The Child Mind BlogBrainstorm
Finding a Better Way to Prevent Teen Suicide
Jan. 10, 2013 Harry Kimball
A new study out of Harvard on teen suicide makes a sobering observation: 55% of people 13 to 18 who plan or attempt suicide have had some contact with the mental health care system. Which means it's not just kids who are not getting attention who are suicidal. It's easy to draw a disturbing conclusion—that there is nothing we can do for some of these kids.
But Dr. David Brent from the University of Pittsburgh sees it differently. "One of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide," he tells the New York Times. In other words, what the study really tells us is that we need to look for better ways to help adolescents in distress and leverage the tools we already have by taking a holistic approach.
We do have good treatments for the depression that can lead to suicidal behavior—but we are not always successful at delivering them, particularly to adolescents. At the Child Mind Institute we often get questions from parents frustrated by children who refuse or neglect treatment for a variety of psychiatric disorders, including depression. Antidepressant medication alone isn't always enough; studies show that the best treatment is a combination of antidepressant medication and behavioral therapy that can be very important in helping kids recognize and redirect their very negative thoughts and feelings.
The study also highlights a very important point: that kids most at risk for suicide are those who are not only depressed but impulsive, so depression combined with ADHD or substance abuse or explosive behavior is a potentially more toxic situation.
But it's also the case that adolescents, even as they are more emotionally labile than any other period of development, are in the process of separating from parents, which can make them disturbingly elusive.
The Times speaks to a mother who lost her daughter to suicide, who was being treated for depression. "I think there might have been some carelessness in the way the treatment was done, Margaret McConnell says. "And I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn't taking it regularly."
Knowing what's really going on with a teenager who's seeking independence can be one of the most difficult challenges of parenting. The Times story ends on that note : "Ms. McConnell said that her daughter's depression had seemed mild and that there was no warning that she would take her life.View Comments | Add Comment
Fearless Friends and Canine Companions
Jan. 4, 2013 Harry Kimball
We like to think that there is always a little bit of magic going on at the Child Mind Institute, but today was something else. It was the last day of our Fearless Friends program for kids with obsessive-compulsive disorder and specific phobias, and Dr. Jerry Bubrick, who runs it, had told me that a therapy dog would be in the office. At about 11 am I got an email from his iPhone. "Come now to Jenna's desk!!!"
There I met Jezebel, or Jezzie, who was calmly passing the time with two Fearless Friends, a boy and a girl, and eating cucumber slices for some reason. In the course of just a few minutes the girl, who was quite afraid of dogs, pet Jezzie "on her back and on all four legs," as she put it. I think she got the nose, because she said it was "really wet." Oh, and the real prize: "I found her tickle spot."
Throughout all of this Jerry and his colleagues Dr. Jamie Howard and Dr. Rachel Busman gently guided the interaction, which of course was a clever and delightful bit of exposure therapy. But it was the little boy who truly grabbed my attention. (Jamie told me later that his issue with the texture of cucumbers explained that odd detail.) At one point when the young lady was petting Jezzie, he asked, "Did you let her lick you yet?" No was the answer. "I wonder when you will," he said.
In case the point is lost, these children were in the care of smart, caring adults, but they had also been taught to support each other. And that says a lot about programs like Fearless Friends and Brave Buddies in particular, and about the Child Mind Institute as a whole. I won't even mention the other therapy dog, Safronelle, that mysteriously appeared, or the visitor who said the atmosphere today was like Google headquarters. I'll close with what the boy whispered to the girl as I walked away; Jamie told me later. "If she sticks her tongue out, she's just yawning," he soothed her. "Don't worry."View Comments | Add Comment
The Wrong Response to the Newtown Shootings
Jan. 4, 2013 Caroline Miller
The last couple of weeks have been especially painful for people with autism and the people who love them. We've heard from a number of parents that their kids with autism have been the targets of hostility—in person and online—ever since speculation that Adam Lanza had autism hit the media.
