The Child Mind BlogBrainstorm

  • Why We Love Jennifer Lawrence (Even More)
    Feb. 26, 2013 Caroline Miller

    In fact, it's pretty hard not to love Jennifer Lawrence, who's played some of the most compelling female roles in movies in the last few years, from Ree in Winter's Bone to Katniss in The Hunger Games to Tiffany in Silver Linings Playbook. But after the Academy Awards Sunday night we appreciate her even more, for taking the opportunity, talking to the press just after her win, to commit to fighting for openness about mental illness

    The director of Silver Linings, David O. Russell, has been fabulously direct about how his family's struggles influenced the film, and Robert DeNiro made his own statement by actually crying on the Katie Couric show. Now Lawrence has stepped up as well, and we couldn't be more pleased. "I don't think we're going to stop until we get rid of the stigma for mental illness," she said. "I know David O. Russell won't, and I hope that this helps."

    She went on to say, "It's just so bizarre how in this world if you have asthma, you take asthma medication. If you have diabetes, you take diabetes medication. But as soon as you have to take medicine for your mind, it's such a stigma behind it."

    If you 've seen the movie, this comment is funny because it reflects the very first bonding moment between Tiffany and Pat, the bipolar character played by Bradley Cooper. The two have barely met before they blithely embarrass their dinner party companions by comparing notes on various meds they've taken.

    In the movie Lawrence plays someone struggling with depression; she brings to the role a combination of vulnerability and toughness that's hard to resist, and reflects the courage of many people who have wrestled with mental illness.

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  • MTV Looks at Autism in 'World of Jenks'
    Feb. 25, 2013 Harry Kimball

    I just took a look at a couple of episodes of the second season of World of Jenks, a documentary series on MTV that follows director and star Andrew Jenks as he injects himself into the lives of three diverse young people in "extraordinary circumstances." One is D-Real, a dancer and former drug dealer who is fighting against the gun violence on the streets of Oakland that took his brother. One is Kaylin, an aspiring fashion designer who almost lost a leg and her pelvis to an aggressive cancer that constantly threatens to return. And then there is Chad, who is autistic.

    Chad's verbal communication is excellent, but his strict routines are limiting; he sleeps every night on the floor of his parents' room. He is affable and funny, but his discomfort with certain social situations and environments teeters towards explosive anger. At 21, his emotional development seems to lag far behind his physical size.

    The ostensible star of the show, Andrew Jenks, is genuine; his enthusiasm and desire to help appear real, and the show is an upbeat one. But running through Jenks is a melancholy that defies Jenks' optimism and cheerleading. This vein is obvious for D-Real and Kaylin, struggling with gun violence and cancer.

    The melancholy in Chad's story is further below the surface. In the episodes I watched he prepares for and participates in his graduation from a special needs school in Westchester County, New York. Jenks emphasizes that this is really important for Chad; Chad himself expresses "exquisite" relief at having graduated.

    But when Jenks turns his camera on Chad's mother after the graduation, she says the moment is "bittersweet." A teacher celebrating the accomplishment of the graduating class of the Westchester Exceptional Children's School also strikes an ominous note. "The sanctity and safety of our school is no longer with them," she says.

    Chad is at the age when young people begin to "age out" of supportive care, educational accommodations, and special education provisions required by law. For people like Chad and his family, who may have depended on support, it can be a profound challenge. Chad's ability to move independently in the "real world" is untested; in one scene, we see a nightly routine: his father brushing his teeth for him.

    There are lessons there to be learned by the viewers of World of Jenks, lessons about the variability of the hurdles people face and the universality of the courage it takes to approach them. Which brings me to another star of the series, one that might escape many viewers: the Westchester Exceptional Children's School.

    On its website, the school describes its own journey. "We opened our doors in the Goldens Bridge Community House in 1969 to two children, a staff of two, and eighty dollars, in what was then considered an 'experiment'—day schooling instead of hospitalization." And it hasn't been easy. "We have had to meet the familiar specter of debts, loans and mortgages in a stubborn struggle to keep our doors open and our ideals alive. Yet a small band of parents and professionals, filled with a tremendous sense of purpose, helped carry us."

