The Child Mind BlogBrainstorm
Donor Gives $650M for Mental Illness Research
July 22, 2014 Harry Kimball
Psychiatric research got a big boost yesterday with the announcement of a $650 million gift to the Broad Institute, the interdisciplinary research group at Harvard and MIT that simultaneously announced exciting new genetic research into schizophrenia. The money comes from Ted Stanley, a longtime supporter of treatment research who has intimate knowledge of mental illness—his son has bipolar, which went untreated for 2 years after diagnosis until a crisis landed him in police custody.
Happily, that encounter ended with mood stabilizer treatment that took Jonathan Stanley from what he calls "psychotic to normal." But the elder Stanley knows that we still haven't developed therapies that work for everyone struggling with mental illness. He aims to change that. "I would like to purchase that happy ending for other people," he tells the New York Times. We're happy that he has the means to try.View Comments | Add Comment
Spanking May Be Legal but It's Not Effective
July 22, 2014 Rachel Ehmke
A court in New York is saying that it's legal to spank children, but that doesn't mean that you should.
It was up for debate after the father of an 8-year-old boy was declared by a family court judge to have abused his son by spanking him (and possibly also using a belt on him). The dad denied using a belt, and an appeals court found that his spanking was "a reasonable use of force."
Legal decisions aside, parents should know that there are more effective ways to discipline kids, so focusing on how much violence constitutes abuse misses the mark.
Research shows that giving kids attention-even negative attention-for misbehaving can backfire. For one thing kids want to get attention from their parents, so it can actually be reinforcing when they get a rise out of mom and dad. Also parents often don't give consequences for bad behavior consistently enough, or they delay the punishment, making it less effective.
Instead, experts who work with kids who have disruptive behavior recommend ignoring minor misbehavior and using consistent timeouts when consequences are needed. And, just as important, experts stress trying to prevent misbehavior before it happens and rewarding good behavior when you see it. For more on this read our ABCs for parents trying to manage problem behavior.View Comments | Add Comment
Jack Antonoff's New Anthem: I Wanna Get Better
July 17, 2014 Jessica Kashiwabara
Jack Antonoff is best known as the guitarist of fun., the band responsible for the hit song "We Are Young," and some might know him as Lena Dunham's boyfriend. But this week he stepped out on his own with the release of a debut album under the name Bleachers. The lead single, "I Wanna Get Better," is not only catchy, but also serves as an autobiographical account of Antonoff's darkest moments and how he's struggled with anxiety.
In an interview with Time magazine, Antonoff discussed the painful experiences surrounding his youth: he was bullied in school, his younger sister died of brain cancer, and a cousin was killed while serving in Iraq. He developed a severe panic attack disorder and hypochondria, and in 2006, anxiety so severe he rarely left his home. For a long time, he suppressed his grief, but eventually found the therapy and medication that works for him.
Through his songs, he explores those feelings of loss and now with Bleachers (the name is a nod to high school), Antonoff keys in on his lost teenage years. As he says, "I feel like I had a childhood that I'm constantly mourning."
Sharing those feelings, Antonoff has struck a chord with fans and gained more than just success. In fact, he says his biggest reward has been the connection his fans have to his music and to him. The musician frequently hears from fans about their own struggles with anxiety and depression. To Antonoff, this is much more profound than being a teen idol. As he puts it, "Who would want to be the kind of artist that's worshipped by fans when you can be the kind of artist that's comforted by fans?"
With "I Wanna Get Better," Antonoff gives back to his fans a hopeful message and a mantra to keep with them through the hard times.View Comments | Add Comment
Jail's Mentally Ill Are Targets of Violence by Guards
July 14, 2014 Caroline Miller
Rikers Island is a New York City jail and a New York City problem, but anyone who worries about the mentally ill will find this story in the New York Times stunning. The piece is the result of an investigation into violence perpetrated against inmates with mental illness by correction officers.
For starters, the brutality is shocking, often including beatings inflicted on handcuffed inmates, resulting in a litany of broken noses, jaws, and eye-sockets, along with internal injuries. The incidents that prompt violence include insults to guards, minor provocations, and predictable outbursts of anger—especially predictable in inmates with schizophrenia, bipolar disorder or depression who have been kept in solitary confinement. In five cases last year, inmates were beaten after making suicide attempts.
The numbers are shocking: Last year, 129 inmates suffered what the Times classified as "serious injuries" —ones beyond the capacity of doctors at the jail's clinics to treat—at the hands of corrections officers. And 77 percent of the seriously injured inmates had a mental health diagnosis.
Their numbers, unfortunately, are only rising. Inmates diagnosed with mental illness make up nearly 40 percent of the Rikers population; that's up from 20 percent 8 years ago, the Times reports.
Even in a cell block apparently reserved for inmates with mental illness, the officers seem to have deep skepticism that mental illness is real. "About half are faking it," one officer tells a Times reporter.
To be fair, guards are enormously frustrated, too, and inmates with mental illness are responsible for what the Times calls "an overwhelming majority of assaults on jail staff members." The story details some of the reasons why corrections facilities don't have the right tools to manage inmates with mental illness who lash out. But guards are rarely punished for what appears to be a clear pattern of retaliation.
And finally, it's shocking how little transparency there is in correctional facilities. It took four months of reporting, obtaining a secret internal study, and many interviews with current and former inmates and staff members to put together this report. One of them was Daniel Selling, the director of the jail's mental health services until 2 months ago. As he sums up for the Times, "There's lots of brutality. Horrible brutality."
