The Child Mind BlogBrainstorm

  • 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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  • Brainwave Test for ADHD Skips the Science
    July 22, 2013 Harry Kimball

    Last week we heard news that the FDA has approved the use of a medical device to aid in the diagnosis of ADHD, based on the electroencephalogram, or EEG—electrodes placed at different points around the scalp to measure the electrical activity in your brain. In theory, this sort of innovation is exciting—the practical application of advances in neuroscience that show us that real brain differences underlie psychiatric disorders. These illnesses are now diagnosed by so-called "subjective" means: clinical interviews, rating scales, observation. The objective "blood test"or in this case "brainwave test"for ADHD or depression or autism is in many corners the Holy Grail of psychiatric research.

    But even those who search for that prize acknowledge that we aren't there yet, and experts are skeptical of the device's readiness for primetime. The company who makes it contends that it helped clinicians make a better diagnosis than they would have without it, but doesn't offer any data on that claim. And EEG researchers aren't confident in the technique's accuracy without larger studies and more data. (Dr. Michael Milham, director of the Center for the Developing Brain at the Child Mind Institute, points to a recent study which concludes that the EEG method used by the device does not have diagnostic value in ADHD patients.) Finally, there is the question of exactly what the device measures. If at best the test replicates the observations of a trained clinician, it could simply be identifying symptomssymptoms that can indicate a variety of disorders, and require the interpretation of a trained clinician. "What's the point?" one ADHD expert asks The New York Times.

    But it got FDA approval! That's not as hard as people think, says Dr. Milham, particularly with a passive, non-invasive technique. The fact is that the FDA weighs a drug or a device's benefit against its risk. In this case, it seems by many accounts that the agency was convinced there wasn't any reason not to approve it. But that doesn't mean it's the answer, though we hope that one day EEG and other technologies like MRI and genotyping can be fully leveraged to get the best care to kids who need it.

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  • Summer Scribblers Intensive Writing Intervention Is a Hit
    July 20, 2013 Harry Kimball

    Recently the Child Mind Institute held our first ever session of Summer Scribblers, an intensive writing intervention designed to help struggling kids improve everything from individual word choice and usage to the overarching logic of paragraph construction. All 9 attendees—kids from fourth to eight gradeimproved over the week. But what is perhaps more telling is that both they and their parents reported that they were ready to continue honing their skills at home and at school. And that's the sort of impact we like to make.

    Summer Scribblers is the brainchild of Dominick Auciello, PsyD, of the Child Mind Institute's Learning and Development Center. Similar to our other intensive programs, Dr. Auciello took a proven interventionin this case the University of Kansas' Learning Strategies Curriculumand tried to see if he could condense an intermittent months-long approach into an intensive one without losing effectiveness. The weeklkong program is supported by booster sessions later in the summer, and perhaps through the school year. Everyone seems to agree that we're on the right track.

    But intensive doesn't mean exhausting, Child Mind Institute neuropsychologist Ken Schuster told me. In order that the students not get tired or frustrated by "pounding away at paragraphs," Dr. Schuster said, the week was broken up with field trips. These offered a breather, sure, but also allowed instructors to reinforce the writing lessons in conversation and provided the students material for when they had to put pen to paper again.

    "All the students made progress from their initial baseline-writing sample," says Dr. Auciello. And there was also some defying of expectations. "Some parents expressed surprise that children who are typically very resistant to writing attended so willingly, at how much they enjoyed it, and at how readily they engaged in a boat-load of writing during that week." We can't wait to hear how the first Summer Scribblers class greets the new school year. Based on the week's experiences, the sky's the limit.

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  • Optimizing Children
    July 16, 2013 Rachel Ehmke

    Spreadsheets are increasingly a part of many people's jobs, but do they need to be part of parenting, too? Amy Webb, a digital strategist (I don't know what this is) and bestselling author, thinks so. Her attitude isn't that surprising, since the book she became famous for, Data, A Love Story, is about how she harnessed data to "game" online dating sites and meet her husband. You might also remember her from her  Slate piece (an excerpt from the book) in which she came up with a (color-coded) 72-point list of qualities she deemed necessary in a future mate. People either love her or love to be horrified by her, although she might be losing people with this latest Slate story, about "data-driven parenting."