    That dedication, that resolve, and that cooperative approach are very much on display in this series.

    World of Jenks premieres on MTV March 4, 2013.

    Read more about aging out of educational supports and services for children with autism.

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  • White House Plans Huge Brain Mapping Push
    Feb. 18, 2013 Harry Kimball

    News today that the Obama Administration is planning to unveil an ambitious, Human Genome Project-like initiative to map the human brain is music to our ears. Though the details aren't clear, those in the know are suggesting it will be similar to that billion-dollar effort that lasted more than 10 years. Of course, it won't be easy. As the Times notes:

    Composed of roughly 100 billion neurons that each electrically "spike" in response to outside stimuli, as well as in vast ensembles based on conscious and unconscious activity, the human brain is so complex that scientists have not yet found a way to record the activity of more than a small number of neurons at once.

    Figuring out what is going on deep down in the brain, how it affects our thoughts, moods, and behaviors, and how to helpfully represent this that information is exactly what our science team is doing at the Child Mind Institute. And this nascent federal interest promises to give added momentum to a project that researchers here at the Child Mind Institute and around the world have already begun. We can only hope that the Administration embraces the open science and sharing ethos that is driving innovation in discovery science, and bringing us closer to a map of the brain, whatever it may look like. That hope isn't outlandish—the National Institutes of Health are already leading the charge to make data freely available and encourage a scientific culture of radical transparency and collaboration.

    We look forward to an official announcement of this initiative, and what the resources of the federal government can do to accelerate inquiry into the brain. But rest assuredscientists and researchers in every field all around the world have already taken the first steps. Now, maybe, they get to hop on a locomotive.

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  • Why I’m Rooting for ‘Silver Linings’ for Best Picture
    Feb. 18, 2013 Harold Koplewicz

     I don't know about you, but I know what I'll be rooting for at the Academy Awards Sunday. In the aftermath of Newtown, I'd like to see the Best Picture Oscar go to Silver Linings Playbook, because the most important health issue facing our nation is untreated child and adolescent psychiatric disorders.

    I've already written about what an honest and accurate movie Silver Linings is (despite some Hollywood gloss) in depicting what it takes to wrestle effectively with mental illness. Of course school shootings are very rare, and people with mental illness are much more likely to hurt themselves than anyone else. But the movie illustrates how a chronic illness like bipolar disorder can be treated and managed, just as, say, asthma or diabetes can be, with medical intervention and vigilance and support from family and friends. And it also shows how, left untreated, it can be debilitating both to the sufferer and those around him. It's a powerful message that inclusion and acceptance by the community are important parts of helping someone avoid frustration and hopelessness.

    The trouble is that diseases above the neck just don't get treated the same way as those below the neck: Stigma and embarrassment and misunderstanding get in the way of the happy ending, or at least promising future the character in Silver Linings enjoyed.

    After Newtown, we've begun having a national conversation about the importance of mental illness, and a win for Silver Linings would help keep that going. I'm a big movie fan, and the movies nominated this year dealt with important issues, from chronic disease and old age in Amour to war, terrorism, and security in Zero Dark Thirty. But Silver Linings touched the issues closest to my heart. It made us laugh and cry and most importantly recognize that mental illness is real, common and treatable. An Academy Award would be a great vote of approval.

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  • Details Emerge About Adam and Nancy Lanza
    Feb. 18, 2013 Caroline Miller

    Journalists are beginning to piece together a clearer picture of the lives of Adam and Nancy Lanza, in an effort to understand what could have driven a quiet young man no one suspected of harboring violent fantasies to commit the atrocity in Newtown.

    The Hartford Courant and Frontline teamed up to interview people who knew mother and son, including friends of Nancy's, parents of Adam's classmates, and a former school staff member who took an interest in trying to help Adam, who he saw as severely withdrawn. The Courant reports, in the first of a two installments, that Nancy told friends and teachers that Adam was diagnosed with sensory processing disorder and Asperger's. He had an IEP and he was enrolled in a special education program at Newtown High School, the former staff member said, while also attending mainstream classes in his core subjects.

