes the more we become accustomed to it. With the help of CMI staff Marc Shuldiner, Jessica Meister, Erika Rooney, Naomi Reyfield, and Julia Brilliante, the kids performed what's known as "exposures." Some kids at the workshop were afraid of germs, so they'd practice handling money, sitting on the hotel conference room floor, and not washing their hands. Some kids with obsessions over symmetry or making things "just right" practiced not correcting mistakes, wearing twisted socks, or putting shirts on backwards. Kids who were afraid of heights took rides in the hotel's big glass elevator with Dr. Bubrick. One boy who was very troubled by aggressive thoughts that he couldn't control practiced holding a plastic knife to a clinician's arm.

    The idea of doing something you're afraid of in a room full of strangers sounds tough, but in this case it might have actually been an advantage. At the beginning of the workshop the team from the Child Mind Institute spent time explaining what OCD is and what symptoms might look like. "We saw a lot of head nodding," said Dr. Busman. "Kids would call out, 'Oh, I used to do that.'" Some kids remembered each other from attending past conferences, but others got to know each other quickly, bonding over shared experiences. The boy who was disturbed by his aggressive thoughts told the group that just admitting that he had these fears was an exposure on its own, but his peers were in a unique position to understand what he was going through, which helped destigmatize his confession.

    The kids also understood how to help each other during exposures. One of the hardest concepts for parents of children with OCD to grasp is how to provide comfort without giving reassurance, which can actually exacerbate a child's anxiety. During one difficult exposure, Dr. Busman remembered one boy who recognized the dilemma telling her, "I want to say something supportive, but I don't want to be reassuring."

    Parents didn't participate in the workshop directly. Some watched from the sidelines, but many attended parent-targeted talks happening elsewhere at the conference. Instead, the kids worked through their exposures together, and everyone made progress. "It was very challenging and very cool," said Dr. Busman.

    The workshop was a mini version of Fearless Friends, the Child Mind Institute's intensive weeklong treatment program for kids with OCD and specific phobias that starts again August 19th. The Child Mind Institute also hopes to do another workshop for next year's IOCDF conference in Los Angeles.  

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  • Liza Long's Son Talks About His Mental Illness
    Aug. 5, 2013 Caroline Miller

    Liza Long, best known as the woman who wrote "I am Adam Lanza's mother" in the wake of the Newtown school shootings, was criticized at the time for exposing her son to public scrutiny, though she changed his name. She wrote that he had frightening rages: "A few weeks ago, Michael pulled a knife and threatened to kill me and then himself after I asked him to return his overdue library books."

    Now Long has recorded an irresistible interview with Michael on StoryCorps in which the 13-year-old talks about the outburst she wrote about. He says his memory of the knife-wielding incident is a little blurry, but her description was pretty much accurate. "I didn't want to do it, but I didn't have control," he says.

    You can read about the interview on the NPR site, but it's better to listen to his voice, which reminds you just how young 13 years old is. "It almost feels like there's some extraterrestrial being taking control of me," Michael says, "and making me do all these crazy things."

    He says he doesn't mean to blow up the way he does. "I actually don't like it. And yet there's not really anything I can do about it." He worries that what he calls his "stupid rages" make him "unlikable."

    He adds, poignantly, that "people can't actually understand what mental illness is if they don't either have a mental illness or have lived and been with someone who does."

    Michael describes having a string of diagnoses—bipolar disorder, ADHD, intermittent explosive disorder, oppositional defiant disorder—and says what he'd really like is a treatment that cures him of the mental illness, rather than just helping with symptoms.

    In the meantime he says he gets pleasure from reading and writing—he's up to 47,000 words on his novel, The Demi-Gods From Outer Space. "It's a mix between sci-fi and mythology," he says.

    "Wow," says his mom. "Well, thank you. I really appreciate you taking time to talk to me."  We appreciate it, too.

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  • The Ravitz Report: Woody Allen Favorites and 'Happy Go Lucky'
    Aug. 2, 2013 Alan Ravitz, MD, MS

    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 recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

    You don't need me to tell you about Woody Allen movies (although my favorites are Cries and Whispers—no, wait, that's Ingmar Bergman—no, I mean Interiors and Stardust Memories—no, that's Fellini; no, it's Woody). So I saw the latest the other night and liked it very much. One of the best characters was Ginger, played by actress Sally Hawkins. And that reminded me of another of her films, Happy Go Lucky, in which she plays a teacher who is so optimistic that she drives everyone around her crazy. Very enjoyable and very deep at the same time. About what makes us happy, about how we create the worlds in which we live. It's a Netflix instant download.

