Advice & Support

Last week Nature Medicine published an article on the work of CMI's Dr. Michael Milham and his collaborators on functional magnetic resonance imagery and the future of psychiatric diagnosis. The growth of the field is quite staggering, writes Roxanne Khamsi, suggesting a future that moves incredibly quickly. "Back in 1995, people were still testing whether functional MRI was of any use," a researcher tells her. Today, Dr. Milham has reached a point where clinical applications are looking more and more likely.

Part of the reason the field is moving so quickly is the explosion of data sharing and open neuroscience, as embodied by Dr. Milham endeavors like the 1,000 Functional Connectomes Project and the ADHD-200 competition. For the latter, Khamsi writes, the group had planned "to collect scans of 200 subjects, 100 with ADHD and 100 control counterparts. But when word got out about the competition, close to 1,000 scans poured in from eight different labs around the world."

This amount of cooperation surprised even Dr. Milham. "We really overachieved on this one," he tells Khamsi. But despite the bright future, fMRI isn't ready for the doctor's office, and we can't know in what way the data being collected and analyzed will change diagnosis and treatment in the future. "I have a lot of people who ask me to use scanning to diagnose their child," he says. "It's not appropriate." Until the future comes, diagnosis and treatment are in the hands of trained clinicians—which Dr. Milham is, as well.

Join Dr. Milham for a live tweetchat on the occasion of Brain Awareness Week, Tuesday, March 14th, 2012, at 1 pm EST. Dr. Milham will be joined by Dr. Richard Rende of Brown University and others. Click here for more information on how to participate.

A lawmaker in Wisconsin is trying to make single parenting even harder. Senator Glenn Grothman has introduced a bill that would require a state agency to "emphasize nonmarital parenthood as a contributing factor to child abuse and neglect."

We have a lot of trouble with this, of course. Parenting is tough for everyone, and the value of two engaged and present parents is clear, but conflating single parenting with child abuse is revolting. Unfortunately, it gets even worse, as the senator's argument against single parents is apparently rooted in "the role of fathers in the primary prevention of child abuse and neglect." (The idea that women will contribute to child abuse and neglect without a male corrective is so absurd that we won't even discuss it here.)

It's worth pointing out that Grothman's position seems to be originating more out of politics than concern for the supposedly abused children of single families. As Lylah M. Alphonse writes at Yahoo! Shine, the senator believes that "the government urges women not to get married by making programs like low-income housing assistance, school choice, WIC, tax credits, and food stamps more attractive than marriage. 

Now, if a woman is ever in a situation where she considers food stamps more attractive than marriage then that says a lot more about the married life she is anticipating than any government swag. The truth is that women no longer need to settle for Mr. Wrong out of shame or stay in a bad marriage out of financial necessity.  We are lucky if we can find a good partner to help shoulder the burden (and share the joys) of parenthood, but we no longer need to force it, and thank goodness for that. Children who come from nuclear families but live in violent or unhappy homes have a much harder road than the ones raised by loving and responsible single parents. If you want a success story, you need look no further than the White House.

Single parenting isn't going anywhere. A recent study from the research group Child Trends found that most births occur outside of marriage for women under 30, pointing to a potential generational trend. Our own Health Editor Gail Saltz, MD, appeared on the Today show last year to discuss the increasing number of Hollywood stars who are choosing to be single moms (something tells me they aren't doing it for the food stamps). On the program Dr. Saltz was honest about the difficulties these children will face. Single parenting brings unique challenges to parents and children, there's no doubt about it. But we should focus on helping the kids instead of introducing legislation written to chastise women. 

In the New York Times yesterday, KJ Dell'Antonia asked readers what they think about a nascent trend in top-tier New York City private schools: starting college prep at the beginning of high school. "Are Ninth Graders Ready for College Applications?" the headline asks.

I'd like to step back a bit and ask a different question, which most of the commenters on the story seem to have in mind: regardless of the necessities and realities of secondary and post-secondary education today, should high school freshman be barraged by thoughts of college? I don't think so.

This brings to mind an episode of the public radio program This American Life, where serious debate centered on the issue of whether middle schoolers actually benefitted from school at all, given the dramatic developmental changes being wrought by puberty. Similarly, high schoolers are approaching advanced topics, not only academically but socially, and becoming the people they will be. But the person you are isn't the college you get in to, and encouraging a focus on what comes 4 years from now discourages engagement with the here and now.