Joslyn Grey writes on Babble about some of the more hateful initiatives out there to link autism to the shooting. Notes Grey, who has two kids with Asperger's, "The worst thing my kids are going to do to you, on the other hand, is entangle you in a detailed discussion of the similarities between Lord Vader and Lord Voldemort."
There's a kind of awful confusion at the heart of this anti-autism campaign: that the kind of cold-blooded resolve of a young man who kills children and their teachers is connected to the lack of affect many people with autism display. People with autism may have difficulty reading social cues from other people, and responding accordingly, but that doesn't mean they lack empathy. And the kind of explosiveness kids with autism may display when they are frustrated or overwhelmed has nothing in common with premeditated murder. It is, in fact, most often directed at themselves.
What is true is that mental illness, especially when it's untreated or misunderstood, can result in isolation, frustration, misery and psychosis, and the way to prevent that is to make it possible for people to be more open about needing and seeking treatment.
The worst possible outcome of this tragedy would be making parents feel less free to discuss the worries they have about a child for fear that the child will be branded a potential Adam Lanza.
Let the final word go to the many, many autism parents sharing sweet photos of their kids on Autism Shines, to help dispel the misunderstanding that autism explains this killer's behavior. These kids don't deserve it.View Comments | Add Comment
Lady Gaga Now Providing Free Therapy to Fans
Dec. 31, 2012 Rachel Ehmke
Lady Gaga keeps surprising us by finding new ways to reach out to kids who are struggling. She's has become a kind of pop spokesperson for the importance of discussing—and treating—mental health issues. Now the singer has announced a new plan to provide free counseling before concerts on her current tour. The counseling will take place on the tour's Born Brave Bus and will be part of a tailgating experience that includes food, games, and DJs.
Okay, mental health care in such a festive atmosphere seems a little incongruous, but Gaga specializes in defying expectations. On her Twitter account she explained, "I feel like most kids don't look for help because they feel embarrassed so mom + I wanted to break the stigmas around 'help' and make it fun." She also wrote, "BornBrave Bus is a place where mental health + depression are taken seriously w/ no judgment, FREE real help available to all."
No way to know whether kids will take her up on her offer, but Gaga (who is only facilitating the sessions) says fans can expect "professional private or group chats about mental health, depression, bullying, school & friends."
Given how intimidating it can be to admit you need help for mental health issues, and how often stigma prevents or delays people from seeking treatment, we can't help but applaud. By extending her heartfelt support and resources to fans Lady Gaga is trying to make that first step easier. Sometimes just saying how you feel out loud can be an important beginning.View Comments | Add Comment
Notes on Newtown and 'Adam Lanza's Mother'
Dec. 17, 2012 Harold S. Koplewicz, MD
Liza Long has written a piece called "I Am Adam Lanza's Mother" that has gone viral on the Web. Her son has threatened to take her life and to take his own, and has been arrested and hospitalized numerous times. "We still don't know what's wrong with Michael," she writes. "Autism spectrum, ADHD, Oppositional Defiant or Intermittent Explosive Disorder have all been tossed around at various meetings."
What she does know is that she is afraid in the wake of the Newtown shootings.
I am sharing this story because I am Adam Lanza's mother. I am Dylan Klebold's and Eric Harris's mother. I am James Holmes's mother. I am Jared Loughner's mother. I am Seung-Hui Cho's mother. And these boys—and their mothers—need help. In the wake of another horrific national tragedy, it's easy to talk about guns. But it's time to talk about mental illness.
Unfortunately, Liza's story is not unusual. Some 15 million young people in the U.S. have a psychiatric disorder—and less than half will get any attention. There are three main reasons this public health problem exists: shame and stigma keep families from seeking help early on; institutional barriers limit access to mental health care; and there is not enough research focused on developing innovative, evidence-based treatments.