    The story also makes clear that nothing in these diagnoses is linked to violence against others. Adam was said to respond poorly to "a change in routine or unwanted excitement" by what the staff member described as "completely shutting down." Nancy is said to have picked him up at school frequently when this occurred. For an explanation of how sensory processing challenges affect children, see our story, Sensory Processing Issues Explained.

    But what emerges from the Courant's reporting most powerfully is a sense of Adam's severe isolation. He was in and out of both public and Catholic schools in Newtown, and after his mother withdrew him from Newtown High School after his sophomore year, he seems to have had only sporadic regular contact with other people. Two stints at college and one part-time job at a computer shop didn't last.

    After his parents' divorce in 2009, Adam's father, who had joint custody, saw him weekly, and helped him with his homework, the Courant reports. But Adam cut off contact with his father and older brother, Ryan, two years ago. His mother was often away out of town, or out of the country, according to the story, leaving him prepared meals in the refrigerator. He spent most of his time in his basement room playing video games.

    The Courant says authorities are exploring whether Adam, in his shooting spree at Sandy Hook, was "emulating" the shooting range he had visited with his mother or one of the many "graphically violent video games" found in his room. It's not likely we'll ever know what he could possibly have been thinking. But we do know that profound isolation can have profound consequences, which is one of the reasons it's critically important to keep kids with emotional problems or difficult behavior from being marooned in their homes, with stressed-out parents, because of a lack of services that would enable them to be engaged in a social setting.

    As Dr. Harold Koplewicz puts it, "People who are helpless and hopeless do crazy things." There are lots of ways to get to hopelessness, and people who act out of frustration and isolation are more likely to hurt themselves than anyone else. As law enforcement officials continue to try to unravel the motives for this shooting, that's one thing we know. And it provides some hope for the future, because we know part of the solution: dialogue, community, engagement.

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  • State of the Union Address Overlooks Mental Health Care
    Feb. 13, 2013 Elizabeth Planet

    In his State of the Union address last night, President Obama touched on many of the top policy priorities and debates of our time: climate change, national security, cyber security, immigration reform, education, jobs, the economy, domestic violence, tax reform, wage equality, Medicare, deficit reduction, and more.  

    The President covered a lot of ground in one hour, but he missed an important opportunity to affirm the importance of addressing the gaps in mental health care for our nation's young people.  

    More than 15 million American children have a psychiatric or learning disorder, but fewer than half of them will ever get help. Failure to treat mental health disorders in young people can increase their risk for academic failure, alcohol and other substance abuse, bullying, conflict with families, and authorities, and unemployment.

    In recent months, the President and many elected officials in Washington have shown their determination to effect change.  

    In the wake of the tragedy in Newtown, Connecticut, President Obama and Vice President Biden convened experts in mental health to help shape new policies to educate the public about psychiatric disorders, to increase access to mental health care, and to improve the quality of care.  The Child Mind Institute was pleased to have a seat at that table.  

    Lawmakers in the House and Senate have reached across the aisle to take similar action, introducing legislation to provide school based mental health services, to expand community sites offering mental health care, and to ensure that treatment is based on the latest evidence about what works. 

    The President has called for a national conversation to increase awareness about mental health, and to reduce the stigma associated with mental illness, which all too often prevents families from getting the care they need.  Last night's State of the Union address could have served as the perfect platform for launching that conversation.  

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  • ADHD Subtypes: Researchers Find Functional Brain Differences
    Feb. 12, 2013 Harry Kimball

    One of the criticisms leveled against certain psychiatric diagnoses like ADHD is that they are too indistinct—that in defining some disorders as "spectrum" disorders we risk pathologizing everyday behavior. If one kid with ADHD is hyper and impulsive, a critic might say, and another kid is just spacy, and a third kid is both, what's the disorder? You can't have your cake and eat it, too.

    Well, new research from our own Dr. Michael Milham, director of the Center for the Developing Brain at the Child Mind Institute, has brought advances in brain imaging technology and methodology to bear on this issue with results that promise a future of more rigorous diagnosis and better understanding of neurodevelopment. A paper out earlier this month and co-authored by Dr. Milham in the journal Frontiers in Systems Neuroscience describes a project touching on everything from open science collaboration, the unique challenges in pediatric imaging, and the very nature of psychiatric diagnosis.

