The Child Mind BlogBrainstorm

  • The Ravitz Report: 'Ghost World'
    March 22, 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 will recommend here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

    I saw a patient yesterday, and she noticed that I had a DVD of "Ghost World" (d. Terry Zwigoff, 2001) on my shelf. She told me that she read the comic and saw the movie, and that one of the characters, Enid, reminded her of herself. Got me to thinking that I really liked this somewhat disturbing coming of age film about two sort of angry high school seniors (Thora Birch and Scarlett Johannson) who just don't quite fit in, and the very quirky and sort of sad guy (Steve Buscemi) with whom they get involved. Zwigoff directed "Crumb." Birch starred in "American Beauty." 

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  • Caring, Proactive Approach to School Violence
    March 18, 2013 Harry Kimball

    We've heard a lot of talk recently about the link between mental illness and school violence—talk that has the unfortunate consequence of making people afraid of kids who might be struggling, and a lot more likely to hurt themselves than anybody else. That fear and stigma in turn produces isolationthe worst thing for a depressed or angry teenager.

    That's why we were heartened to read about a new program in Los Angeles that does the opposite: encourages people to speak up when kids say or do something concerning, and then gets to know those kids. The LA program, as described in the New York Times, is dubbed the School Threat Assessment Response Team, and it appears to be remarkably successful.

    "When we looked at kids who had committed attacks, the vast majority had come to the attention of an adult for a behavior that was concerning but would not necessarily cause someone to conclude they were planning an attack," says a former Secret Service agent whose research provides the foundation for STARTS across the country. The LA team's leader describes what happens when a young person at risk comes to their attention. "We'll go to a school, evaluate the individual there, then what we'll also do is go to the kid's home and we'll ask to see the bedroom and we'll do a very data-driven assessment," he says. "We're trying to figure out, what are the triggers here? What are the risk factors? What's really going on and how can we intervene?"

    This obviously requires cooperation between mental health professionals, schools, police, and families that seems like it might be almost impossible in some cities and states. But beyond an "initial shock," an affiliated detective says, "We get a lot of cooperation from parents...they want to know, too, what did I miss?"

    This sort of intensive approach raises a lot of questions even as it appears to deliver results. Does it violate privacy? Do kids get caught up when they don't deserve to? Perhaps—I suggest you read for yourself. But the program represents a crucial understanding that people who are hopeless and isolated can make disastrous choicesand that it takes a multipronged approach to help. From START's website: "The goals are relatively straightforward: develop relevant partnerships to mitigate/eliminate threats; assist students of concern in their efforts to complete their education without incident; and prevent a Columbine or Virginia Tech incident."

    Put simply, we know that children's mental health, the safety of the school environment, the strength of the community, a family's ability to reach its potentialthese are all interconnected. And the first step in aiding kids is providing a trusting framework of people close to them to be able to reach out and say, "He needs help."

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  • Lena Dunham Brings Her OCD Experience to 'Girls'
    March 12, 2013 Rachel Ehmke

    Fans of the HBO show Girls may have been surprised to see an OCD storyline introduced last week. We learned that Hannah, the character played by the show's creator and head writer Lena Dunham, was diagnosed with obsessive-compulsive disorder as a child and is having a relapse now, brought on by a recent breakup and stress over her book deal.

    Hannah is falling back into an old anxious habit of doing things in increments of eight (open the front door eight times, eat eight chips, even bump into a stranger eight times at a restaurant), counting as she goes along. As luck would have it her parents are in town, and they noticed her old compulsion immediately.

    What follows is a thoughtful and realistic depiction of what it can be like when young adults are dealing with mental illness. Her father reverts to baby talk, calling the flare up "getting county" and wants her to come back home and consult her pediatrician. Meanwhile Hannah, who is having a hard time admitting even to herself that her OCD is back, resents her parents' interference and tries to convince them that she is in control. When she gets coerced into treatment she tells her psychiatrist, "I will really do anything you say if you tell my parents I'm okay" instead of facing the fact that she needs help.

    The downward spiral continued in Sunday night's episode, when one of her compulsions put her in the emergency room, and in a preview for next week's episode her father accuses her of not taking her medication.

    It's a good illustration of how a psychiatric disorder can threaten hard-won autonomy and undermine a fragile self-image. Disorders like OCD can be very successfully managed, but they can also recur. Acknowledging that old, unwanted behavior patterns are back is the first painful step to mastering them again.

    The sensitivity of this plot line comes in part from the fact that Lena Dunham has struggled with OCD in real life. In an interview Dunham said:

    It's something that I've struggled with so I feel as though I am able to shed a certain kind of light on the experience and do something that doesn't necessarily feel cookie cutter. One of my biggest pet peeves is when people go like, 'I just love it when my room's clean; I'm so OCD!' It's like, actually no, you're just a neat person and not a slob animal.

