The Child Mind BlogBrainstorm
Treating Schizophrenia Early, and With More Than Medication
Oct. 26, 2015 Caroline Miller
The importance of early mental health interventions got a big boost in a just-published study of 400 young adults with schizophrenia. In the NIMH-funded study of patients who had experienced their first psychotic episode, or break from reality, it was shown that the sooner treatment was started, the better they did.
Treatment that combined psychotherapy and low doses of antipsychotic medications, along with family education and support, proved more effective than standard care, which usually relies on higher doses of medication alone.
The program, which was developed at Hofstra University, was implemented at 34 clinics around the country where teams of specialists were trained to coordinate care for each individual. Patients treated at clinics using the program showed more improvement in symptoms, along with better relationships, quality of life, and involvement in school and work than those who got standard community care. They also stayed longer in treatment.
This news underscores the value of programs designed to catch teenagers exhibiting signs of psychosis before the first full-blown psychotic episode. Again, there's evidence that if they do develop schizophrenia, the treatment and support can delay onset and reduce its impact on their functioning and their families.Read More
Sesame Street Debuts an Autistic Character
Oct. 22, 2015 Beth Arky
There's a new girl on the block over at Sesame Street. Julia has red hair, bright eyes and a big smile. She's also autistic. Julia is part of a new educational and awareness initiative, Sesame Street and Autism: See Amazing in All Children, aimed at building understanding and destigmatizing differences.
The initiative, which uses the hash tag #SeeAmazing, includes a free app that features new storybooks led by We're Amazing, 1, 2, 3 and more interactive tools and resources like videos and daily routine cards.
In the storybooks, Julia explains to her friends how she plays a little differently. "If you're 5 years old and see another kid not making eye contact with you, you may think that child doesn't want to play with you. But that's not the case," Sherrie Westin, executive vice president of global impacts and philanthropy, told People. "We want to create greater awareness and empathy."
Julia's character is a real step forward—but it might be the real-world stories that really hit home for many viewers. We found ourselves touched and impressed by a four-minute video peek into a day in the life of Nasaiah, a young boy with autism. If everyone could see the joys and everyday challenges from his family's perspective, understanding wouldn't be far behind. And with muppet Abby enlisted as a guide, she of the "sparkle-tastic!" catchphrase, the message is calibrated to land where it will do the most good: our kids' ears.
Sesame Street created the initiative with input from parents of both autistic and typically developing kids, autistic adults and special-needs teachers, including everyone from blogger Frank Campagna of Autism Daddy, who also works on the show, to the Autistic Self Advocacy Network.
And relatedly, from The Times: What it means to think that Fozzie Bear was already the first autistic Muppet.Read More
On the Shoulders of Giants 2015: Tom Insel on Building the Future of Mental Health Care
Oct. 16, 2015 Harry Kimball
The Child Mind Institute welcomed an inquisitive crowd yesterday to the auditorium at the New York Academy of Medicine for its fifth annual On the Shoulders of Giants scientific symposium, celebrating achievement in neuroscience and the strong community that nurtures that success. This year the neuroscience lecture series honored the 2015 Child Mind Institute Distinguished Scientist, Dr. Tom Insel, director of the National Institute of Mental Health, and also featured presentations by Dr. Conor Liston, of Weill Cornell Medical College, and Dr. Nim Tottenham, of Columbia University.
Dr. Insel laid out a bold and optimistc vision for the future of mental health services delivery, aided by scientific advances. His theme was that while "we have problems with access and problems with quality" in mental health care, the central challenge is to better understand the treatments we have now, and when and with whom they'll be effective. He drew the parallel to the revolution in childhood cancer mortality, which wasn't due to a "magic bullet" treatment. "What really happened is that the way we provided care got better," he said. "We moved practice into research so that every family became a partner in research, and that's what needs to happen here." Dr. Insel hopes that both advances in academic research technology like genomics and imaging, as well as the ubiquity of smart phone tech for data gathering in the everyday world, will contribute to a sea change in service delivery where all the appropriate treatments can be integrated into high quality "network solutions."
For example, Dr. Insel noted, "many of the projects coming out of the Child Mind Institute, particularly a project like the Healthy Brain Network, are going to give us the fundamentals, the kind of science we need to be able to provide far better services in the future."
