The Child Mind BlogBrainstorm
Company to Test Vyvanse Safety in Kids Under 6
June 16, 2014 Harry Kimball
It's interesting to hear that Shire, the maker of the Vyvanse stimulant medication for ADHD, has agreed to an FDA request that it evaluate the drug for children younger than 6. Kids under 6 may well be getting prescriptions already, but prior testing only looked at the effects in kids over 6.
This underscores one of the more peculiar aspects of the way a medication approved by the FDA for one illness or group of people can also then be legally prescribed for an entirely different disorder, or to treat a whole new demographic—kids, for instance.
This is a heartening development, given the considerable alarm recently over the rise in stimulant prescriptions, particularly for very young kids. The FDA taking an active interest in addressing concerns with sound science is fantastic. The fact that Shire has agreed to expend effort to answer questions that are very important to kids and families is also encouraging.
Of course, there is a lot more to this than just cooperation, I'm sure. In fact, the Financial Times reports that Shire will get another 6 months of lucrative patent protection out of the deal, at least. And other details aren't immediately clear, including how rigorous the trials will be.
Sure, there is a lot to be cynical about when it comes to pharmaceutical marketing and the interplay between government and big business. But in this case it certainly seems like a gap in the system was recognized, consumers were listened to, and proactive action was taken. Shire insiders tell the Financial Times that establishing "firm data on safety and efficacy" for Vyvanse in younger children "was in the public interest." I'm happy for the time being thinking that we can all work together for that purpose.View Comments | Add Comment
Teen Overcomes Anxiety to Compete on ‘America’s Got Talent’
June 13, 2014 Beth Arky
When Anna Clendening competed on America's Got Talent this week, she brought her music and a whole lot of courage. Before launching into a heartfelt rendition of Leonard Cohen's "Hallelujah," the 20-year-old shared her story of being bedridden as recently as four months ago by a crippling anxiety disorder, panic attacks and depression that first manifest themselves when she was 14.
"It felt like my mind had given up on me," she said in a segment that has since gone viral. "I didn't see a future. I just didn't want to be here anymore." She credits therapy, her parents and, like so many others with mental health issues, finding something she loves to do with helping her battle her issues.
Talent judge Howie Mandel, who was diagnosed with OCD and ADHD as an adult, told Clendening, "People really don't know what it takes and how much suffering it is. For you to even show up today is so amazing." He encouraged her further, saying, "There isn't anybody alive that at some time doesn't need help in coping."
The singer got a standing ovation and Mandel was so moved he hugged her despite his fear of germs. She also received countless accolades in online comments and on social media. Erin Roberts Jones, who writes about autism and anxiety on her Mutha Lovin' Autism Facebook page, posted, "This hits so close to home. What an inspirational young woman for all of us dealing with anxiety and panic attacks. Just wow."
Clendening is far from alone. By mid-adolescence girls are more than twice as likely to be diagnosed with a mood disorder as boys. Teenage girls who participated in an online conversation about anxiety hosted by the Child Mind Institute and Amy Poehler's Smart Girls stressed it's important to face your fears to overcome your challenges. We applaud Anna Clendening for bravely stepping on that stage as she gets the help she needs.View Comments | Add Comment
Audra McDonald and ADHD Medication
June 11, 2014 Caroline Miller
If you're tired of hearing people equate ADHD medication with lazy parenting, you'll enjoy Belinda Luscombe's open letter to Audra McDonald in Time. Luscombe was responding to McDonald 's comment, in accepting her sixth Tony Award Sunday night, that her parents' unwillingness to put her on stimulant medication led to her stunning success in musical theater.
"I want to thank my mom and dad up in heaven," McDonald said, "for disobeying the doctors' orders and not medicating the hyperactive girl and finding out what she was into instead and pushing her into the theater."
Luscombe is, of course, glad things worked out well for McDonald, and sure that the immensely talented singer didn't mean to put down parents who do decide to give kids ADHD medication. But that's certainly the effect of comments like this.
What bothers me is why McDonald thinks parents who try medication don't also try to help their kids find out what they are good at and passionate about. Of course they do. Who said it was either/or?