    So far the show has done a great job of doing that, and I've even seen several Girls-inspired OCD primers popping up across the Internet. (Here's one great example.) Mental illness portrayed right in the media is a rarity, and seeing it on a popular show that gets people talking is good for everybody. 

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  • Temple Grandin on Autistic Kids and Video Games
    March 11, 2013 Caroline Miller

    This morning we caught up with a rather interesting new conversation with Temple Grandin, posted by Autism Live, in which she offers her striking trademark combination of insight and common sense.

    Asked by a parent what she thinks of inclusion for autistic kids, Grandin recalled that she herself had a successful experience with inclusion in a small, rural lower school. But her stint in a big public high school was a disaster, so she was sent to a specialized boarding school. There she did more talking to adults (not to speak of  horses) than other kids, but that was fine by her, she said, because "I'll be honest, socializing with teenagers was not a life-skill I needed."

    Bad experiences in middle and high school are the reason a lot of parents turn to home schooling, she noted. "For some kids, getting away from the whole teenage scene is the best thing you can do," but not if home schooling means letting kids retreat to their rooms and become "video game recluses." Grandin is passionate about autistic kids, in fact all kids, learning early to do work, around the house and outside the house. She believes that work skills she was taught early—sewing and mucking out horse stalls and carpentry—made a huge difference in her development.

    "You've gotta stretch these kids," she says. Kids should be doing more physical work, and more making and building things."One of the worst things schools ever did was taking out things like auto shop, wood shop, metal shop, art, and cooking—all those hands-on classes that can turn into great careers."

    And video games? An hour a day. As a kid, she was allowed just one hour to do what was her equivalent of playing video games—spinning a brass ring that covered a bolt on her  bed, and studying it as it slowed down. She could have done it for hours, and been riveted, she notes, but she was allowed just one, and then she had to be out of her room doing something.

    By the way, asked if she believes she would still have a diagnosis of autism under the new criteria in DSM-5, Grandin said absolutely. She had full-blown symptoms of autism as a child, she said, including very delayed speech, rocking, spinning, flapping, repetitive behaviors. What helped her develop her talents so effectively, a parent wondered. Superb early intervention, great teachers, work skills developed early. And there were  good people all along the way who helped her, she said—even in the cattle industry she so famously criticized.

    For more conversations between Grandin and Autism Live's host Shannon Penrod visit Autism Live's Interview Series With Temple Grandin here.

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  • AP Style: Nuanced Understanding of Mental Illness
    March 8, 2013 Harry Kimball

    Yesterday the Associated Press released new guidelines for its reporters when writing about mental illness, and we're happy to say that the entry in the AP Stylebook hits all the right notes. (And since AP Style is essentially the lingua franca of news organizations everywhere, these standards will be widely disseminated.) Rarely does a press release warm the heart.

    The best thing about the AP's guidelines is that they aren't really about word choice—although it does caution reporters not to "use derogatory terms, such as insane, crazy/crazed, nuts, or deranged." They are more about when and why we mention mental illness, and what sources of information are appropriate and credible. "This isn't only a question of which words we use to describe a person's illness," AP's executive editor says. "There are important journalistic questions, too."

    The guidelines start strong: "Do not describe an individual as mentally ill unless it is clearly pertinent to the story and the diagnosis is properly sourced." The AP is telling its reporters to think before they report a fact that could have nothing to do with the story to resist preconceived assumptions that that weirdness and violence are tied to mental illness—and not to believe armchair diagnosticians for the same reason. Excellent advice.

    "Do not assume that mental illness is a factor in violent crime." Check. "Avoid unsubstantiated statements by witnesses and first responders." Check. "Double-check specific symptoms and diagnoses." Double-check.

    These are guidelines for good reporting, and I think it takes courage for an organization to admit that it needs to be a little more specific in saying good reporting practices don't stop when mental illness enters the picture. And that leads to the kicker. Go to the source, the guidelines read. "Whenever possible, rely on people with mental illness to talk about their own diagnoses." J-school 101, but we're happy to see it in print.

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  • Three Moms on How Kids Keep Them in the Moment
    March 8, 2013 Beth Arky

    Last month, Emily Rapp did the unimaginable: She buried her child. Her son, Ronan, died just short of his third birthday. Rapp and her husband had been living with the knowledge that he would not survive long since January, 2011, when their then-9-month-old was diagnosed with Tay-Sachs disease. To deal with her grief, Rapp turned to writing a blog and now a new book, The Still Point of the Turning World, which offers all parents a powerful message, one that can be so easily forgotten in a world of ambitious parenting and overscheduled kids.

