The Child Mind BlogBrainstorm
When the ADHD Diagnosis Is Wrong
Aug. 21, 2012 Harry Kimball
On Sunday, the New York Times published a piece by Bronwen Hruska that takes a stern look at a real phenomenon: treating disorders that aren't there. In Hruska's case, it was her son Will's ADHD, diagnosed in the fourth grade at the urging of his teacher, who found his wandering attention problematic—or the lack of the disorder.
In a nutshell, Hruska succumbed to pressure to have Will evaluated, he was diagnosed with ADHD inattentive type, and treatment with methylphenidate seemed to help him focus a bit. But after a year the medication "stopped working," Will stopped taking it, and he turned out fine. "For him, it was a matter of growing up, settling down and learning how to get organized," she writes.
"There's no clinical test for" ADHD, Hruska continues, which leaves room for this sort of confusion. "Doctors make diagnoses based on subjective impressions from a series of interviews and questionnaires." This and her experience lead her to the conclusion that overdiagnosis is rampant, and that "instead of leveling the playing field for kids who really do suffer from a deficit, we're ratcheting up the level of competition with performance-enhancing drugs."
It is heartening that Hruska concedes that some children "really do suffer from a deficit" in attention and self-regulation of impulsive and hyperactive behavior. But has stimulant medication for ADHD really crossed completely into the realm of "performance-enhancing" pill dispensed for less-than-perfect classroom behavior? As we've said before, we know there is misdiagnosis. But we also know there are many kids who get no diagnosis who really do need help, and it would be a shame if the phenomenon of parents being pressured into thinking their kids have a problem prevents kids who are really struggling and suffering from getting the care they need.
This means that we need better diagnostic tools, and better training for the medical professionals who care for our children, two things I doubt Hruska would disagree with. That's why it's exciting that we are getting closer to biological markers that can identify psychiatric disorders with more certainty, and that there is a growing awareness that diagnosis needs to be approached with more rigor both in the psychiatrist's office and in the pediatrician's office, where most kids are diagnosed.
We agree with Hruska that we hate to see medication that's important for kids who are seriously impaired misused by those who are looking for an advantage. She worries that we're teaching kids to reach for a pill when they're faced with challenges.
But this worry threatens to overshadow children in need. As one commenter on an accompanying blog post wrote, "Would you say this to an asthmatic? 'I'm afraid that if you don't experience the challenge of gasping for breath as a child, that when you have a setback at work, you'll just reach for an inhaler.'"View Comments | Add Comment
Autism, Airplanes, and Alec Baldwin?
Aug. 14, 2012 Harry Kimball
We couldn't help thinking of Alec Baldwin when we heard that a young woman named Carly Fleischmann got cross recently when American Airlines attendants insisted that she stow the iPad she uses to communicate for takeoff and landing.
Carly, a 17-year-old who has autism, insisted that she had been able to use the iPad on many other flights, and held her ground until the captain got involved, and allowed her to keep it open, though the fight attendant continued to insist that she not use it.
Unlike Baldwin, she didn't get into a shouting match or get thrown off the plane. But like him she had the nerve to express skepticism about the reasons for the rule. And like him she shared her travel and technology woes on the Web.
Now, I am as far from an expert on avionics and signal interference as you can get, and though I think many of us are skeptical about cell phone and electronics rules on airplanes I don't presume to tell airlines or the FAA their business. But I think Carly's stand illustrates how people with different methods of communication—she is nonverbal—are asking to be treated with respect. "It's time for you to move with the times," she writes on her Facebook page, "and understand that an iPad is not just for fun it's for people who really need it too."
Happily, the FAA is considering a course that would change the rules and let people like Carly hang on to their devices during takeoff and landing. As she puts it, "can you imagine being on the airplane and being asked not to talk for over 25 minutes?"
Coincidentally, the game Baldwin was playing was called "Words With Friends." It seems appropriate.View Comments | Add Comment
London 2012: The Real Olympic Role Models
Aug. 7, 2012 Harry Kimball
Ah, the Olympics. Primed for tales of triumph and perseverance in the face of daunting odds, we arrive at our TV sets every two years (four if you're prickly about the particular season) and watch the biggest mélange of sporting events in the world unfold on the international stage.