Liza is involved in the mental health care system, but we know that most parents do not seek help as soon as symptoms appear. Stigma and shame keep families from acting even when their child may be exhibiting alarming behaviors. On average it takes two years before a parent will seek professional help for a child with psychiatric symptoms. If they do get help, they still may not have the full support of their community due to persistent misconceptions about mental illness.
We often place the blame on parents, teachers, the media, or the children themselves. We speculate freely about things like diet or immunizations being contributing factors. But the bottom line is this: we simply don't treat disorders that occur from the neck up with the same respect, compassion and scientific rigor as disorders that occur in any other part of the body. And we won't be able to change that until we are able to de-stigmatize psychiatric and learning disorders.
Difficulty getting access to care is another big reason why psychiatric disorders in children and teens often go untreated. Health insurance typically does not cover outpatient psychiatric services, and even when there is coverage, insurance may only pay a fraction of the cost of the services. Access to care is also a problem. There are just 7500 practicing child and adolescent psychiatrists in the whole US—far fewer than are needed. Those who do practice are often forced because of managed care to limit patients to cursory 15-minute medication management visits, ignoring the more time-consuming behavioral treatments and psychosocial interventions that could be highly effective.
Then there is the lack of innovative treatments. Progress is basically at a standstill on the medication side; we haven't seen a truly new, original drug for childhood psychiatric disorders since Prozac was released in the 1980s. But we also haven't seen innovation in the way that treatment is delivered.
The standard of care is still the once-a-week outpatient appointment. While that's convenient for the treating physician, it just doesn't address the kind of problems that Liza's son is experiencing. A more flexible, multidisciplinary approach—and one that includes parents—is needed. New and effective psychosocial interventions do exist, but there are too few trained professionals with the skills to provide them.
While mass shootings are rare, the pain of untreated psychiatric disorders is common and the social cost quite steep. These children are more likely to have academic failure, school dropout, use illicit drugs, be a bully and be bullied, and have interactions with the legal system than typical kids.
We are scared of illness we don't understand. 50 years ago we were afraid of cancer. 25 years ago it was AIDS. Now it's time to understand mental illness for what it is: disease of the brain. We need to spread the word. We need to start training more professionals on evidenced based psychosocial interventions and treatments, and teach pediatricians, school personnel, and parents about the warning signs and symptoms of psychiatric illness so they feel comfortable getting kids help. And we need more investment in research science so we're able to identify biological markers of risk, improve diagnosis, and test whether treatments are effective by tracking real changes in the brain.
Yes, these solutions aren't easy and they are expensive. But talking about children's mental health is doable, developing new treatments is essential, and research science is critical if we want our children to have healthy, enjoyable, and productive lives. And if we want to give Liza Long and her family the answers they need.View Comments | Add Comment
Mass Shooting at Connecticut School
Dec. 14, 2012 Harry Kimball
We have nowhere near all the facts, but it is obvious that a terrible tragedy is unfolding in Newtown, CT, where a gunman opened fire in an elementary school this morning. Reports suggest that dozens of people are dead, many of them children. This act is incomprehensible, and our hearts go out to the entire community.
It is important that children everywhere, and particularly those close to this traumatic event, have the support of their parents and the community in understanding and adapting to facts we hope no child has to face. We have assembled some advice from experts here explaining the signs of trauma in children and giving advice to parents and teachers who are helping children cope.
Our thoughts are with the people of Newtown, and we hope a tragedy like this never happens again.View Comments | Add Comment
'Getting Better Is Not a Solo Thing'
Dec. 13, 2012 Caroline Miller
A wonderful 13-year-old named Franny kicked off the Child Mind Institute's third annual Child Advocacy Award Dinner last night, telling a hushed crowd of 900 guests about the anxiety that had, a year earlier, effectively shut down her life. She wasn't going to school. She could barely leave her apartment.
Terror is the best word I could find to describe my feelings most of the time—sometimes terror so powerful you feel like your heart is just dropping out of your body. And I was scared of what was in my own head—thoughts I knew weren't normal, thoughts of harming myself or ending my life.