    "A child is a person, not a project," she wrote recently at Today. "Ease up. Chaos will find all of us eventually, but in the moment, how can you be fully present? How can you love your child purely and simply, with no agenda, without a goal, without a net?"

    As she says in the book, "Ronan was Ronan. He was never just a sick baby. My life as his mother was more than just managing the illness and the many difficulties it presented." On the Today show this morning she added, "The message that I want the book to convey is that we should love our children for who they are in the moment, right now, no matter what they become or what they achieve."

    This reminder takes on special meaning for parents of children and teens with developmental, cognitive, emotional or social challenges, who can find themselves consumed by 24/7 advocacy and support for their kids.

    We thought about Rapp's comment when we read Beth Andersen's latest post about her son, Nik, at Maternal Instincts. She rejoices about a milestone "many, many years in the making" and "still a work in progress": Writing his name at age 9.

    Nik has multiple disabilities including autism, cerebral palsy and other health issues related to his extremely premature birth at 27 weeks, and he's nonverbal. "He may not ever really talk; we suspect he has some nerve damage to some of the areas needed to articulate certain sounds," Andersen explains. "But he tries. He always, always tries. I think that is the gift I was really writing about...his grit and determination. He's taught me so much in his short life. I am so incredibly proud of his efforts and his perseverance."

    Andersen says that having a child born so prematurely and so fragile teaches you a lot about yourself. "You learn your capacity to block out fear and focus on love and hope," she says. "Watching other very sick babies around you—some of whom don't make it—teaches you to stay firmly grounded in the moment. All you have is here and now; you learn to celebrate the things which so many people take for granted every day."

    Jess Wilson, who blogs at Diary of a Mom about her autistic daughter, shares Andersen's and Rapp's way of thinking. Yesterday's update on Diary's facebook page:

    "Love may not always be expressed in the ways in which we've become conditioned to believe that it 'ought' to be. But if we are open to accepting it as it is most freely and comfortably given, we get the immeasurable gift of authenticity—of raw, genuine emotion unadulterated by the confines of convention and expectation.

    "And when it is delivered," she adds,  "if we are there—truly THERE to receive it, it is a gift beyond measure."

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  • The Ravitz Report: 'Nobody Knows'
    March 8, 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 will recommend here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

    "Nobody Knows" (d. Hirokazu Kore-eda 2004, Japan) This is a film about a group of young children who are abandoned by their mother and left to fend for themselves in a large Japanese city. Their ongoing but unrealistic attachment to their mother, and their hope for her return, informs their behavior and interactions with one another. This is a great film.

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  • Genetic Link for ADHD, Autism, Bipolar, More
    March 5, 2013 Harry Kimball

    Last week the New York Times reported on an intriguing study—"the largest genetic study yet of psychiatric disorders," according to its authors-with these results: there are genetic risk factors for disorders like autism, bipolar disorder, schizophreniaand some of them are the same across disorders.

    The authors looked at genetic information from more than 60,000 people, about half with no psychiatric diagnosis and half with schizophrenia, bipolar, autism, major depression, or ADHD. In a nutshell, they found mutations in the clinical population at four DNA locations that conferred some risk for all five disorders. Although two of these locations suggest the possibility of a novel treatment, the authors caution that the impact of this study should be more along of the lines of changing how we think about mental illness.

    The study jibes in particular with the push to replace the "subjective" measures like symptomology in diagnosing psychiatric disorders with objective tests, which haven't been available. As the authors write in their conclusion: "Our findings are relevant to the goal of moving beyond descriptive syndromes in psychiatry and towards a nosology informed by disease cause. " (We should note that the risk implied by these DNA mutations is very smalland that the genesis of all of these disorders remains a complex combination of biological and environmental factors.)

    This study is particularly important because investigators have not only located a contributing biological risk factor, but they've put forward an argument for reimagining how we group disorders.

    As the authors add: "The finding that genetic variants have cross-disorder effects is an empirical step towards helping clinicians understand the common co-occurrence of clinical phenotypes in individual patients." Or, in English: These sorts of results have the potential to help real people struggling with mental illness get better care from better informed clinicians. Sounds good to us.

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  • Art Auction Raises $2 Million for Science of Brain Development
    March 4, 2013 Caroline Miller

    We called it "great art for great science," but the Child Mind Institute's benefit auction at Sotheby's last week also turned out to be about great friends. Peter Brant and Stephanie Seymour Brant curated a group of 22 stellar pieces, and the crowd bid so enthusiastically that the evening succeeded in raising more than $2 million for the search for better understanding, and treatment, of childhood psychiatric and learning disorders. 