But triumph, humility, and perseverance are not the only qualities on display. While there have been many gracious acceptances of silver medals, and joyous bronzes, there have also been irritable disappointments, unsportsmanlike conduct, and some high profile disqualifications. Even the top athletes, the ones "favored" to reach the medal stand, sometimes appear like less than stellar role models. While Michael Phelps seems to have lived down his dalliance with a bong from a few years ago, his teammate Ryan Lochte has picked up the bad-boy mantle. "Jeah! Jeah! Jeah!" No.
So who to look up to? I propose that gold has little to do with it, and that a little digging will turn up an Olympian of every stripe for every young person looking for examples to guide them. There are some high-profile examples of this—veterans returning for one more shot, like the swimmer Anthony Ervin, who won gold in 2000 in the 50m freestyle, then spiraled into drug and alcohol abuse, a suicide attempt, and trouble with the law before returning to the sport for this Olympics. He placed 5th in the final.
Then there are international stars trying to break in to the higher reaches of their disciplines despite amazing obstacles, like the South African runner Oscar Pistorius, who first needed to master the sport on artificial legs and then convince the world he could compete with everyone else. He didn't make the final in the 400m in London, but his mere presence seems like validation enough for his incredible efforts.
But if we go even deeper we begin to see what the Olympics can really be about, and to find the garden-variety determined athletes who necessarily embody what the Olympic experiment can teach our young people and ourselves. Remember, the vast majority of people with Olympic dreams have no reason to expect a gold medal. The vast majority are trying to make their country's team so that they can show what they can do, even if everyone around them doubts the validity of their talents. The vast majority compete with others who have gold "in their grasp" because it can be just as valuable, and just as inspiring, for someone to attempt what others think is beyond theirs.
What I like to focus on—at the same time that I cheer for US gold, which seems impossible to avoid—are all the competitors for whom the medal stand is less of an obsession or even a likelihood. The competitors who understand—and help us understand—that the Olympic spirit that is most valuable lives not just in the favorites but also in the most unlikely people and corners of the world.
When he placed well enough in the heats to advance to the semi-final of the 400m, Pistorius told the Globe and Mail that he understood his limitations. "My times are off the top guys in the world," he said. "I had to run a really hard race to make the semi-final." But that doesn't mean he isn't Olympic material, he continued, quoting from his late mother. "She always told me, 'A loser isn't the person who gets involved and comes last, it's the person who doesn't get involved in the first place.'"View Comments | Add Comment
Squeezing Teenage Girls Into Girdles
Aug. 6, 2012 Rachel Ehmke
You have to wonder, is it the Mad Men effect? The corsets and girdles that went out of style in the 70s are back, now discreetly called "shapewear," and they're being marketed to girls as young as 13. Good Morning America recently reported on the trend in a segment that described shapewear like Spanx as "necessary," "a way of life," and "the must-have accessory" for teenagers, who are said to be wearing them every day to school. "You've got the training bra and then you've got the Spanx. Everyone wears them," one girl tells the camera.
It's not only bizarrely retro, it's frankly alarming to see people returning to the girdle, particularly if it is becoming a right of passage for girls before their bodies are even developed enough to wear a real bra. Besides making girls more likely to develop an eating disorder, child psychologist Ned Hallowell says the popularity of shapewear for teens might mean "never being happy with your own body image."
And some of it is even being designed especially for teenagers: Jill Zarin, formerly of The Real Housewives of New York City, has such a line of girdles called, grossly, Skweez. In her interview Zarin argues that shapewear is good for girls because it "normalizes" their bodies—a claim that tells a young girl her unsqueezed body isn't normal. That has to be one of the worst messages you can send a 13-year-old, along with the message that spandex is the best way to make yourself fit the idealized norm of what women's bodies should look like. We are used to celebrities and non-celebrities alike supplementing (or maybe supplanting) healthy diet and exercise with Photoshopping and Spanx. But without proper perspective, these things can distort a child's reality. It's 2012. Healthy diet and exercise should be the new normal, not body shame and spandex.View Comments | Add Comment
Teens Take Note: The Style Rookie Grows Up
July 31, 2012 Rachel Ehmke
After four years in the spotlight, Tavi Gevinson, the girl who's famous for launching her first blog at 11 and getting embraced by the fashion world as an idiosyncratic genius at 12, is sixteen. And she's one of the most interesting 16-year-olds around.