    First an explanation of what data-driven parenting means. Webb was anxious about being at "advanced maternal age" with the birth of her first child (another thing trending) so at 16 weeks she began tracking how much water she drank, how many milligrams of DHA she consumed, and how much she weighed every day of her pregnancy. After giving birth, a pediatrician told her to start measuring how much the baby was eating because she wasn't gaining enough weight. Webb expanded on this advice and began a spreadsheet that also recorded detailed descriptions of dirty diapers and her daughter's sleep habits, noting any potentially interfering factors, like air conditioning and church bells.

    They also measured how attentive the newborn was to readings from The New Yorker, Popular Mechanics, and board books they'd "received as gifts" (do we need to justify reading children's books to children?), factoring in the time of day and picture vs. word quotient. As their daughter got older, they began recording advances in vocabulary ("Dec. 10, 'ga' and 'mmm' sounds consistently") and, of course, new foods. The result is a kind of baby book on steroids, and Webb's been keeping it up for several years now.

    They use their data to inform their parenting decisions, Webb says. "It occurred to us that while our baby daughter couldn't communicate directly beyond crying, we could have a deeply intimate, beneficial conversation with her through data. We realized that we could quantify and study her in an attempt to optimize all of her development."

    Now, I don't want to get too down on this. Clearly she cares about her child and they are trying hard to be good parents. But her data collection does make me, and a lot of Internet commenters, uncomfortable. For one thing, having an "intimate, beneficial conversation" through data sounds like the kind of thing Google, Amazon, and everyone else would say to justify their constant surveillance. Shouldn't our parents, at least, be counted on to not turn us into a collection of data points? Also, at what point is she going to stop? The aloof teenage years are going to be tough on data.

    But mostly I'm disturbed because these spreadsheets seem to be less about finding a way to bond with their child and more about "optimizing" her. It's very descriptive of the kind of hyperfocus that makes parents start stressing and strategizing over the Harvard application before their kids even know how to tie a shoe. This is a woman trying to build an SAT vocabulary, not coo over pictures of a Very Hungry Caterpillar. Which isn't the worst thing. They're still bonding, whatever she's reading, and it is good for kids to hear lots of new words. But what happens when the child declines to be "optimized," as children are so wont to do?

    At least when she was using algorithms to meet her future husband, Webb had a goal with a clear end in sight. Now Webb's goal is her child's life, and that narrative is going to be a lot more complicated.

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  • Ratings Over Science: Jenny McCarthy on 'The View'
    July 16, 2013 Caroline Miller

    Science took a hit yesterday when ABC named Jenny McCarthy to be one of the co-hosts of The View. Of course, daytime talk shows court controversy, as well as telegentic blonde former models, but giving the celebrity spokesperson for the anti-vaccine movement a place at the table is a very disturbing move.

    You may dismiss the show, as many do, as silly talk, but a good deal of that talk is about politics and serious issues—not to mention serious guests who include sitting presidents and their wives. So it was fairly stunning to hear Barbara Walters, in announcing the hire, describe McCarthy this way: "Jenny brings us intelligence as well as warmth and humor. She can be serious and outrageous. She has connected with our audience and offers a fresh point of view."

    A "fresh point of view" is a shameful way to sugarcoat McCarthy's campaign against medical science and leadership of an anti-vaccine movement that endangers lives. Treating science as just one opinion among many is anything but harmless. As Time TV critic James Poniewozik puts it:

    To say that you can simply shrug off differences about medical fact as "outrageousness" or "controversy" is to feed the belief that science in general, be it vaccines or climate change or evolution, is simply subjective: you have your truth and I have mine. But we don't. The Earth didn't revolve around the sun only for Galileo.

    Even if McCarthy has been told by ABC management that the subject of vaccines is off the table, the hire gives her credibility, which can only inflame the vaccine conspiracy that she has been the voice of for years. As Alex Pareene points out on Slate:

    "Vaccine conspiracies, like so much modern cult conspiracy culture, perpetuates itself and lives on indefinitely thanks to the community-building and archiving of the Internet. With the help of some very prominent advocates, with huge audiences and a great deal of influence, it has spread far beyond the fringe."