    Joining the Brants as hosts were Daniel and Brooke Garber Neidich, and guests included Larry Gagosian, John McEnroe, Aby Rosen, Ron Delsener, Dori Cooperman, Vito Schnabel, and Jessica Hart. Artists who donated works included Jeff Koons, Elizabeth Peyton, Enoc Perez, John Currin, David Salle, Julian Schnabel, and Patrick Demarchelier.

    Encouraged (to say the least) by auctioneer Tobias Meyer, Sotheby's worldwide head of contemporary art, bidders blew by the $95,000 estimate on Nate Lowman's "Fleshtone," which finally sold for $235,000. And the evening's top bid went to Urs Fischer's "Paranoia/Squirrel," which hit $360,000. (By the way, if you missed the Fischer show at the New Museum a couple of years ago, you might have seen the giant yellow teddy bear with reading lamp that was installed outside the Seagram Building for several months.) Other standouts that sailed by their estimates were a Richard Prince triptych that drew $175,000 and a Dan Colen that drew $145,000.   

    Many thanks to the Brants and Sotheby's, all the terrific artists who donated work, and all the collectors who participated so generously. It was a huge success for the science of brain development, and the kids in the future who will benefit from it.

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  • One Man's (Involuntary) Introduction to Mindfulness
    March 1, 2013 Tim Kelly

    Every morning when I wake up I take a few minutes to identify three goals for my day.  Then I put a rubber band around my wrist as a reminder of them. At the end of the day, if I have achieved my goals, I add the rubber band to my expanding rubber band ball.

    Last Friday ended a productive workweek filled with wins and an expanding rubber band ball. On Friday evening, I checked my briefcase and hung my coat on a restaurant wall to settle down for a Mexican dinner with friends. When we were ready to leave, I grabbed my briefcase, and scrambled inside my coat pocket to check my email. No phone.  It wasn't in my coat.  Where could it be? The table? Nope. The floor? No. My pants pockets? I checked three times. "Quick," I yelled to my friend, "call it, it has to be here." It wasn't. Someone had stolen my phone. 

    I was just thinking how vulnerable I would be without my communication lifeline, weekend to-do lists, time-saving tools, articles that I had saved to read—the list (on my phone) goes on and on—then I remembered I also had no Internet at my apartment. It had been shut off earlier in the week when the credit card on my cable account expired. The notification emails from the cable company apparently were some of the 4,000 unread messages in my inbox. 

    Cue 26-year-old metropolitan male meltdown in New York City.

    When I got home I was exhausted. I decided to de-arm my rubber band, add it to my rubber band ball, and disconnect until I had to reconnect with a phone on Monday.

    I woke up late on Saturday and missed the spin class I had signed up for 26 hours in advance using one of my phone apps. The weekend papers didn't download onto my iPad without Internet service, so I grabbed them along with a coffee at the store on the corner. I read for hours on a park bench overlooking one of the snow-covered Central Park lawns—a view that would have been a "no filter" Instagram shot, for sure.

    After reading the papers, I picked up my laundry and went back to my apartment.  I don't own a TV (buying one has been on one of my phone task lists for three years) and without Pandora, I decided to clean my apartment to songs on CDs that I had discovered over the holidays in my childhood bedroom. They were incredible tunes, the type that motivate you to sing loudly and badly, and break into an occasional dance with a ski cap and a "decorative" orange apron. 

    The allure of recouping some time and space to think, on my own and without interruptions, was suddenly attractive. I spent my two disconnected days kicking around coffee shops, reading, exercising, and eating at new restaurants, my thinking not punctuated by "breaking news" alerts or Facebook status updates. I walked around not in conversation on the phone. I ate at new restaurants without checking online reviews. There were many unexpected firsts during my post-meltdown personal days and it was terrific.

    At this point, I want to extend a big thank you to the person who stole my phone on Friday night. You're a dirtbag, 100 percent, but by having my smartphone in your hand, you kept it from mine. That, in turn, forced me to recoup some mindfulness and reorient myself before another week's worth of rubber band goals.

    The return on investing in a dose of mindfulness is invaluable. My mindful weekend helped me recapture a motivating vision of my future—a context my daily goals have been lacking in recent months. My two post-meltdown days taught me that there's a time and a place for technology-assisted activities, and a time to be mindful. 

    Now, with all this said, I'd be remiss not to report that by Monday I was anxiously, not mindfully, waiting to receive my new phone. But when the workweek comes to a close and I celebrate over dinner (with my phone in a more secure place), my expectations for the weekend will be refocused to include time and space to think, recharge, and reposition myself—and, of course, to pay that overdue cable bill.

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