The Child Mind BlogBrainstorm

  • Sleep and School: What a Difference an Hour Makes
    Oct. 22, 2012 Caroline Miller

    It's not like we didn't know it, but now we have evidence: Kids who get more sleep behave better in school. Measurably better.

    Researchers in Montreal gave one group of kids ages 7 to 11 an average of 27 more minutes of sleep than they had typically gotten, and found that it cut down significantly on emotional volatility and restless and impulsive behavior at school, according to findings published in Pediatrics.

    On the other hand, cutting about an hour of sleep from a similar group had the opposite effect.

    Okay, there were only 37 kids in the group, and the sleep experiment only lasted for five nights. And if you're wondering about that random-sounding 27 minutes, that's because while they got the children in bed an hour earlier than usual, it seems they only actually slept half that time.

    But still. Their teachers, who didn't know who was pulling extra sleep and who was deprived, recorded significant differences on behavior scales for attention, impulsivity, and emotional lability—crying, outbursts, becoming easily frustrated.

    It's worth noting because it's easy to underestimate how much lack of sleep affects kids' performance in school, and how important it is to address that when you're trying to sort out problem behavior.

    When my kids were in high school, and staying up all hours to study or finish projects they waited too long to start, we used to quote a line we heard another mom use: "Go to bed. Get a B."  Maybe that should be amended: Go to bed. Get an A.

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  • A New Diagnosis for Explosive Children
    Oct. 22, 2012 Caroline Miller

    Chronically irritable and explosive children are the subject of a new disorder called disruptive mood dysregulation disorder, one of the biggest changes in the upcoming psychiatric disorder guide revision known as the DSM-5.

    The disorder—DMDD for short—is the result of a long struggle in the psychiatric community over how to better understand and treat children with uncontrollable behaviors. These kids can be so difficult to manage—to keep them from harming themselves and other children, and even adults—that they are often put on antipsychotic medication or sent to residential treatment.

    Children who are extremely irritable and prone to extreme outbursts have, for the last several decades, been diagnosed with bipolar disorder, though they don't show the classic symptoms, dramatic mood swings between depression and mania. Psychiatrists who work with these kids have been unsatisfied with the diagnostic choices and treatment options they have.

    So the struggle has been to isolate and define this specific set of behaviors in a way that will lay the groundwork for more effective treatment, especially to help avoid overmedication. The Wall Street Journal chronicles the process and thinking that led to the new diagnosis in a very interesting story that lays out the back-and-forth that's gone on in the committee working on this issue, as well as the consequences, in terms of money and medications, that flow from any new diagnosis. Even names of new disorders have consequences, as the uproar against the first name proposed for DMDD—temper dysregulation disorder—demonstrates. Parents hated the name because, as one mother explained, "The use of the term 'temper' in the diagnosis connotes a bad personality," when what the child actually suffers is a "severe condition resulting from a dysfunction in the brain."

    There is always a lot of skepticism greeting new disorders, as if psychiatrists are inventing things for themselves to treat, but as the Journal story makes clear, what everyone agrees is that these children are in severe distress, and there should be a high priority on finding better ways to understand what's happening to them.

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  • 'Falling': A Touching and Sensitive Play About Autism
    Oct. 19, 2012 Michelle Kaplan

    I recently had the privilege of attending Falling, a touching play that just opened off-Broadway at the Minetta Lane Theater in Manhattan. The play explores the challenges and painful issues that families can face when raising a teenage child with autism. Playwright Deanna Jent draws on her own experiences as the mother of an autistic son, and the result is genuine and moving.

    In the play, the parents devote all of their time and energy to managing their 18-year-old autistic son—alternately endearing and angry, mentally limited but physically powerful—and their typically developing younger daughter is left to fend for herself. She carries a lot of resentment towards her parents as well as her brother, and it brings up the issue of how difficult it can be to give equal attention to your children when one child needs so much more support.

    The play brings up the stress that raising a severely autistic child can have on a marriage, when parents have different opinions on how to best deal with rigid routines and aggressive behavior. What happens when one parent feels their child would be safer in a group home? What happens when extended family members don't understand or agree with the decisions that parents make about raising their children?

    In one especially painful moment in the play the mom imagines what life would be like if her son was no longer with them, and her reaction is one of relief. It highlights the emotional double bind a parent can face, being overwhelmed by negative feelings towards a child while also unconditionally loving him. These feelings are not often admitted or accepted without judgment, and Jent is able to portray this in a very honest way.

    Additionally, the play brings up the need for more services to support young adults with special needs who are aging out of the system in our society. I highly recommend Falling, as it is not only an exceptional theatrical experience, but also an educational one.

    Falling has partnered with the Anderson Center for Autism, and producers have announced that through October, $5 from every full-price ticket will be donated to the organization Autism Speaks.

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  • The Ravitz Report: His Way
    Oct. 19, 2012 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.