    For me personally, one of the more interesting developments described in Dr. Milham's paper are the new approaches to minimizing movement "artifacts" during analysis of brain scans collected from multiple sites, of children of multiple ages, with or without ADHD. Essentially, he and his co-authors introduce new and better methods of getting imaging data from fidgety kids. This may sound banal, but when we consider that a lack of large-scale data sets from pediatric populations with psychiatric disorders is a signal hurdle to research in child mental health, its importance is clear.

    Another conclusion in the paper might be picked up more quickly: that subtypes of ADHD, like inattentive-type or combined-type, manifest in the brain as distinct differences in connectivity when compared to each other and to typical brains. You should definitely check out the paper to see how the researchers made these distinctions, and how they relate to our growing understanding of how the brain talks to itself, and how these communication networks are implicated in mental disorders. But the grand takeaway is this: the different subtypes of ADHD are distinct but also with real basis in the biological functioning of the brain. And our imaging tools are beginning to let us discern between themand one day perhaps diagnose the underlying illness.

    This work is exciting for neuroscience, exciting for mental health research, and potentially transformative in terms of how we think about psychiatric disorders in kids. It is also representative of the Child Mind Institute's scientific mission, and shows an awareness of how far we need to go. This proof-of-concept research is exciting, Dr. Milham and his co-authors write. But—

    It is only through the future creation of a large-scale datasets, with coordinated recruitment, deep phenotyping, multimodal data acquisition...and likely improved homogeneity in our subgrouping...that a fair assessment of the predictive potential of MR-based approaches will be realized.

    We're not there yet, they caution. But there is a clear pathone that gets clearer every time research like this illuminates the biology of the brain and bolsters the science of neuropsychiatric illness. 

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  • 'Silver Linings,' Mood Disorders, and Robert De Niro in Tears
    Feb. 5, 2013 Caroline Miller

    If you've ever loved someone who has been affected by mental illness, and maybe even if you haven't, I hope you'll take a look at the video of an interview Katie Couric did today with Robert De Niro, Bradley Cooper, and the director of Silver Linings Playbook, David O. Russell.

    Russell sums up elegantly and affectingly why he wanted to make this movie for his son, who has a mood disorder. He talks about what it's like to have a child whose moods could "pull him down the drain or turn into a tornado" on a moment's notice, a son "who told me when he was 10 or 11 that life was so hard for him he didn't know if he wanted to keep going." 

    Russell says he wanted to make a movie that would help his son "feel like he's part of the world." And De Niro, asked what it meant to him to be involved in this very personal project, breaks down in tears, able to say very little except that he knows "exactly" what Russell is talking about.

    The sweetest part of the interview is a discussion of the scene in the middle of the night when Pat, the bipolar character played by Cooper, has a meltdown.  There's a lot of yelling and screaming and crashing, and a nosy neighbor with a video camera shows up at the front door to see what the ruckus is. De Niro, Pat's father, chases the boy away, in a protective fury.

    That boy is played by Russell's son. And Russell wants you to know that scene comes from his own experience. "You have this chaos in your house that's so humbling. These reckonings of the soul, whether it's a marriage or a child, they always seem to happen in your pajamas at 2 am, and you look over at your neighbors and say, it's going down."

    Russell adds, "It was beautiful for my son to be the 'other guy' in that moment"—not the one melting down—as well as to find himself, momentarily, in Raging Bull.  We would add that it was generous and lovely for this accomplished man to share his experience, and to recognize how many families fight every day to care for and protect struggling children.

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  • JFK's Stirring Words on Mental Illness, 50 Years On
    Feb. 5, 2013 Harry Kimball

    We must fix mental health care in this country. And that is what President John F. Kennedy thought 50 years ago today when he passionately advocated for reform of the broken institutional mental health care system that, in his words, leads "in most cases to a lifetime of disablement for the patient and a lifetime of hardship for his family." He continues:

    This situation has been tolerated far too long. It has troubled our national conscience—but only as a problem unpleasant to mention, easy to postpone, and despairing of solution.