Franny talked about finding help at the Child Mind Institute, starting the eighth grade at a new school and restarting her life. It was lovely to see her dazzling smile. And to hear her message to other kids:
If there's one thing I want to say to someone who is feeling as bad as I was feeling a year ago, it's this: You can be helped. It's so possible. You're not not not not alone. Getting better is not a solo thing.
For me Franny's words—"Getting better is not a solo thing"—expressed the theme of the evening, which focused on the Child Mind Institute's work not only helping children who are struggling now, but helping children in the future by pushing a transformative new paradigm for research into brain development. To do this work it takes not only brilliant clinicians, but researchers of many disciplines—neurobiologists and computer scientists and engineers, for starters—and supporters willing to invest generously in the work that has the most promise for improving diagnosis and treatment. Our Child Advocacy Award winner, Michael Fascitelli, sounded that theme in accepting the award last night.
There's nothing more important than our kids. We all have many great causes that we support, but this one has the most direct impact on the future.
And Dr. Nora Volkow, the director of the National Institute on Drug Abuse whose pioneering work showed that drug addiction is a disease of the brain, got to the core of the Child Mind Institute's mission as she accepted the 2013 Distinguished Scientist Award:
Thirty years ago, when I was a young psychiatrist seeing adult patients, we realized that these disorders first manifested in childhood and adolescence; now we have the tools for early intervention that can change the course of a life for the better, and that is what is happening here.
If you want to get a better sense of how the science we're supporting can help change the lives of children—and see and hear a little bit from Franny—check out this video, which was shown last night. The evening was festive as well as fruitful, as Dr. Harold Koplewicz put it this morning, we have 6.4 million reasons to thank everyone who came and contributed and helped make the event a success.
View photos from the event:View Comments | Add Comment
Sarah Ferguson on Girls and Self-Esteem
Dec. 3, 2012 Caroline Miller
Sarah Ferguson, Duchess of York, stopped by the Child Mind Institute this morning to learn a little more about what we do and talk a bit about an issue of special concern to her—helping girls develop healthy self-esteem.
Sarah is appealingly frank and she talks rather disarmingly about her own struggles with self-esteem, especially when she was a young princess being ridiculed by the British tabloids as "fat, frumpy Fergie" and "The Duchess of Pork." "I lost all my self-esteem, I lost any confidence I had, I lost myself, completely," she said, "and I don't want any girl to have to go through that. So I focus a lot of my attention on building self-esteem at a very young age."
She empathizes with young girls who compare themselves to "stick-thin" models and feel inadequate. "I had that with Diana, who was stick-thin, and I was always the one running behind with the rather large backside," she said.
She talks about the importance of parents listening to children and taking their fears and frustrations seriously, and letting them know that you love them "completely as they are."
She also talked at some length about discovering that her daughter, Princess Beatrice, is dyslexic. Beatrice was 7 years old when she seemed to lose her joy, feel ostracized at school, become introverted. Sarah thought at first that her daughter might have been targeted by bullies because she was a princess, but a very good teacher, she said, explained that Beatrice was struggling with reading and not being able to keep up with the other children. With special help in school, Sarah said, Beatrice did well and has recently finished college.
Sarah supports many different efforts to help children and has published quite a few children's books, including her latest, Ballerina Rosie, about a little girl whose red curls are always "squeaking out of her bun" and whose tutu is usually askew, who thinks all the girls in her ballet class are perfect except her. Suffice it to say that a shot of confidence comes her way, compliments of the Duchess.View Comments | Add Comment
'Far From the Tree': Parenting Children Who Are Different
Nov. 30, 2012 Caroline Miller
Andrew Solomon's new book, Far From the Tree, about parents of children who are dramatically different from them—or, perhaps more to the point, different from what the average parent hopes for or expects in children—is being reviewed, annotated, discussed and dissected all over. Book reviewers have applauded it for offering a candid and often surprising look at parents' struggles to accept and passion to protect children with "differences" ranging from autism to Down syndrome to dwarfism; kids who are gay or deaf or prodigies or killers.