For those who don't know about her, Gevinson is a true wunderkind. Part of what makes her so fascinating is that she is pioneering a new kind of child celebrity made possible by the Internet: she is famous for what she thinks. Her first blog The Style Rookie went viral, earning her regular invitations to high profile fashion shows, sometimes even sitting next to Vogue editor Anna Wintour. At 15 she diversified, founding Rookie, a feminist website for teenage girls. Right now she's gracing the cover of Bust magazine and she has a profile in the Style section of the New York Times. This is not the first time Gevinson has been profiled by the Times. And yet she's still a real teenager, who says things like "daisies are literally the best thing ever" and has a reputation for crying when she listens to Taylor Swift songs. And like all teenagers, Gevinson is reinventing herself. Her roots are in fashion, but she says these days she is more interested by pop culture and feminism. She ditched her dyed bluish-gray granny hair for a blonde Laura Palmer Twin Peaks cut. Lately she's been wearing mod eyeliner and trying more form fitting clothing, although she worries men will think it is for them. She's growing up, and it's changing her creative output.
Gevinson told Bust, "My sister Rivkah always tells me that I'm really lucky that I discovered feminism when I was 12, because I gained an understanding about it as I was hitting that teenage-girl self-esteem drop." That drop in self-esteem for teenage girls is a really big deal. Earlier this month the Keep It Real anti-Photoshop campaign released a study saying that 53 percent of 13-year-old girls are unhappy with their bodies. The number increases to 78 percent by age 17. Even worse, 80% of 10-year-olds say they've been on a diet. The data is alarming, but it also makes sense because girls know women get more attention for how they look than for what they do.
Rookie is trying to change that. The site cares about fashion (no product of Gevinson's could ever ignore it), but it treats style as art and a way to express yourself-not a way to attract a boy. The writers interview cool, successful women and share advice on how to join a band (something girls still aren't conditioned to do) or how to become "the next Didion, or Hurston, or Woolf, or you." Yesterday they ran a story about how to safely skip school and have a great time doing it. Like Amy Poehler's Smart Girls at the Party, Rookie just wants girls to get up and do something. And they're leading by example. At Rookie Gevinson is the editor-in-chief and half of her staff are teenagers. The editorial director, Anaheed Alani, is 41 and calls Gevinson her boss. In Bust Alani writes, "My philosophy on bosses has always been that I won't work for someone who isn't smarter than me, and Tavi Gevinson definitely fits my criteria." She's clearly inspired by the 16-year-old, and so are the girls who turned out in droves to meet Tavi during Rookie's recent promotional road trip. "I actually started my own blog because of her," one girl told the Times. We're sure she isn't the only one.View Comments | Add Comment
Springsteen Is Depression's Newest Role Model
July 26, 2012 Caroline Miller
The headline on David Remnick's new New Yorker profile of Bruce Springsteen is "We Are Alive," a nice bit of understatement for a 62-year-old rocker who's not only an enduring icon but a "preposterously fit" wild man on stage, his performances "joyously demonic," as Remnick puts it, "as close as a white man of Social Security age can get to James Brown circa 1962."
But it's also a good headline because Springsteen's creativity has always been powered in part by "the darker currents of his psyche," as Remnick writes, and in the piece Springsteen acknowledges experiencing periods of profound depression for more than 30 years, including crippling bouts of self-doubt and self-loathing. "He was feeling suicidal," Springsteen's friend and biographer Dave Marsh tells Remnick about an episode in 1982 that sent him to a therapist for the first time. "He was on a rocket ride, from nothing to something, and now you are getting your ass kissed day and night. You might start to have some inner conflicts about your real self-worth."
Why is it important that Springsteen is open and thoughtful in this interview about living with depression? Because his candor could actually save lives other than his own. The biggest contributor to teenage suicide is unrecognized mental illness. Especially at risk are teenage boys who hide their depression and anxiety from their parents and friends, because they are ashamed to admit their feelings of despair and worthlessness. What we need most, notes Dr. Alan Apter, an Israeli psychiatrist who is an expert in suicide, is prominent role models to tell teenage boys that it's not unmanly to ask for help. For Israelis, he notes, it might be military officers. For American boys, he suggests, that might be sports stars.