    OK, this is an emergency report, because you have to see this movie. It's called His Way, a documentary on HBO GO about a music executive and movie producer named Jerry Weintraub who managed, at one time or another, Elvis, Frank Sinatra, Bob Dylan (and even John Denver) and then went on to produce lots of movies that I'm sure you've seen. He's a genuine force of nature. The film is both entertaining and awe-inspiring (sort of). What I found most thought provoking, though, was his domestic situation—a very long marriage, with lots of kids, and a longtime girlfriend who's friendly with his wife. I see so many divorces, and so many profoundly unhappy people in those divorces. It was a relief to see what could have been a disaster work out so well. Admittedly, Weintraub's is an extremely unusual situation, but WOW, what fun! 

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  • In October, 'Let's Talk' About Sex
    Oct. 17, 2012 Harry Kimball

    We like to say that talking to your kids about sex should be a "continuing conversation" between parents and children that starts young and evolves along with development. But not all parents can make that happen—which is why we are happy that Planned Parenthood has launched "Let's Talk Month" to encourage all parents to open a dialogue with their kids, no matter how long they've waited. It's never too late to start instilling good values concerning sex.

    Planned Parenthood has a bunch of informative articles and videos with practical advice on how to talk to teens about sex, and in particular on how to get them to respond and to keep the level of discomfort as low as possible.

    But I think the most interesting and important thing for parents that Planned Parenthood is providing is a statistic from a poll the organization conducted of about 1,000 teens and one of their parents. In general, almost all parents and kids said that they had spoken to each other about sex. But when you break it down, a disconnect emerges between what parents think they've talked about and what kids think. For instance, "49.9 percent of parents said they've discussed healthy and unhealthy relationships many times with their teens." That number for teenswho are the exact same children those parents were talking aboutis just 31.5 percent.

    Clearly, there is a lot of talking but not as much communication. So, even though it can be a little uncomfortable, it's very important that conversations about sex are clear, and that parents are forthright with their values and expectations. One way to achieve this is for parents to remember they are parents, not friends. A panel from the Freedom Institute explained this very nicely to our own Caroline Miller, and you can read about it here in a childmind.org piece on why frank sex talks are the most effective.

    As Planned Parenthood New York president Joan Malin puts it in a piece on the Huffington Post, "Let's Talk Month is a great time to begin, or continue, the conversation." The poll shows that parents and teens are doing a pretty good job, but we can do better. Rememberthough it might not seem like it, there is no one that influences a teen's attitudes about sex more than parents.

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  • Lessons From Looking at Temple Grandin's Brain
    Oct. 16, 2012 Harry Kimball

    Though people with Asperger's disorder aren't all socially awkward geniuses, as the stereotype goes, interest in so-called "savants" on the spectrum remains. The most famous of these is arguably the animal scientist and advocate Temple Grandin—and now we know what her brain looks like.

    Researchers at the University of Utah and other institutions used many different brain imaging techniques, as well as neuropsychological testing, to get an idea of what sets her brain apart from those "typical" people. The professor was compared against three controls, and some interesting structural differences emerged. (We should note that every brain is different, even if you aren't on the autism spectrum, and three controls is not the hugest sample group.)

    Temple GrandinAccording to the work presented at the Society of Neuroscience meeting and reported by the Simons Foundation Autism Research Initiative, Grandin's brain is larger overall than is typical, and has "enhanced" connections between brain regions associated with visual thinking as well as an oversized amygdala, the deep brain structure thought to be responsible for emotion. There are also "compromised" connections relative to controls, for instance, in areas tied to language and facial recognition. That we've reached this point in imaging technology and our understanding of autism is pretty remarkable.

    I believe the lessons here are fairly simple, and one of them we knew already: Temple Grandin is an amazing person. It's not a stretch to assume that she has a relatively remarkable brain, and this research suggests that. But the other observation is that we now know enough to predict where the brain differences will likely bethat we know when someone doesn't act or think "typically," we're probably going to see some changes in areas that we're getting better at predicting.

    The crucial caveat here is that no brain is "typical." It's sort of an old saw, but no person with autism is typical, either. And no person without autism is typical. We are all on a spectrum of humanity, and it's clear that some of us are closer to the center of the bell curve, as it were. And some of us are, for better or worse, outliers.

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  • Why ADHD Pills Won't Help Kids in Poor Schools
    Oct. 15, 2012 Caroline Miller

    Dr. Nancy Rappaport has written a terrific piece outlining why it's important that kids not be given ADHD medications just because they're not doing well in school or are behaving badly. That is, without a real diagnosis of ADHD, by someone who believes it's a real thing.

    She is responding to the piece that ran last week in the New York Times, in which a Georgia pediatrician describes prescribing the ADHD medication for kids who go to lousy schools as a form of "social justice." We can't fix the schools, he said, so we "fix" the kids.

    It's a particularly bad idea, she writes, to use ADHD meds to manage distracted or disruptive kids in poor schools without an actual diagnosis because there are a lot of other reasons why those kids may be distracted or disruptive, and if they're not addressed, those problems aren't going to go away with a prescription for Adderall. In fact they might very well get worse.

    For example, a child who has experienced trauma has many of the same symptoms as ADHD—"the hyperactivity, the disorganized approach, the distraction, the frequent mood changes, the anger, the reactivity," explains Dr. Rappaport, a Harvard professor of psychiatry who focuses on kids' mental health and schools. Undiagnosed learning disorders may cause a child to tune out, or to act out in frustration. These kids need a very different kind of help to do well in school—and life.