    If you want to see what lots of other people had to say about the hire, read the comments of  some of the 2,000-plus people who have signed a petition on to urge a boycott of The View over the McCarthy hire. I'll give the last word here to one of them, Pennsylvania pediatrician Jane Longacre:

    Vaccines have saved more children's lives than any other public health intervention in history other than clean water. Don't allow ratings to take precedence over children's health!

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  • The Life and Death of 'Glee' Star Cory Monteith
    July 15, 2013 Beth Arky

    News of Glee star Cory Monteith's death over the weekend sent fans reeling. As Finn, the high school football star-turned-musical theater heartthrob, the 31-year-old actor had been a favorite, embodying the teenager who transforms from a kneejerk bully to someone who thinks for himself, making friends with those he once belittled.

    Cory Monteith

    When the show debuted in 2009, Finn was the stereotypical homophobic jock, throwing slushies into the faces of unsuspecting kids walking through the halls of McKinley High. So it was wonderful to watch him evolve into someone who cared and stood up for members of his diverse new glee club gang, including the wheelchair-bound Artie and the gay Kurt, who would eventually become his half brother. And when he fell for geeky girl Rachel (played by real-life-girlfriend-to-be Lea Michele), we fell in love with the star-crossed pair, too.

    But the successful high schooler Finn couldn't have been more different from Monteith. The Canadian actor, who was found Saturday in his Vancouver hotel room, was a high school dropout who had been battling drug addiction since he was 13. Monteith had announced in March he was entering rehab. An autopsy was to be performed today; the authorities have ruled out foul play.

    According to reports, Monteith dropped out at 16 after attending 16 schools, then worked as a Wal-Mart greeter and a school bus driver before checking into rehab at 19. As he told a Canadian talk show host in a 2011 interview, doing drugs "wasn't so much about the substances per se, it was more about not fitting in.... I hadn't found myself at all."

    Raising Drug-Free Kids: How Can the Science of Addiction Help Us?
    Featuring Nora Volkow, MD, Director, National Institute on Drug Abuse


    The actor was careful not to send the wrong message to his fans. He said he hoped his struggles with addiction would serve as an example: "I don't want kids to think it's O.K. to drop out of school and get high, and they'll be famous actors, too. But for those people who might give up: Get real about what you want and go after it."

    Monteith got real thanks to his involvement in the arts, something he credited for turning his life around, much as it did Finn's. "I think kids really need a place to go and feel like they belong," he said in a video posted on the site for Project Limelight, a Vancouver charity offering theater and arts programs to at-risk youth. "When I was a kid, I struggled a lot with who I was and where my life was going and what I was interested in. And I was fortunate to have the arts inspire me."

    Finn floundered post-graduation, leaving the Army soon after he signed up, but he found his way again when he returned to McKinley to direct the next generation of glee club members. Sadly, Monteith did not share his character's happy fate. But we like to think his example might inspire other struggling kids to find themselves through the arts, and those battling addiction or some other mental health problem to get help. 

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  • Understanding ADHD With Non-Stimulant Meds
    July 2, 2013 Harry Kimball

    Last week Dr. Jeffrey Newcorn, a child and adolescent psychiatrist and professor at Mount Sinai Medical Center, stopped by the Child Mind Institute to give a presentation on advances in ADHD medication—specifically his research on atomoxetine (brand name Strattera), a non-stimulant compound that is seeing increasing use.

    For me his most interesting point was that because stimulants are so effective at treating most cases of ADHD, the field has come to define the disorderin the criteria listed for a diagnosispartly by the targets of that treatment.

    "Our criteria are really strongly built to things that stimulants make better," Newcorn said. "So there is a real premium on efficiency of processing, getting tasks completed, finding boring things interestingthe things that stimulants do better." But as a clinician and researcher, Newcorn sees two problems here. For one, there are many more dimensions to the disorder—as he puts it, "all the things about ADHD that we'd like to track better that aren't part of our criteria." Andrelatedly, as he demonstratedthough most people with ADHD respond to stimulants, many don't. How to help them, he said, begins with understanding how they are different.

    Newcorn's rationale for pursuing atomoxetine emerged from a widely known clinical fact: there are two classes of stimulants, and if one doesn't work well for a young person with ADHD, chances are the other class will. About 80% of patients will respond to either methylphenidate or amphetamine. Are those other 20% just out of luck? Not if you broaden your idea of what "response" is, and understand that the two classes of stimulants, though similar, work differently in the brain. Why can't something else work?