That said, engagement is exactly what colleges are looking for-good grades, extracurriculars, a full dance card as it were. "It's the deep involvement that matters," writes one commenter. And the less distraction the better, writes another. "Focusing too much on the hoops to jump through takes away from the actual educational experience and the skills that the child is supposed to be developing."

When I was in 9^th grade in New York City I had a lot of things on my mind, and college was not one of them. Of course, when I look back (and even when I looked back from 12^th grade) I see that I was doing and encouraged to do the sorts of activities and projects that can be of value in the admissions process. I just wasn't thinking of them that way, which is probably a good thing. 9^th graders have better things to worry about.

Perhaps this is naïve in a world with constant talk of China's ascendancy, economic uncertainty, and an expensive school down the block that is preparing your child's "competitors" from age 14 on. But that doesn't mean that it is wrong. My favorite comment from the story: "'Plan hobbies'?? Something is not right with this picture."

Calling someone a slut is such a high school thing to do. It's a word mean girls throw at each other. That a grown man, a conservative radio commentator, would call a college student a "slut" and a "prostitute" for advocating insurance coverage for contraception isn't just outrageous. It's gross.

Even before Rush Limbaugh demeaned Sandra Fluke in such a grotesque way on national radio, the presidential campaign had taken a bizarre turn into the bedroom with the battle over contraception—a battle most of us (including  the 80% of Catholics who use contraception) thought was over in the 1950s. Then Rush took it into the dorm room, and it became an assault on our daughters.

"If we're going to have to pay for this, then we want something in return, Ms. Fluke," he said on the air. "And that would be the videos of all this sex posted online so we can see what we're getting for our money."

This leering fantasy is exactly what young women don't need: to have some guy who's been married four times (and has no children) suggest that protecting themselves from pregnancy is tantamount to being promiscuous. Embarrassment  and lack of access to contraception are big contributors to teen pregnancy; telling girls a prescription for birth control isn't a health issue but evidence that they're "easy" is exactly the wrong message.

Once advertisers started pulling out of his show, Limbaugh apologized, but the apology was almost as bad: " I should not have used the language I did," he told listeners. "Those two words were inappropriate. They distracted from the point that I was actually trying to make."

The point we'd like to make is that there's a bigger problem here than the choice of words. Our message to young women should be that the days of the double standard are over; the days should be over when a prescription for Viagra is considered health care and contraception isn't. And even more so, the days should be over when people in positions of power feel free to attack a young woman for being sexually active. The mixed messages girls get from this kind of trash talk have wide-ranging consequences.

What we need to tell our daughters (and our politicians) is that birth control isn't sexy, it's healthy, and the myth that girls who take care of their bodies aren't "good girls" is no longer acceptable.

Last week Gawker pointed us to a Pew study with a reliably snarky headline, "The Internet Either Is or Is Not Ruining Teens' Brains, Say Experts." The thing is, that's an accurate statement, to a point. The more than a thousand technologists, futurists, academics, and critics queried are fairly reliably split about whether they agree with one of two statements, which begin:

In 2020 the brains of multitasking teens and young adults are "wired" differently from those over age 35 and overall it yields helpful results.

Or:

In 2020, the brains of multitasking teens and young adults are "wired" differently from those over age 35 and overall it yields baleful results.

Baleful! Yeesh. About 55% of respondents agreed with the more optimistic statement, which prophesies no "notable cognitive shortcomings" associated with a greater facility at multitasking and online information gathering, and "changes in learning and cognition among the young" that produce generally "positive outcomes."

Another 42% weren't so bullish on the future, and agreed instead with the second statement. In 2020, it continues, young people "do not retain information; they spend most of their energy sharing short social messages, being entertained, and being distracted away from deep engagement with people and knowledge."

But the survey wasn't really about these two extremes. Those questions were a "tension pair" that was "designed to provoke detailed elaborations," the authors note in polling jargon, and that is exactly what they did, eliciting much less black-and-white ruminations from the experts. The most insightful suggest that the advance of technology is inevitable but the effects are not, and that the real measure of the future is how we educate our children about new media.