    It's troubling to acknowledge that we have to put the word "real" in front of diagnosis, to distinguish between a knee-jerk prescription and a serious assessment of a child's behavior. Dr. Harold Koplewicz makes this point, and explains the difference, on a roundtable video on Huffpost Live. He also makes the point that the majority of kids who have behavior problems in school don't have ADHD, and the one-pill-fits-all approach does a serious disservice to those who really do have the disorder, and do need the medication.  

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  • The Ravitz Report: Cyrus
    Oct. 11, 2012 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.

    CyrusCyrus is also very dark and very funny, but it’s touching as well. Jonah Hill plays Cyrus, a twenty-something who has a strangely close relationship to his mom, played by Marisa Tomei. Cyrus is on the warpath (in a passive-aggressive sort of way) with his mom’s new boyfriend, played by John C. Reilly.

    Talk about Oedipal conflict! For adults and teens.

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  • ADHD Medication: A Pill for Failing Schools?
    Oct. 9, 2012 Caroline Miller

    The New York Times has a provocative and compelling story on the front page today about the use of ADHD medications. It will be widely shared—and widely misinterpreted. 

    The story is about the growing use of ADHD medications to help kids struggling in school—kids, that is, who don't have ADHD. A lot has been written about middle class kids cribbing Adderall to help them score better on tests, or scoring their own prescriptions to enhance their chances of making it into an Ivy League college. But this is about a different set of kids: those whose schools are underfunded and whose parents can't afford the non-pharmaceutical support they need to enhance their school performance.

    In the story we hear a lot from Dr. Michael Anderson, a well-meaning pediatrician near Atlanta who routinely prescribes ADHD meds to kids essentially because they're struggling in school.  "I don't have a whole lot of choice," he tells the Times reporter. "We've decided as a society that it's too expensive to modify the kid's environment. So we have to modify the kid."

    Dr. Anderson sees it as an issue of social justice, of "evening the scales a little bit" for these kids who would otherwise almost surely be failing in school—in schools, that is, that he perceives as clearly failing them.  

    Whoa. We need to establish some facts here. Kids who are failing in or behaving badly in school don't necessarily have ADHD. It does a serious disservice to both kids who do have ADHD and kids who don't to prescribe it as a fix for bad schools.

    ADHD isn't a disorder that just happens in school—to qualify for a diagnosis, a child must exhibit extreme inattention, hyperactivity and impulsivity in several settings, not just the classroom. It's what we call a global impairment, and it's not responsible or competent to see stimulant meds simply as a tool to improve school performance—or to compensate for a lousy school.

    We know it happens, and we worry that it happens much more to kids whose families don't have the resources to get other kinds of support they might really need—tutoring, behavioral therapy, smaller classrooms, better-trained teachers, consistent structure.

    We worry along with one school superintendent who speculates that what's happening is a doctor who "sees a kid failing in overcrowded classes with 42 other kids and the frustrated parents asking what they can do. The doctor says, 'Maybe it's ADHD, let's give this a try.' "

    This story also fuels the myth that ADHD medication is dangerous.  The unsubstantiated suggestion that these meds can lead to lifelong addiction is irresponsible. There is a clear body of evidence that taking ADHD meds in childhood and adolescence does not increase the risk of addiction or abuse, and in fact they are among the safest, most effective, best-studied, and least easy-to-abuse psychotropic medications we have.

    So what we have here is a sympathetic pediatrician arguing that when a kid is struggling in school, trying ADHD meds might be the most cost-effective thing he can do to help. "I am the doctor for the patient, not for society." It may be cost-effective, but we'd argue that it's not good either for the patient or the society.

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  • NBA Player Royce White Gets a New Travel Plan for his Anxiety
    Oct. 9, 2012 Rachel Ehmke

    Royce White, the NBA rookie recently drafted to play for the Houston Rockets, is catching attention again because of his anxiety, this time after he requested permission to travel to close road games by bus due to his fear of flying. While White has already gotten on several planes with his new team over the summer, flying is stressful for him, and he says he'd prefer to avoid it whenever possible as part of a "more healthy work environment."

    royceWhite, who has generalized anxiety disorder and OCD, explained, "It's honest to just say, 'I have some anxiety.' It's a whole different level of honesty to say to the Rockets, 'I have anxiety, and this is what I need to do to be healthy and can you accommodate me?' I felt that it was necessary to take that step."

    White's skill is undeniable—people are already speculating that he'll have a spot on the NBA All-Rookie team—but he's always been upfront that he brings his anxiety along with his talent. This makes him a fascinating figure in sports, since athletes are often conditioned to mask their fears and weaknesses. But White does his best to be candid, both because he says he wants to be a role model for kids and because he believes getting the support he needs will make him a better player. Fortunately it looks like he has found a team that thinks the same way. The Rockets knew about White's anxiety and fear of flying before they drafted him, and they have agreed to let him drive to games whenever possible. Here's wishing them luck.

    Learn more about Royce White and his anxiety here.

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