    "It makes sense to look at atomoxetine," he said, which targets some of the same neurotransmitters as stimulantsbut in a very different way and in different parts of the brain, as Newcorn illustrated with imaging studies. Its effects are also different, he postulated, serving more to "drive mental effort" and "increase" the signal as opposed to stimulants, which "decrease noise." And it can help people who have been labeled non-responders to treatment.

    The upshot here is that all cases of ADHD aren't the sameand that Newcorn is blazing a trail into a future of personalized medicine. There is no place and no need anymore for a "one size fits all approach" to ADHD treatment, he said. Instead of settling on averageson the sunny but still wanting 80% response rate for stimulantswe can and should figure out "which drug is best for which patients." Or, as he put it, "our goal is not to treat partial responders with something that doesn't work too well." And by thinking about ADHD in a more catholic way, we find that the tools to achieve a better goal may be in front of us.

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  • Mental Health Shot Down With Gun Control
    July 2, 2013 Caroline Miller

    Back in the winter, when Congress was considering (however briefly) legislation reining in gun sales, some mental health measures were attached to the bill under discussion. The logic was that both initiatives were responses to the shootings at Sandy Hook Elementary School—measures designed to help keep children safer.

    While the gun control proposals on the table—extending background checks to sales at gun shows, or limiting the size of magazines for semi-automatic weapons—proved too controversial to get serious traction in the Senate, let alone the House, the mental health measures had widespread bipartisan support.

    So it's ironic that the defeat of gun control took the mental health bills off the agenda too.

    "When we had the bill on the gun debate last month, I think the only amendment, that passed was the one on mental health," Senator Roy Blunt of Missouri told a reporter at Missourinet last month, noting that the mental health provision cleared the Senate 95 to 2.

    The measure he was referring to is called the Mental Health First Aid Act of 2013, and it authorizes the launch of a demonstration program to support mental health first aid trainings nationwide on how to identify, understand, and respond to the signs of mental illnesses. It was introduced by Mark Begich (D-Alaska) and Kelly Ayotte (R-N.H.), and had eight other cosponsors from both parties, including Sen. Blunt.

    That's a bill that would have been especially meaningful for kids struggling with psychiatric issues, since it would support training for adults who work with young people—teachers, scout leaders, church leaders, etc.—to help them identify, understand, and respond to the signs of psychiatric problems.

    There are a number of other bills that were also proposed in the wake of Sandy Hook that also claimed bipartisan support, including one that would boost funding for local mental health centers. We have to wonder why interest in these bills disappeared as soon as gun control was declared dead—and we'd like to see them resuscitated.

    Whenever gun violence erupts, mental health initiatives are touted as the one thing everyone can agree on—supporters of the NRA and the Gabby Giffords and Brady campaigns alike. But for members of Congress they seem to gain traction only as an alternative to gun measures. We'd like to see that across-the-aisle support amount to more than a way for politicians to appear to be proactive in the wake of tragedy.

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  • Amy Winehouse and Bulimia
    June 25, 2013 Rachel Ehmke

    We thought we knew the Amy Winehouse story. The gossip press, obsessed with her self-destructive rampages, documented every boozy blowout and run-in with the law until she was a caricature of a celebrity in a downward spiral. That Winehouse was bulimic since her teenage years was less well known, although I remember seeing lots of "Scary Skinny!" style captions under paparazzi photos of the singer walking around Camden in her trademark ballet flats, often looking intoxicated.

    Her eating disorder wasn't a secret, but it just didn't get the same attention that her drug use did, at least until now. This week her brother, Alex Winehouse, told the press that he blames bulimia for her death, not substance abuse. In an interview with the Observer he said, "She suffered from bulimia very badly. That's not, like, a revelation—you knew just by looking at her... She would have died eventually, the way she was going, but what really killed her was the bulimia."