Luscombe has a son with ADHD who was having a very hard time with learning. "We've tried the theater, sports, music, wearing him out, getting him more sleep, meditation, diet, being super-disciplinarian, being not too disciplinarian, art, bribery and shouting," she writes. "But the thing that worked best, that enabled him to learn to read and stopped him from getting into trouble at school, was medicine."
What works for one kid doesn't necessarily work for another, and parents of kids with ADHD deserve more support, not more anxiety.
UPDATE: Tiime has posted a response from Audra McDonald to Luscombe's letter, acknowledging that the needs of each child have to be considered individually, and filling in a little more detail about her parents' decision. They were "struggling with the question of how best to help their struggling, unhappy, hyperactive child," she writes, when they happened to see a troupe of children performing at a dinner theater, and thought "it might be a good outlet for my energy, an oasis for my emotions and possibly a place for me to build some desperately needed confidence."
It turned out to be a "life-changing decision," she writes, and one we can well imagine her strong feelings about. The response is worth reading, and the turning point she describes is one we hear about a lot from adults who have struggled with attention problems. Finding a passion that will be the focus of your life can be transformative, whether medication helps you find it, and succeed at it, or not.View Comments | Add Comment
The Truth About Troubled Children
June 10, 2014 Harry Kimball
Today there's news of another school shooting in Oregon, close on the heels of the tragic loss of seven lives at the hands of Elliot Rodger. While it's painful for all of us to hear of children being gunned down by a disturbed young man, for some parents there is an added source of pain. These shootings cause "a shiver of dread in certain parents all over the country, particularly those with teenagers and young adult children who seem capable of violence," as the New York Times writes. The dreadful question: "Could my boy ever do that?"
Times reporter Benedict Carey is preparing an article "about the struggles of families trying to get help for such troubled children," and the paper is asking for parents and family members to tell their own stories. Here at the Child Mind Institute, we applaud this project, because authentic, nuanced stories from families and young people with psychiatric disorders are a powerful—maybe the most powerful—way to make mental illness real to the public in all of its complications.
Too often in the news we are asked to reduce reality to extreme caricatures. Take young men with psychiatric diagnoses, for instance: On the one hand we imagine a psychotic murderer who is beyond saving. On the other, a boy whose harmless behavior is being pathologized by overweening doctors and unnecessary treatment. But we know that between the extremes of "psycho killer" and "boys will be boys" lies the reality of many families—children with real struggles, real barriers to getting good care for them, and the real potential of young people to respond to the right treatment and support.
We hope those of you with stories to tell about troubling and even violent behavior in childhood, and the struggles and triumphs inherent in dealing with these problems, will share them with the Times. Maybe by doing that we can bring some detail to the conversation and start coming up with solutions to the complex problems we face.View Comments | Add Comment
Kurt Vonnegut on Mindfulness
May 30, 2014 Jessica Kashiwabara
Mindfulness seems to be on everyone's minds these days. The best example we've seen in a long time comes from the late, great Kurt Vonnegut, as featured in the new anthology of his commencement speeches, "If This Isn't Nice, What Is?: Advice for the Young". Vonnegut writes about how happiness comes from the quiet moments that we don't often appreciate, and that "it's a terrible waste to be happy and not notice it." Mindfulness is all about being present in those moments, slowing down and enjoying what you have right now. Vonnegut summarizes this perfectly speaking about advice he got from an uncle:
"My Uncle Alex Vonnegut, an insurance salesman who lived at 5033 North Pennsylvania, taught me something very important. He said that when things are going really well we should be sure to notice it. He was talking about very simple occasions, not great victories. Maybe drinking lemonade under a shade tree, or listening to music coming from a concert hall while standing in the dark outside, or, dare I say, after a kiss. He told me that it was important at such times to say out loud, "If this isn't nice, what is?"
If that isn't a great mantra, what is?View Comments | Add Comment
Tennis Star Taylor Townsend Brings Body Positivity to Grand Slam
May 30, 2014 Beth Arky
Townsend, 18, got much-deserved attention for her stunning Grand Slam debut Wednesday. The 205th-ranked wild card upset No. 20 seed Alize Cornet of France, making her the youngest American to reach the third round since 2003. She also put those who have complained in the past about her weight in their place.