The aggregation of these various (and arguably radically different) challenges to parenting is provocative, and critics have found it very affecting. Dwight Garner, the often-acerbic New York Times book critic, calls it "knotty, gargantuan and lion-hearted."
But to me, what's especially interesting are responses and recollections from parents for whom the emotional landscape Solomon is exploring is intimately, sometimes painfully, familiar.
Slate offers an intense essay by Cristina Nehring, a writer and single mother of a girl with Down syndrome who seconds some of Solomon's conclusions: "Hard love is in no way inferior to easy love," she cites, and "Diversity is what unites us all." But she takes issue with others, including the idea that the prospect of a limited future leads to "chronic sadness" in parents of children with Down syndrome. "I find it leads to "chronic carpe diem"—a chronic desire to seize the day and wring the best possible from every moment—and from myself."
It bothers Nehring that Solomon echoes the notion that while autism is mysterious, Down syndrome is not. "Autists are prodigies, introverts, misunderstood; people with Down syndrome are just dumb and dull," she writes. "And yet, Eurydice has always been mysterious to me." And she adds about her daughter, "The joy Eurydice takes in each detail of life is the most infectious quality I've ever known."
In a sometimes painfully honest piece in the National Journal, Ron Fournier, a veteran Associated Press reporter, offers a very different take on his relationship with his autistic son Tyler. Fournier's journey starts with his frustration and disappointment that Tyler is terrible at sports—which had been his only real model for father-son bonding—and his admission that he was upset at Tyler's typically Asperger's behaviors. "I was not just embarrassed about Tyler's manners; I was embarrassed about being embarrassed." He was also upset when the psychologist who diagnosed Tyler at 12 said that he was also depressed. He was sad and socially isolated, and "mortified about his failure to live up to my expectations," Fournier writes guiltily. What's sweet and funny about this piece is the role that two presidents—George W. Bush and Bill Clinton—play in teaching this former White House reporter how to be a better father to a son who has fallen, or maybe just landed, "far from the tree."View Comments | Add Comment
Sandy Isn't Over: View From the Rockaways
Nov. 12, 2012 Harry Kimball
Yesterday I stood on Beach 95th Street in the Rockaways amid drifts of sand, piles of sodden insulation and sheetrock, and discarded furniture. The apartment behind me smelled of developing mold—I knew because I had been inside tearing down walls in the hope to save the building from being totally contaminated.
Across the street, people from all over the region had come to offer food and supplies, and cars and buses filled the parking lot that until recently had served the beach, now in ruins. Hundreds of people in shirts advertising their membership in church groups and relief organizations went from home to home, offering help. On Saturday, when I asked a guy I was working with where he lived, I expected the answer to be Brooklyn, say, or Queens. "Virginia," he replied.
If you are in the Rockaways, or on Staten Island, or in hard hit parts of New Jersey or Long Island, you can see that Hurricane Sandy isn't over though the winds have passed. These neighborhoods are not yet in recovery. Ripping down walls to arrest the spread mold even as heat and hot water and electricity are absent and the temperatures drop is not recovery—it is a desperate measure.
Through all of this, parents are trying to protect their children and keep life from becoming totally alien. (This jibes with our own Dr. Jamie Howard's advice for parents following a traumatic event, which you can watch here.) Kids on the Rockaways are going to school—maybe not the shuttered buildings out there, but keeping routine nonetheless. I saw young people pitching in to dig out cars and houses from sand drifts, giving purpose to a time that could easily inspire doubt and dismay. Even as I saw adults understandably at their wits' ends, I saw kids who demonstrated just how resilient kids can be, particularly when their families and their community are standing strong behind them.
The homeowner others and I were helping yesterday had a three-week-old daughter, and he was determined not to have anything in their home that could harm her. Her name: Sandy. I'm sure she'll be a force of nature.View Comments | Add Comment