    President Kennedy was talking specifically about mentally impaired patients languishing in huge, inhumane hospitals. Those institutions have been closed, but the robust community care he envisioned to replace them hasn't materialized. The president hit many of the same points we make today: inadequately treated mental illness costs our economy billions of dollars. Most signs of psychiatric disorders appear in childhood. And yet we do not—not now, and not in 1963treat these diseases with the same urgency as what he calls "diseases of the body." These "are beginning to give ground in man's increasing struggle to find their cause and cure," he wrote half a century ago. "But the public understanding, treatment and prevention of mental disabilities have not made comparable progress since the earliest days of modern history," he laments.

    But I think we can take heart in JFK's words. His goaldeinstitutionalizationmay not have been the whole answer, but it was achieved. And it was achieved by a combination of will and means. Listen to him: "The time has come for a bold new approach. New medical, scientific, and social tools and insights are now available."

    Fifty years down the road we would do well to remember JFK's optimism and his resolve to change what needed to be changed. We are wiser now in many ways; let us borrow the strength from the past to put that wisdom into practice.

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  • Stimulants and Suicide: A Tragic Story With Misleading Implications
    Feb. 4, 2013 Caroline Miller

    The very sad piece in the New York Times yesterday about a young man who committed suicide after serious abuse of stimulant medications was upsetting for a number of reasons. It's a terribly tragic story about mishandled medication, about the ravages of addiction, and about the powerlessness of parents to help adult children who are self-destructively mentally ill.

    It is also verges on the kind of fear-mongering that is unhelpful to parents trying to provide the best support and care to struggling children. Families whose children have ADHD deserve, we think, a more even-handed assessment of the risks of the disorder and its treatments, as well as the circumstances leading to the suicide of Richard Fee.

    Fee was a young man who, according to his father, had no symptoms of ADHD, but was able to convince a series of mental heath practitioners that he had the disorder and persuade them to provide multiple prescriptions for stimulant medications he was abusing. The story paints a painful picture of lapses in the mental health care system. Most painful of all was the portrait of his father practically accosting a psychiatrist who had been fooled by his son's fabrications and begging him to stop providing the prescriptions. It's appalling that he couldn't get the message across that his son was an addict, and that a series of mental health practitioners didn't do due diligence about how many prescriptions he had already filled.

    But the story was also disturbing because the writer did painfully little to make it clear how far this kind of abuse of stimulants is from monitored use by children and adolescents who actually have ADHD. It suggests two misleading and frightening notions. First, that taking stimulant medication for ADHD puts kids at higher risk for addiction. Research shows that it doesn't. For kids with ADHD, medication is not a steppingstone to the kind of abuse Fee was engaged in.

    The second misleading suggestion: that it's easy to take a little too much Ritalin or Adderall and end up in the predicament that Fee was in, addicted and at risk for the kind of psychotic, suicidal crash that ended his life. The fact is that stimulant medications are metabolized rapidly in the body, and when one takes them according to a doctor's orders the medication does not accumulate in the body. You have to do a lot of sustained doubling up on medications to accumulate enough amphetamines in the body to enable the crippling withdrawal symptoms that Fee is said to have experienced.

    It's terrible that Richard Fee was able to manipulate a lax system to get enough medication to get into very serious trouble. It is terrible that Fee's caring and tireless parents knew their son was out of control and found themselves powerless to intervene on his behalf.

    But it's also unfortunate that this story slyly inflates the risks of stimulant medications used appropriately by not acknowledging that Fee's abrupt change in personality, extreme behavior, and suicide may well have had other contributing factors. For a doctor with no connection to Fee to say that stimulants "in all likelihood" were the "primary issue" contributing to his suicide is irresponsible, and to print this statement is reckless. Fee was at a prime age for the onset several other major psychiatric disorders, and was also apparently abusing marijuana, which has also been linked to higher risk of suicidal thoughts, psychotic symptoms and depression. Did he have depression or mania or schizophrenia? We have no idea. Are stimulants fairly safe for people with ADHD under the close care of a physician and with the support of the family? Yes.

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