"The question we face as individuals, organizations, educators and perhaps especially as parents," writes Alexandra Samuel of the Social + Media Centre, "is how we can help today's kids to prepare for that world—the world they will actually live in and help to create—instead of the world we are already nostalgic for." We just have trouble accepting the future and leaving the past behind. "The tendency to moralize and fret over new media seems to be wired into us," notes Christopher J. Ferguson of Texas A&M. But the new media landscape is where our children will live, and to make the most of it they will need tools to thrive there.

The term of art for this sort of education is "internet literacy," and it seems more critically important every day as computers and mobile devices become ubiquitous, everywhere from the bedroom to the classroom. We've seen how easy it is for technology to be bent to malicious or simply unhelpful ends, but turning Luddite is not a valid solution for most people. These changes in the media landscape will change how our children learn and interact—but it's up to parents and educators working with young people to ensure that the change is one for the better.

Lady Gaga toned down her act a bit (but not too much, happily) to go to Harvard yesterday to launch an anti-bullying campaign named after her acceptance anthem "Born This Way." While Gaga has been vocal about supporting more stringent anti-bullying laws, her foundation will be aimed at encouraging kids themselves to be kinder and empowering them to "challenge meanness and cruelty."

In an interview with Nick Kristof of the New York Times she called it a bottom-up movement to make it cooler for young people to be nice, rather than a top-down crackdown on bullying.

And she talked about her own experiences as a target of bullies: "There was a certain point in my high school years when I just couldn't even focus on class because I was so embarrassed all the time," she told Kristof. "I was so ashamed of who I was."

Her foundation aims to see that kids have a "safe place" to develop their individuality—which she wisely sees as depending on promoting tolerance among their peers and encouraging them to stand up for kids who are different.

Adolescence is the time when we are most vulnerable to intimidation, when self-expression seems riskiest and rejection most painful. Coming to the defense of young people who are struggling to pass through that gauntlet is an apt mission for someone who has so brilliantly invented and reinvented herself.

While Parenthood's season finale had many intense, lovely and tissue-worthy moments—not to mention one very steamy scene—those who have been following the high-drama episodes featuring Max Braverman and his family were disappointed that the boy with Asperger's played a minimal role.

But Max took center stage online after the web site Television Without Pity touted its "Parenthood: Rules for Being a Braverman" photo gallery on Facebook under the status update "Max has never heard the word 'no' in his life." TWoP is known for its snark factor and there's no debating Parenthood is ripe for some riffs.

But snark turned offensive when TWoP asserted "You Cannot Discipline Max." The site, which didn't even mention Max's autism spectrum disorder, claimed, "The universe will not allow" the boys' parents to keep him from getting what he wants, "so a Braverman must be prepared for many trips to see dinosaur bones." The flip remark refers to a gripping episode that showed a rigid Max tantrum and then disappear, one of autism parents' greatest fears.

Shannon Des Roches Rosa, who is co-editor of The Thinking Person's Guide to Autism and blogs at Squidalicious, pulled no punches when she weighed in on TPGA's Facebook page: "I expect the folks at TWoP to be snarky; I don't expect them to be jerks. Their recent piece on Parenthood is studded with Asperger's-delegitimizing gems."

"I get that this is a snarky publication, however it doesn't make it right," adds Sharon da Vanport, exective director at Autism Women's Network, who has an ASD diagnosis, as does one of her children. "Timing is everything. I don't believe our community is quite ready for these kinds of giggles yet, because of the way Asperger's is marginalized and stigmatized in the media. TWoP FAILS."

When one commenter defended TWoP, writing, "Are you kidding me? You must have confused these folks with the folks from Television With Pity," Emily Willingham, another co-editor of TPGA who blogs at Double X Science, responded, "Pity or its absence isn't the issue here."

The issue is awareness and, with any luck, understanding. Children and teens with Asperger's and other "high-functioning" forms of autism have a hidden disability. Because they exhibit "quirky" or challenging behaviors without any clear physical manifestations, the world too often views them as unruly brats and their caregivers as bad parents. TWoP's rant is yet another reminder that most people just don't "get it." 

Many parents of kids with ASD and adults on the spectrum have embraced the show, created by Jason Katims (Friday Night Lights), who has a son with Asperger's. They applaud him for portraying realistically a very complicated disorder and its effects on a child and his family, quite an accomplishment within the confines of a one-hour network series.