"Sky's the limit," a jubilant Townsend said after doing her victory dance.
It's that kind of attitude that helped her rise above her problems in 2012, when she became embroiled in controversy over what the United States Tennis Association termed her "physical condition"—in other words, her weight. Despite the fact that the lefty won the Australian Open juniors at 15, the USTA tried to stop her from competing at the U.S. Open, saying it would not restore its funding until the then-top-ranked junior in the world lost weight, forcing her mother, Sheila, to cover travel expenses.
At the time, Serena Williams, who has also been criticized for her weight, said, "For a female, particularly, in the United States, in particular, and African-American, to have to deal with that is unnecessary. Women athletes come in all different sizes and shapes and colors and everything. I think you can see that more than anywhere on the tennis tour."
Instead of giving up, Townsend gave up on her USTA coaches, partnering with Zina Garrison, a former Wimbledon runner-up, and Kamau Murray, a tennis coach she has known since she was 6. Garrison said the experience only made the teen stronger: "The biggest thing was just getting her to understand that she's fine. Everybody doesn't have the same shape of our bodies. She's very clear on that now."View Comments | Add Comment
Brandon and Michi Marshall Speak Out Loud for Children's Behavioral Healthcare
May 27, 2014 Harry Kimball
The final Speak Up for Kids "road trip" event was held in Chicago last Wednesday, with an introduction by some very special guests. Bears' wide receiver Brandon Marshall and his wife Michi, who have just pledged $1 million to the mental health community from their Brandon Marshall Foundation, opened up the panel discussion on integrated mental and physical healthcare with equal parts humility and inspiration.
"I can't tell you about the strengths and weaknesses of integrated care," Marshall joked. "I'm not a professional. But what I am is a patient. So I can give you my story." He received a diagnosis of borderline personality disorder (BPD) in 2010, but the emotional and behavioral problems were there long before. "My life was a living hell."
Standing beside his wife, Marshall described just the sort of distressed interpersonal relations that are such an insidious part of BPD. "We had a dream home and I sat in a darkened room for days. When I walked out my front door I had to have a hoodie on because I didn't want to talk to anybody. My wife is beautiful, but I couldn't tell her I loved her, I couldn't connect with those emotions."
BPD is associated with suicidal thoughts, and Marshall acknowledged this when he said, "Now I understand why famous people, celebrities, millionaires sometimes take their lives. We grow up sometimes thinking that if we have security, if we make a million dollars, we'll be happy, but there's more than that."
Marshall has described the treatment program at Harvard's McLean Hospital that enabled him to take back his life. "It's like a light bulb's been turned on in my dark room," he told the Sun Sentinel at the time. (The state-of-the-art treatment for BPD is called dialectical behavior therapy, and last week a very accomplished DBT clinician, Dr. Alec Miller, described the therapy for us. Here's a video.)
The Marshalls' dream for kids acknowledges that there area a lot, like Brandon, who come from very chaotic homes, who act out in school because they need help. "We would love to see every school, not just in Chicago, but in the nation and possibly the world, have onsite behavioral healthcare services that not only treat the children but also the families," he pledged. "That's the root of our issues." When we address the problems of our children, "we're not dealing with the surface, we're not dealing with the shell."
Introducing CMI president Dr. Harold Koplewicz, and perhaps addressing other clinicians in the room, Marshall noted that "people like you really save guys like myself." But looking at the Marshalls it was clear that their strength and resolve has the potential to create a movement that will save many more kids, by making their needs visible, and fighting the stigma that keeps so many of them from getting care. We're thrilled to be on their team.View Comments | Add Comment
I Speak Up Because I Know I'm Not Alone!
May 27, 2014 Natasha Lerner
Hey. I want to say that people should speak up about mental health because I want them to. I know that sounds selfish but hear me out.
When I was in the worst parts of my anxiety I was convinced I was the only one who felt this way. I thought I was insane. I finally had the courage to tell a friend that I saw a therapist when I was in fifth grade and she laughed and asked if I was going to be sent to the loony bin. I was so upset I never wanted to go back. This girl that I had told was supposed to be my best friend and if she laughed then I knew something was wrong with me.