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  • The Ravitz Report: 'Diva'
    July 26, 2013 Alan Ravitz, MD, MS

    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 recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety. 

    I subscribe to a service that makes daily film recommendations. A few days ago it recommended a French neo-noir directed by Jean-Jacques Beineix. That got me thinking about the director's other films, one of which is an all-time favorite that's nothing but fun. It's called Diva, from 1981—unbelievably stylish, fast moving, suspenseful, and like nothing I'd ever seen before. And besides all the gangsters, one of the characters is a very cool (and very stylish) philosopher. So this movie provides both cheap thrills and French intellectual pretension at the same time. What a combination! You can download it from Amazon for $1.99. (It's subtitled.) 

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  • Our Wishes for the Royal Baby
    July 23, 2013 Caroline Miller

    I can't resist a baby, royal or otherwise, so count me in with the millions worldwide who were pleased by the news of the birth of the young prince yesterday. 

    Ever since Kate Middleton's pregnancy was announced, the prospect of a new heir to the throne has worked as a nice antidepressant for Britons laid low by the prolonged recession there and the austerity prescribed to cure it. The royal birth also promises, pundits tell us, to act as a stimulant to the lagging British economy, though I'm not sure how that works. How many commemorative baby spoons, HRH onesies, and Union Jack booties can the populace really buy?

    As for the unnamed prince—as of this writing, psychics say he'll be George but bookmakers are favoring Henry—what we wish for him is a happy childhood in the most ordinary sense: loving parents with a good relationship, high but realistic expectations, and protection from the intrusive press.

    For the rest of us, Kate and Wills and their son offer some of the magic of the young Charles and Diana-fairy tale royalty with a modern twist. Like Diana, Kate is a commoner with a radiant smile. The text alert I got on my phone about the birth yesterday described the new baby as "descended from kings and coal miners."

    Unfortunately, the marriage of Charles and Diana was modern in the worst way, with betrayals and counter-betrayals, psychic warfare dissected in painful detail by a rabid tabloid press. Long before Diana died, the royal fantasy had been thoroughly bloodied, and we felt sorry that her lovely boys could hardly avoid hearing constantly about the mess of their parents' marriage.

    So we hope the Duke and Duchess of Cambridge take greater pleasure in each other's company, and are able to form a strong and loving relationship that will give their children an emotionally rich upbringing. It's the best gift any child could get.

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  • Outrage and Apology Over Rap Lyrics
    July 22, 2013 Caroline Miller

    Over the weekend, the autism community responded with outrage to some offensive lyrics from hip-hop artists Drake and J. Cole—and drew a surprisingly swift and effusive apology from Cole. The lyrics involved were the use of "autistic" and "retarded" as a putdown, in the recently released track "Jodeci Freestyle," as in, "I'm artistic, you niggas is autistic, retarded."

    This backlash-and-apology were particularly interesting in the context of the song itself, which manages to call women "hoes," sluts, bitches and freaks, among other things, and ends practically every sentence with "niggas," which lots of news sites feel the need to reproduce as "n---as."

    While a lot of us feel outrage fatigue when it comes to hip hop lyrics, autism bloggers and advocates have been using this sort of off-handed insult effectively as a rallying cry and teachable moment. And this time Cole decided to take instruction. "Last week, when I first saw a comment from someone outraged about the lyric, I realized right away that what I said was wrong," he wrote. "I was instantly embarrassed that I would be ignorant enough say something so hurtful."

    There is no way to know whether Cole was suddenly schooled by the blogger attacks or the petition to boycott the two rappers or the fact that, as Rolling Stone reminds us, both Lil Wayne and Rick Ross lost endorsement deals recently because of offensive lyrics—Lil Wayne's about Emmett Till, and Ross's appearing to condone date rape. Or perhaps it was all of the above. As a commenter on Cole's web site said, defending him from the charge of acting ignorantly: "J. Cole graduated Magna Cum Laude from St. Johns University, with a degree in communications."

    Whatever it is, we can't disagree with this comment, from his apology:

    To the parents who are fighting through the frustrations that must come with raising a child with severe autism, finding strength and patience that they never knew they had; to the college student with Asperger's syndrome; to all those overcoming autism. You deserve medals, not disrespect.

    I know some activists won't like the part about "overcoming autism," but you have to like the part about medals, not disrespect. Hopefully Cole remembers: Word is bond.

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