    I think hearing this comes as a shock to people because it deviates from the meteoric-rise-and-fall-of-a-celebrity story that we've internalized. Winehouse may have died at 27—putting her in the romanticized 27 Club of other musicians like Jim Morrison, Janis Joplin, and Kurt Cobain, who died tragically at that age—but her demons were around years before she got famous. It's a good reminder that substance abuse and addiction often don't come out of thin air. People who develop problems with substances often struggle with something else first—untreated depression, trauma, eating disorders—that don't get resolved so they begin self-medicating.

    Alex Winehouse's interview is also welcome because bulimia tends to be a very private thing that individuals and families struggle with quietly. Hearing people talk publically about it—and how dangerous it can be—is important. "We all knew she was doing it but it's almost impossible [to tackle], especially if you're not talking about it," her brother said. The Winehouse family has formed a foundation focused on drug and alcohol abuse and also recently donated money to Beat, an eating disorder charity.  Alex told The Guardian "We had to support eating disorder charities because no one talks about it."

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  • ADHD and Substance Abuse: Are Meds Really to Blame?
    June 24, 2013 Nancy Konigsberg

    This is a guest post by Nancy Konigsberg, an occupational therapist and applied behavioral analysis therapist who has a son with ADHD.

    Every time I see an article debating the benefit and/or consequences of giving children stimulant medication for ADHD I take notice. When I read recently that that researchers found a link between ADHD and substance abuse, but no link between medication specifically and substance abuse, I wanted to know why, and why people were speculating that the use of stimulant medications might contribute to substance abuse.

    This matters to me personally because my son has ADHD and he takes stimulant medication. But I am also a pediatric O.T. and I recently completed a post-graduate program in Applied Behavior Analysis. What my professional experience and education have taught me is that a disorder does not define behavior. The principle of behavior analysis is that behavior has a function—a child acts in order to get something tangible, or get attention, or to escape something, for instance. Behavior is either strengthened or diminished by the history of reinforcement. Whatever consequence immediately follows a behavior reinforces (negatively or positively) that behavior. If a child is having a tantrum and the parent says "I will give you a treat if you stop tantrumming" and the child stops and gets the treat, the tantrum was just reinforced. That is, the child understands that having a tantrum results in getting a treat.

    Until my son was in first grade, when he started on stimulant medication, I would get calls and complaints about his behavior on almost a daily basis. He was thrown out of programs and demoted. It's not that he was badly behaved per se. It was just that he couldn't sit still, he couldn't follow directions and that he had a hard time adjusting to a group environment. Almost the minute he started the meds, his life started to change. He could listen and attend and interact appropriately with his peers.  This allowed him to do well academically. And it wasn't just in academics that he started to excel. He was named "outstanding music student of the year" and "most improved swimmer" on the swim team. Prior to taking the medication he had difficulties with motor skills. It seems that the medication allowed him to process information much better. Slowing him down allowed him to learn. And when he learned, he started to succeed. When he succeeded he got rewarded with commendations, trophies and good grades. The reinforcement of recognition and praise keeps my son on track. 

    This makes me wonder about the link between ADHD and substance abuse: whether those kids who have ADHD and don't get positive feedback turn to drugs because of their history of reinforcement. When children aren't behaving appropriately or aren't doing well in school they usually hear criticism instead of praise. If all they ever hear is "Why can't you do better?" or "Why did you get detention?" or "Why can't you do anything right?" they develop poor self-esteem. They don't get feedback that will keep them on a good path. Their history of reinforcement is one of negativity. Ultimately, they seek approval from peers or escape or just a means to feel good. They achieve this with substances such as drugs and alcohol. 

    The study linking ADHD and substance abuse itself offers evidence for this hypothesis. The researchers noted that children with comorbid ADHD and ODD/CD (oppositional defiant disorder/conduct disorder) may be much more at risk than those with just ADHD. They observed that the ODD/CD might be the problem rather than the ADHD. They also noted that there is evidence that parental maltreatment is more likely to independently predict substance abuse problems than childhood ADHD. The point here is that the history of reinforcement might be the most relevant factor in contributing to future substance abuse.

    Why do I bring all of this up? It is easy to form misconceptions when we hear that children with ADHD are three times more likely to develop substance use problems than typical children. And it is easy to shy away from trying stimulant meds when you hear that they may be related to addiction.  But the ADHD or stimulants might not have a causal relationship with substance use. It may well be that it is the history of reinforcement for a child which is much more predictive of future behavior. 

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