Of course, "we do have real treatments that work for these developmental brain disorders," Dr. Insel reiterated in answer to an audience question. But often which one will work for which individual is still something of a mystery, "so what care your child receives depends on what door you knock on." A version of this problem motivates Dr. Conor Liston, whose research runs the gamut from stressed-out rodents to depressed human patients. In a freewheeling presentation, Dr. Liston described how his lab's observations about dysfunction at the synaptic level led to measures of subtypes of depression based on abnormal brain connectivity identifiable in MRI brain scans—in short, biomarkers not only for depression, but for novel subtypes of the disorder.
That is not what excites Dr. Liston, however. "Bottom line is we don't need a brain scan to diagnose depression," he said. But if it could inform treatment, that would have an impact. "Our treatments do work well for some people, but they typically take a long time and they often don't work on the first try. So it would be great if we could design better treatments based on these observations." One area where he is already seeing promise—both in treatment response and in the predictive power of his research—is called transcranial magnetic stimulation.
Finishing off the morning, Dr. Nim Tottenham began her presentation by sternly (and jokingly) reminding the audience that "childhood is important." Her research concerning the connection between brain regions responsible for emotion and emotional regulation (the amygdala and the prefrontal cortex, respectively) and how it changes over time allowed her to paint a detailed picture of childhood behavior and offer a convincing explanation of how normal development can go off track.
Dr. Tottenham showed through her lab's research and experiments that "the caregiver exerts a powerful regulatory influence" on the developing neurobiology of emotion, limiting the power of the amygdala maintaining immature brain processes and relationships for the extended period of human development. In other words, as she put it, "immaturity is a luxury humans were given." And while all of the secrets of childhood may rightly elude us, the complex social, biological, and developmental factors at play conspire together so that there is "something special about events that get under the skin" during our earliest years—bad or good.
Prior to the presentations, five New York City-area high school seniors were awarded Rising Scientist Scholarships for their already demonstrated commitment to scientific inquiry. "These are five remarkable young ladies who give us hope," said Child Mind Institute president Harold S. Koplewicz, MD, before presenting the awards. In the spirit of On the Shoulders of Giants, Dr. Koplewicz thanked parents and teachers for getting the winners this far, and then read a selection of what their nominators had written about them: "Meticulous. Patient. Responsible. Organized. Extraordinary. Simply outstanding. A natural scientist."
"I think we can all have hope that these five women will carry the ball," he concluded.
Dr. Insel took a moment to echo the message of community and lineage at the beginning of his remarks to the general audience. Scientific progress "builds incrementally over generations," he said, "and it's part of the fun of being part of scientific life—you both get to benefit from mentors who care and you get to generate the next group who will in turn also be mentors." Science is "a very social endeavor."Read More
The Oregon Shooting: What's Wrong With Blaming Mental Illness
Oct. 6, 2015 Beth Arky
Another horrific mass shooting, another chance to place the blame. For many who are adamant opponents of gun control, that means focusing on the mentally ill. Last week's rampage at Oregon's Umpqua Community College had a number of presidential candidates and other public figures pointing to the role mental illness may have played in the devastation wrought by the 26-year-old shooter, who took nine lives before killing himself.
As satirist John Oliver pointed out, the sudden political interest in mental health after a mass shooting is not always sincere. During a particularly apt analysis on Sunday's Last Week Tonight With John Oliver on HBO, Oliver said, "Perhaps the clearest sign of just how little we want to talk about mental health is that one of the only times it's actively brought up, as we've seen yet again this week, is in the aftermath of a mass shooting as a means of steering the conversation away from gun control."
Besides being disingenuous, pointing fingers at mental illness right now is dangerous, too. As Oliver explained, the aftermath of a mass shooting might be the "worst time" to talk about mental health because "the vast majority of mentally ill people are nonviolent, and the vast majority of gun violence is committed by non-mentally ill people." The reality, Oliver added, is that "mentally ill people are far more likely to be the victims of violence rather than the perpetrators, so the fact that we tend to only discuss mental health in a mass shooting context is deeply misleading."
Not only is it misleading, it effectively endorses the stigma that keeps many people from getting the kind of care that could transform their lives. What could be a constructive conversation becomes scapegoating.