Or maybe an entertainer? Granted, the Springsteen-fever of the mid-80s and "Born In the USA" has ebbed a bit, and he isn't that young anymore. But who could resist the Boss as a masculine role model—rock and roll's answer to a legendary Israeli fighter pilot? "I'm thirty years in analysis!" he tells Remnick, and he's still up there, trading energy with the crowd and his band, "exciting people and exciting yourself into some higher state." Or, as he sings, you might feel stuck or down, but "the night's busting open / These two lanes will take us anywhere."View Comments | Add Comment
James Holmes and the Downside of Amateur Diagnoses
July 23, 2012 Caroline Miller
With a frustrating lack of information emerging about James Holmes, the young man who opened fire at a midnight movie screening last week, there is loose talk all over about what kind of mental illness could drive a promising neuroscience grad student to commit such a horrific act.
All we know at this point is that we can't understand it; we have no idea whether he had a history of psychiatric illness or had been exhibiting warning signs of a psychotic breakdown. And the amateur diagnoses we've been hearing are painfully misinformed, most spectacularly this comment from Joe Scarborough this morning:
As soon as I heard about this shooting, I knew who it was. I knew it was a young, white male, probably from an affluent neighborhood, disconnected from society— it happens time and time again. Most of it has to do with mental health; you have these people that are somewhere, I believe, on the autism scale. I don't know if that's the case here, but it happens more often than not. People that can walk around in society, they can function on college campuses—they can even excel on college campuses—but are socially disconnected.
Even more stunning than the vision of these zombies walking around on college campuses is the fact that Scarborough has a son with Asperger's, and he went so far as to say that while his own son "is loved by everybody in his family and is wonderful," one has to worry about "those who may not have a loving family and a support group and may be a bit further along on the autism spectrum."
That statement is so misguided it makes me speechless. The fact is, of course, that there is no evidence linking autism with this kind of premeditated violence, and Scarborough's casual branding of college kids with autism as tragedies waiting to happen is the kind of thing that hurts a lot of innocent people. As Lydia Brown, a very sharp young woman who writes a blog called Autistic Hoya, put it in a post Friday:
When these things happen, there's always a second round of victims. And that's us, the neurodiverse. And we wait for it to happen because we know it will. It always does. And every time, it cuts deeper, reopens the torrent of unidentifiable emotions mangled together in a bizarre and incomprehensible mezcla.
It's certainly no balm to the people suffering from this tragedy, but if we can resist tarring a whole group—whether it's quiet white boys from affluent neighborhoods who play video games or people with autism who are "farther along on the spectrum" than Joe Scarborough's son—we can minimize the damage to a lot of other people.View Comments | Add Comment
Hats Off to Dr. David Herzog for Advocacy on Eating Disorders
July 19, 2012 Caroline Miller
This week The Boston Globe named Dr. David Herzog one of "12 Bostonians who are changing the world." The shoutout was for Dr. Herzog's leadership and advocacy on eating disorders—encouraging people to speak out to fight the shame attached to anorexia and bulimia—and for his diplomatic outreach to the fashion media, which this spring resulted in a pledge from Vogue magazine to avoid using underage models or those who appear to have eating disorders.
Our congratulations to Dr. Herzog, who is a friend and member of the Child Mind Institute Scientific Research Council. Dr. Herzog is the director of the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital. Every year the center sponsors a public forum on body image and the media, inviting prominent players in fashion and the media to speak.
The headliner of the forum this year was Arianna Huffington, who acknowledged that her two daughters, now at Yale, both struggled with eating disorders. Huffington said she knew her daughter Isabella had developed an eating problem when, at 12 years old, she refused to eat a piece of her own birthday cake. "The image of Isabella refusing her birthday cake," Dr. Herzog writes in a blog on the Huffington Post, "captured the fear and powerlessness that many parents encounter upon spotting signs of an eating disorder in their child."
You can hear Dr. Herzog talk about the early signs of an eating disorder parents should be alert to in the video below.
Stress and the Special Needs Parent
July 18, 2012 Beth Arky
Parents—especially mothers—are constantly bombarded by the latest "best" way to raise children. These range wildly from the strict, pushy Tiger Mom to the laissez-faire French Maman. Now comes a study reported on Forbes.com that parenting styles affect parents, too. The more "intense" your style of mothering, it seems, the greater your own risk of stress and depression.