Now that I've surrounded myself with friends I trust, and who are supportive, I realize how that girl who laughed at me was wrong. I'm glad to tell people about the issues I've had and have. I want them to know that it happened to me and that I turned out fine enough.
I also found out that some of my idols have had anxiety: David Bowie, Alanis Morissette, Aretha Franklin, Courtney Love, Winona Ryder and so many more. You can tell by the list of people I admire, I'm into art and music (mostly music).
I know it sounds a little cheesy, but trust me it makes people feel like they aren't alone.View Comments | Add Comment
Elliot Rodger and the Santa Barbara Shootings
May 26, 2014 Harold S. Koplewicz, MD
On Friday night in California, 22-year-old Elliot Rodger used knives and handguns to take the lives of 6 college students, and then his own. The question of why has been followed quickly by these: "How could we have stopped this? Would better gun control laws have helped? Was he mentally ill?"
News reports, and Rodger's own "manifesto," suggest that he was receiving mental health treatment, although his diagnosis if any remains unclear. His parents were alerted by alarming social media posts and a message from Rodger's therapist. As many have noted, he bought the firearms used in the attacks legally according to California law.
I do not know exactly what Rodger was struggling with, but it is clear that he was a profoundly ill young man. And I hesitate to give credence to his writing, titled "My Twisted World: The Story of Elliot Rodger," which runs to more than a hundred pages and would never have been read if he had not done such a terrible thing. But his deep jealousy, feelings of inferiority, and hatred of women shine through any artifice.
I'd like instead to focus on something that was put accurately if limitedly by the Santa Barbara sheriff investigating the spree killing. "I think that he was able to fly under the radar, so to speak, in terms of his likelihood or propensity to hurt anyone else," he told the New York Times. It seems as though Rodger was a "flying under the radar" in many other respects, including his profound inability to engage socially with his peers, and the angry frustration this caused for years leading up to his time in Santa Barbara and his unspeakable acts.
Elliot Rodger appears to have experienced a tough, even brutal social adolescence, by his telling. His home life was difficult and disjointed; his needs for peer approval were not met, despite his striving. However, unlike the untold number of other young people who encounter these setbacks, he developed a horrifying all-or-nothing solution.
These young people must not be ignored—we need to be better educated as a society to see signs of real distress and move to intervene. In his manifesto, Rodger suggests that his "Day of Retribution" need not have happened if women his age had taken an interest in him. I say it could, possibly, have been avoided if the community around him had the knowledge and tools to be more proactive.
By way of example, in hindsight the sheriff regretted that officers called to Rodger's apartment in April hadn't made a more thorough investigation. But we can all be more attentive, caring, and willing to help now, before it ever gets to that point.View Comments | Add Comment
Students Try Speaking Up, but Their School Won't Let Them
May 22, 2014 Caroline Miller
Late last year two Michigan high school students found out, accidentally, that they had both experienced depression. Neither had been open about their struggles, even with their closest friends. They found it was a big relief to talk about their feelings, and the antidepressants they were both taking.
Since they both worked on the school newspaper, they decided to do a special issue on mental illness in teenagers. They interviewed high school students who shared stories of depression, eating disorders, prescription abuse, insomnia and anxiety. The kids all agreed to use their real names, and their parents signed releases.
Then the school refused to let them publish these stories. The students, Madeline Halpert and Eva Rosenfeld, express their frustration in an op ed piece in the New York Times. They're respectful towards the administrators who felt they needed to protect students from doing something that might make them targets of bullying. Still, the writers note, by doing so they reinforced the very stigma that encourages bullies.
I'm impressed by both their personal courage and their journalistic chops. Their reasons for arguing that kids should come out, so to speak, about their struggles with mental illness are especially articulate:
The feeling of being alone is closely linked to depression. This can be exacerbated if there is no one to reach out to. Though there are professionals to talk to, we feel it doesn't compare to sharing your experiences with a peer who has faced similar struggles. And, most important to us, no one afflicted with a mental illness should have to believe that it's something he should feel obliged to hide in the first place.
I hope their piece causes some serious soul-searching among those who still think mental illness is something we should be ashamed to talk about.View Comments | Add Comment