Already this shooting has elicited an outpouring of virulent anti-autism chatter on social media, stimulated in part by the fact that the shooter's mother, Laurel Harper, has written in online postings that both she and her son struggled with Asperger's syndrome.
During his show, Oliver cited the shocking ways the mentally ill are dealt with in this country: We've gone from asylums to no treatment; nursing homes, even for the young and middle-aged; one-way bus tickets out of town; and jails and prisons. Some 2 million people with mental illness go to jail every year, and they are estimated to be 10 times more likely to be behind bars than receiving care in a state psychiatric hospital.
Oliver noted, as countless families have found, that making the criminal justice system a de facto provider of services to the mentally ill isn't just ineffective, it's dangerous. "Because often, when someone is having a mental health emergency, the police will be called, and that can end tragically," he said. "By some estimates, an incredible half of all incidents involving the police use of deadly force involve a mentally ill person."
After playing tapes of Donald Trump, Mike Huckabee, and Ben Carson calling for the need to fix a broken mental health system, Oliver summed up this way: "Fine—do it then. Because if we're going to constantly use mentally ill people to dodge conversations about gun control, then the very least we owe them is a f------ plan."
We can only hope the time will come when it doesn't take shootings to spur this important conversation.Read More
SuperBetter, the Game Designed to Improve Your Mental Health
Sept. 22, 2015 Rachel Ehmke
Six years ago Jane McGonigal, the game designer and creator of several extremely popular TED talks, had what she calls a "stupid household accident" that changed her life. McGonigal knocked her head against an open cabinet door and sustained a traumatic brain injury, with effects that lasted for a full year. She was in a mental fog—unable to concentrate or remember things—and experienced headaches, nausea, and vertigo. Her doctor put her on cognitive rest to help her brain heal quicker, which meant for months she couldn't read, write, work, run, drink coffee, or play video games. "Obviously there was no reason to live," she joked to the crowd she was telling her story to at the New York Public Library last week.
But it began to actually feel that way for her. Like many people who experience serious brain injuries, McGonigal was also feeling depressed and anxious, which only increased as she avoided doing the things that made her happy. In a vicious cycle, her doctors warned her that it would be harder for her brain to recover if she stayed feeling depressed. And so McGonigal, who has big blonde curls and was wearing sparkly tennis shoes to her speaking event, disclosed that she starting having suicidal thoughts. "My brain began telling me that I would like to die."
Jane the Concussion Slayer
During this time she was supposed to be writing her first book, Reality Is Broken, not that she was able to work on it. The book would argue that games make us happier, more creative, and more resilient. She was surrounded by research claiming this, so she started to think maybe a game could be the answer for her. Working in short bursts, and with the help of family and friends, McGonigal began making a game to help herself get better. She called it Jane the Concussion Slayer, in honor of her hero Buffy the Vampire Slayer. Over time her symptoms began to leave, and while she says she can't totally credit the game, she does know that her mood improved as soon as she started playing.
She has since renamed the game SuperBetter and turned it into an app that other people can play to help them with things they are struggling with—anything from weight loss and lowering stress to mental health issues like depression or anxiety. The game isn't therapy, and shouldn't be used in place of therapy for people who have real mental health concerns. But McGonigal says it could be considered a good supplement to treatment, and anyone who has participated in cognitive-behavior therapy will see that it has some similarities.
How the game works
To play the game you have to identify and then battle "bad guys," or the obstacles or triggers in the way of your goal. There are "power-ups," which are specific positive things that you do to break negative cycles that you are in. For a confidence boost, players get to create a powerful secret persona—a version of yourself that is strong and capable of undertaking heroic quests. And as McGonigal wrote in her blog, "If you can't be yourself (due to your symptoms), why not be someone secret and awesome?"
You also need to enlist "allies," which are family and friends who will help you on your quest to get better. Supportive family and friends are a big part of getting better for anyone struggling with a mental health disorder, but asking for their support as part of a game is a novel way of helping them understand what you are going through and also helps bust through some of the stigma.
Gamers are often accused of being lazy couch potatoes more invested in an alternate reality than their own. McGonigal would contest this, and it's clear that SuperBetter requires the opposite of that mentality—to play the game you have to become an active, motivated player in your own life.