The study, based on an online survey of 181 mothers with children age 5 and under, used several measures of "intensity," including whether you feel mothers are more "necessary and capable" than fathers, whether you feel it's your job to provide the most stimulating activities for your child, and whether your child's needs and wants should always come before your own. The study found several of these factors linked to lower life satisfaction and greater depression and stress. While parenting per se didn't put mothers at risk, "aspects of intensive mothering beliefs are detrimental to women's mental health."
It makes sense that moms who give their all to their children and lose sight of their own needs would eventually end up depressed, especially if their children—and spouses, potentially—come to take it for granted. Yet implicit in the study is the idea that these mothers have the option to lighten up on their intensity.
We can't help thinking of mothers caring for special needs kids, whether they have ADHD, autism, sensory processing issues, disruptive behavior, anxiety, or learning disabilities. I daresay many of these moms would be happy to relax a bit, but their children need intense parenting and constant attention. It's not optional.
These are often moms who've had to earn an unofficial PhD in their child's diagnosis, and whose job descriptions include being caregiver, case manager, and advocate. It can take tireless work to connect with the right doctors, teachers, therapists, online resources, and other moms fighting the same fight. They're wrestling with tough issues like medication and bullying, struggling to manage difficult behavior, find the right school, set up play dates, and find experienced sitters, often leaving a paying job to focus on their child's care. It's easy to see why special needs moms would be at risk for stress and depression. (There's a reason Sunday Stillwell named her popular autism blog Adventures in Extreme Parenthood.)
With this in mind, autism mom blogger Alysia Krasnow Butler (Try Defying Gravity) launched something called the Oxygen Mask Project. The name refers to the idea that if your plane is going down, you put on the oxygen mask first so you can help your child with hers. The site offers an important message: "It's time to realize that when parents take care of themselves first, it's not selfish. It's survival.... We're not talking spa vacation. We're talking sitting down for a meal. Drinking our coffee when it's hot." There, parents may share how they are making lifestyle changes to make mental health a priority.
No one is saying that parenting typically developing children isn't stressful. (As one mom of two once told me, "It's the hardest job you'll ever love.") But when your child has special needs, the job intensifies—and with it the need to help moms keep their heads above water.View Comments | Add Comment
Amy Poehler Says Smart Girls Have More Fun
July 17, 2012 Rachel Ehmke
Who can resist Amy Poehler? She's a charming, infectiously funny lady, and she's the star of one of the best shows on television right now. For a long time she's been one of our favorite actresses, and now because of her online TV show and website, Smart Girls at the Party, she's one of our favorite people, too.
In each episode Poehler, the show's host, interviews a girl about something she's passionate about. Past interviews have included Anna the nine-year-old who loves yoga, Rachel the twelve-year-old robot engineer, Valentine the eleven-year-old gardener, and Ruby the seven-year-old feminist. The girls aren't chosen because they are the best at doing yoga poses or keeping orchids alive, they're chosen because they're interested in interesting things, and that's pretty cool. Poehler begins most episodes by saying, "We celebrate extraordinary individuals who are changing the world by being themselves." And did we mention the theme song's refrain is "Smart girls have more fun"? It's a nice message for tweenage girls, and the show is as fun and kooky as everything else Poehler does. But my favorite thing about Smart Girls is the way Poehler genuinely tries to meet these girls where they are. The best example of this is probably the new Smart Girls series called "Ask Amy," in which girls can submit questions and Poehler will answer them on video. The first question comes from a 14-year-old who wants to wear makeup but her father says she's too young. "How am I supposed to feel as pretty as my friends who are allowed to wear makeup?" she asks.
Poehler answers the question like the world's greatest big sister. Her show might be all about celebrating girls who are comfortable being themselves, but being yourself while still fitting in with the group can be a hard line to walk, and Poehler was thoughtful when she gave her answer. She hit all the right points—she said 14-year-olds are naturally pretty without makeup, but she also sincerely empathized with how it feels to get left out of something new and exciting. Ultimately she suggested the girl try to have an adult negotiation with her father about trying just a little bit of makeup, and her answer felt spot-on. The 14-year-old inside all of us was comforted. (Plus Amy offered to talk to the girl's father.)
Happily, Smart Girls at the Party is just starting its second season. We think you and your daughters should check it out—you won't be disappointed. Here's a preview below:View Comments | Add Comment