While fans will have to wait till May to learn if NBC will renew Parenthood for a fourth season, they were encouraged to learn that the finale got the highest ratings since the "dinosaur" episode aired in November. They aren't ready to say goodbye to Max and family after what Entertainment Weekly editor-at-large Ken Tucker called "a rocky, uneven, but overall excellent Parenthood season"—especially when they've seen it can help family, friends and neighbors better understand their children and their lives.

These days I wince when I read stories about how good teachers are the most important factor in how well our students learn. Not because it's not true—it is—but because it's actually been turned into a weapon against teachers. Blame for failing schools is more and more focused on poor teachers, and exposing the "bad apples" has become a rallying cry.

It's absolutely true that there are some weak teachers in most schools, and that those who aren't doing their jobs should be fired.

But the public campaign to drum out teachers with weak evaluations by airing them publicly is more punitive than effective. Any good behavioral therapist will tell you that humiliation is a lousy motivator. And it misses the most important point: The goal should not be just to separate good teachers from bad, but to teach teachers how to be more effective.

In many troubled schools, we drop teachers into almost impossible situations, with huge classes of students who are just not socialized to function well in school, either because they have mental health problems or they come from homes that are chaotic or abusive. Teachers, many of them barely out of college, may know a lot about instruction, but little about managing problem behavior.

We recently met with Nancy Rappoport, a psychiatrist and professor at Harvard Medical School who focuses on how schools handle (and help) children with mental health issues. Dr. Rappaport has written, with behavior analyst Jessica Minahan, a book called The Behavior Code that lays out techniques for minimizing disruptive behavior in the classroom. We know from our experience at the Child Mind Institute that giving parents and teachers the right tools can help kids who are out of control rein in their problematic behavior and function much better in school and at home.  We're doing a pilot program for this training in New York City schools as we speak.

If we really believe good teaching is the key to student achievement, shouldn't it also be the key to teacher achievement?

Bill Gates, who's poured a lot of money and energy into improving schools, gets it exactly right in a recent op-ed piece in the New York Times called "Shame Is Not the Solution": "Developing a systematic way to help teachers get better is the most powerful idea in education today. The surest way to weaken it is to twist it into a capricious exercise in public shaming." 

Those of us at the Child Mind Institute were thrilled last night when Roy Helland won the Academy Award for Best Makeup for The Iron Lady, and then again when Meryl Streep, winning the Oscar for Best Actress, delivered a emotional shout-out to Roy, who's worked with her on nearly every movie she's made since Sophie's Choice. Roy's wife is Ilean Helland, who's worked with Dr. Harold Koplewicz as his executive assistant for 10 years, playing a key leadership role and helping change the lives of thousands of struggling children. We congratulate both Roy and Ilean on this great honor.

Tumblr has announced a new policy to ban content that actively promotes or glorifies self-destructive behaviors including eating disorders, self-injury, and suicide. We've previously reported on Tumblr's dangerous popularity with "thinspiration," or "thinspo," bloggers who use the platform to post encouragement and tips for sustaining starvation.

Some users object that the proposed ban infringes on their right to free speech. Others ask just what the blogging platform considers censor-worthy. Tumblr leadership tried to clarify on the staff blog: 

"Online dialogue about these acts and conditions is incredibly important; this prohibition is intended to reach only those blogs that cross the line into active promotion or glorification. For example, joking that you need to starve yourself after Thanksgiving or that you wanted to kill yourself after a humiliating date is fine, but recommending techniques for self-starvation or self-mutilation is not."

Still others worry that banning dangerous content effectively pushes the problem into the closet. One user shared her fear that the ban would make people who need help feel "even more desperate and voiceless."

Tumblr does seem to be conscious of this criticism, and says they will be deploying PSA-style notices when users search the site for terms considered dangerous, like "thinspo," "proana" and "purging."

In all, most people seem to support the new policy. It certainly seems like a good idea to us, and we admire Tumblr for their sense of corporate social responsibility. The proposed policy changes will go into effect "in the very near future," according to the staff blog. In the meantime, Tumblr leadership is inviting the public to send suggestions to policy@tumblr.com.