It seems clear that the game could have a lot of appeal for kids struggling with mental health disorders. If you are interested in checking out the game, you can download it in the app store or check out McGonigal's new book, SuperBetter, which is about the game and some of the research backing it up.Read More
Advantage Mardy Fish: A Story of Tennis, Anxiety, and Getting Help
Sept. 3, 2015 Harry Kimball
American tennis player Mardy Fish ended his professional career yesterday with a loss in the second round at the US Open, sure, but he ended it on his terms. And considering that the last time he played in Flushing, in 2012, he was so consumed by his panic disorder that he has no memory of half a set against Gilles Simon and had to bow out of a career-defining match against Roger Federer, Fish has come a long way.
What strikes me most are the particular contours of his journey—how universal they are—and what they can teach us about facing up to crippling anxiety. "This isn't a sports story," Fish writes at The Players' Tribune. "I didn't 'choke' in Act Two, and I'm not going to 'win' in Act Three. This is a life story."
He's right—he didn't "win," or win. But that wasn't the point. "This is a story about how a mental health problem took my job away from me. And about how, three years later, I am doing that job again."
And that process started, for Fish, with someone helping him stand outside his anxiety instead of tumbling down the path he was on. "My thoughts were filling with dread," he writes. "Would it happen on the court again? Was I going to get an anxiety attack, again, in front of thousands of people?" His wife presented an option that thoroughly escaped him at the time: don't walk into a setup. "You don't have to play," she told him. And he didn't—but he did begin working towards playing again one day.
The first step towards taking back "the things that mental illness takes away from us," as Fish puts it, is recognizing what's going on, and then working to address it. When a kid has severe performance anxiety, the first step in treatment is not to...throw him under the lights at Arthur Ashe against Roger Federer, to pick a random example. One step at a time, Fish writes. "Addressing your mental health is strength. Talking about your mental health is strength. Seeking information, and help, and treatment, is strength."
That's a great message, no matter the size of the stage, and we're happy that Mardy Fish isn't dropping the ball, as it were, and is "keeping the conversation going, and going, and going."Read More
Cook County Jail's New Warden Is a Psychologist
July 30, 2015 Caroline Miller
There's an excellent story in the New York Times today about Dr. Nneka Jones Tapia, the clinical psychologist who is now the warden of the Cook County Jail in Chicago. Her hiring underscores vividly the fact that American prisons have become de facto mental hospitals—but largely without appropriate care and treatment.
Dr. Jones Tapia is trying to do something about that, with comprehensive mental health screening for inmates and a pioneering transition program that is reducing recidivism. In the program, inmates receive cognitive behavioral therapy and job readiness skills to help them avoid getting into trouble again after release.
Sheriff Thomas Dart, who appointed her to the post, tells the Times reporter that as many as one-third of the jail's 8,600 inmates are mentally ill. And he explains why many of them should not be locked up, in terms we couldn't agree with more:
The person isn't choosing to be schizophrenic. The vast majority of mentally ill people are here for nonviolent crimes, like stealing food to survive or breaking into places, usually looking for somewhere to sleep, or getting caught with drugs because they are self-medicating. How is it different than us locking up diabetics?
Indeed, until we treat mental illness the way we treat diabetes, and get care to kids and young adults before they run afoul of the law, there will be a steady stream of the mentally ill behind bars, and it will continue to be, as Sheriff Dart says in the article, a national disgrace.Read More
Chirlane McCray's Initiative to Connect New Yorkers to Care
July 30, 2015 Caroline Miller
New York First Lady Chirlane McCray has announced her new program, called Connections to Care, aimed at making mental health care more accessible to more low-income New Yorkers.
The $30-million program includes two initiatives we applaud: to add mental health services to existing community agencies that currently don't offer them, and to train more people, from pre-school teachers to job-placement counselors, to recognize signs of things like depression, anxiety, and substance abuse.
In the New York Times story about the plan, Gabrielle Fialkoff, senior adviser to Mayor Bill DeBlasio, says something revealing about the work that needs to be done to make mental health an ordinary topic of conversation. People with mental illness, she notes, are most likely already encountering people who could potentially help them. But unless we combat the stigma and misunderstanding about mental health, we would add, people who are struggling aren't likely to be open about it.
The bottom line: Expanding access to care also has to include making people feel more comfortable asking for help.Read More
Problem Solving, Not Suspension, Sets Kids Up for Success
July 7, 2015 Caroline Miller
An excellent piece in Mother Jones this month drives home the point that using suspensions to punish kids who have behavior problems in school doesn't help them learn how to control their behavior. What it does is channel them into the "school-to-prison pipeline."
A 2011 study of the records of nearly a million kids found that those suspended or expelled—even for minor infractions like small scuffles, using phones or making out—were three times as likely as other students to end up in the juvenile justice system within a year. And kids with diagnosed behavior problems like ADHD are the most likely to be disciplined.
As the writer, Katherine Reynolds Lewis, asks: "Are we treating chronically misbehaving children as though they don't want to behave, when in many cases they simply can't?"
The article chronicles successes in schools that have reoriented their disciplinary approach to helping kids solve their behavior problems instead of punishing them. By recognizing that many kids are struggling with anxiety, learning disabilities, ADHD, or trauma, school staff can help kids identify why they are acting out and teach them techniques to manage their emotions more effectively.
Problem solving strategies are being tried by several hundred schools around the country, from public and private elementary schools to juvenile detention centers. One youth correctional center in Maine found that not only did disciplinary write-ups and injuries of both students and staff decline dramatically; the recidivism rate also dropped from 75 percent to 33 percent.
That's what Ross Greene, who pioneered this skills-based approach, sees as the big win: not just to reduce behavior problems in school, but to set kids up for success on their own.Read More
What Kids (and Parents) Will Learn From 'Inside Out'
June 23, 2015 Harold Koplewicz
What's going on inside the brain is a mystery to many of us. The brain doesn't come with an owner's manual, and it's up to each of us to figure out how to work with what we've got. Learning how to navigate our emotions is one of the major lessons of childhood, in fact, and something that nearly all children struggle with at some point. So I was overjoyed to see Disney's latest Pixar movie, Inside Out, which takes place almost entirely inside an 11-year-old girl's brain. For all of the criticism directed at the movie industry for its questionable moral standards, Hollywood is at its best when it creates compelling, engaging content about complex topics. Inside Out does exactly that.
The movie is about a girl named Riley who moves from Minnesota to San Francisco because of her dad's job. Moving is hard for everyone, but for a child a change like that can feel catastrophic—Riley is leaving behind her house, her friends, her hockey team, even the pond where she skates every winter. We see Riley and her parents struggling to adapt to their new surroundings, but in a novel twist the characters getting most of the screen time in Inside Out are Riley's personified emotions—Joy, Fear, Disgust, Anger, and Sadness. We watch as her emotions try to run the control center in her brain—they call it Headquarters—and see the chaos that ensues when different emotions take over. Part of the charm of the movie is that it takes some of the mystery and fear out of our emotions and imagines what a stressful moment might look like inside our brains.
Kids will enjoy the movie, which is partly an unlikely buddy comedy and road trip starring Joy and Sadness. But if you're a parent you'll appreciate the wonderful lessons that are built into the plot. We tend to think of childhood as a mostly happy time, but of course children experience an intense range of emotions. Inside Out lets kids—and adults—know that all of our feelings are okay, even the ones that don't feel very good at the time. In fact, the unexpected hero of Inside Out is Sadness. When Riley is struggling to cope with the move everyone at Headquarters assumes that Joy will come to the rescue, but it isn't until Riley is allowed to face her sadness that things begin to improve. And perhaps most importantly, the secret to feeling better for Riley is speaking up and telling someone how she feels. For most of the movie Riley tries to be brave and hide that she's struggling from her parents, but she eventually learns that keeping her emotions hidden doesn't help.
In the end Inside Out is a movie about growing up, too. We see the control panel in Riley's brain expand after she learns how to embrace her emotions and talk about how she's feeling. We can see that she is maturing, and ready for the new demands that she will be facing. Parents will find it reassuring and poignant. Kids will laugh at the joke about her newfound interest in boy bands and the looming prospect of puberty. With Inside Out everyone will walk away happy—but know that feeling sad is okay, too.
Harold Koplewicz, MD, is the founding president of the Child Mind Institute. This piece was originally published on Parents.com.Read More