Does it need to be said again how important it is to get treatment to people with mental illness as early as possible, before the trajectory of their lives leads to incarceration? Rikers right now may be an unusually bad place to be mentally ill, but a correctional facility is rarely a place to get the kind of help and support that can turn lives around.View Comments | Add Comment
Tim Howard and Tourette's: Stigma vs. Soccer Greatness
July 8, 2014 Harry Kimball
The World Cup final match isn't until Sunday. But in the minds of many, the champion of the tournament has already been decided: Tim Howard, the US Men's National Team goalie who made Cup history last week with a record 16 saves in a game against Belgium. Of course, the US lost and was eliminated, but Howard's performance continues to amaze. And did you know he has Tourette's?
It should come as no surprise that an incredibly gifted football (soccer) player who happens to have a tic disorder could succeed in his chosen field. We know that people with Tourette's often tend to find symptoms vanish when they focus on something they are deeply engaged in, whether it's singing or blocking a ball. There is even speculation, as with other psychiatric disorders, that something about the altered brain function makes people excel at certain tasks.
In the run-up to the last World Cup, in 2010, the New Yorker interviewed an expert who said some people with Tourette's report "that they sense things in the body movements of others that the rest of us screen out, some signal or vibration, some sensory cue. It's almost like they can see what's going to happen before it happens." As Howard described it then, "You see everything. You're yelling. You're tense. You're so wired-in."
But I think the most important thing is that Howard found a place for himself in the penalty box, and that he didn't let stigma or mean-spiritedness dissuade him from his goal (or blocking others' goals, as it were). In the UK, where he plays professionally, newspaper headlines have scoffed at the possibility of a "disabled" goalie; apparently, one even went so far as to call him a "retard." Though he does not have the coprolalia that accompanies some cases of Tourette's, the possibility that he might spontaneously start cursing is the basis of jokes at his expense.
His response has been admirable: The 16 saves. Being one of the best, if not the best, in the world. "One of the biggest things I can do is be in the public eye," he told Neurology Now last year. "I'm on television, ticcing and twitching. I think that's kind of cool."View Comments | Add Comment
How Trauma Can Be Misdiagnosed as ADHD
July 7, 2014 Caroline Miller
Dr. Nicole Brown, a resident at Johns Hopkins Hospital in Baltimore, was troubled by the number of pediatric patients she saw who had ADHD diagnoses. She didn't doubt that some of them had ADHD. They were described by their parents as hard to manage and their teachers as disruptive and/or inattentive. But they were also kids whose homes and neighborhoods were marked by poverty, violence, and substance abuse.
Dr. Brown was frustrated that the standard treatments for ADHD—behavioral therapy and stimulant medication—weren't helping many of these kids get their symptoms under control. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience,” she says.
Dr. Brown tested her hypothesis with a study that confirmed the link she observed: Kids who endured four or more adverse childhood events were three times more likely to use ADHD medication.
Dr. Brown's experience is detailed in an excellent piece in the Atlantic exploring the concern that kids who experience high levels of stress display symptoms that overlap those of ADHD, and that may be leading to misdiagnoses. Inattentive, hyperactive, and impulsive behavior can be the result of chaos, neglect or abuse, and many doctors prescribing ADHD meds may not have, or take, the time to find out what's happening to kids at home.
"We need to think more carefully about screening for trauma and designing a more trauma-informed treatment plan," says Dr. Brown.View Comments | Add Comment
Please Stop Fear Mongering About ADHD Medications
July 2, 2014 Brooke Garber Neidich
The New York Times ran yet another piece in the op ed section this week that takes a swing at ADHD medications, suggesting that adolescents who take them might be increasing their risk for anxiety disorders.
In the piece, Richard A. Friedman, a psychiatrist at Weill Cornell who is not a specialist in treating children and adolescents, wrote about the fact that teenagers are highly emotionally reactive, and their ability to regulate their emotions is not yet fully developed. They're better at getting anxious than they are at calming down. Researchers think that's one of the reasons they're especially vulnerable to anxiety disorders. So far, so good.
But then Dr. Friedman floated the hypothesis, in the form of two rhetorical questions, that stimulant medications, since they can increase symptoms of anxiety in some kids, might be triggering anxiety disorders. He writes:
Might our promiscuous use of stimulants impair the ability of adolescents to suppress learned fear—something that is a normal part of development—and make them more fearful adults? And could stimulants unwittingly increase the risk of PTSD in adolescents exposed to trauma? In truth, we haven't a clue.
Rhetorical questions may seem harmless, but as a parent, I know that this kind of speculation—when "in truth, we haven't a clue"—stimulates worry without giving us real information.
We know that a lot of kids who have ADHD also have anxiety, and good clinicians are very careful when prescribing stimulant meds for a kid who is also anxious. But there is no evidence at all—and ADHD meds are the most thoroughly researched type of medication in use for kids, including follow-up studies—that kids taking Ritalin or Adderall are more at risk for anxiety disorders than kids who don't take them. And what about the risk of developing anxiety as a result of struggling with untreated ADHD?
I don't like to see parents subjected to what seems to me to be fear mongering. The Times has in the last year or so run a number of pieces that suggest, again and again, and without evidence, that kids who take stimulants are more at risk for substance abuse in later life than other kids. In fact there is substantial evidence from long-term studies that this is not the case.
Of course I'm not in favor of "promiscuous" use of stimulant medications for every kid who is struggling with attention or behavior problems. That really does kids a disservice. But adding these unfounded worries about medication that is very valuable to many kids does both kids and parents a disservice.
Brooke Garber Neidich is the chair of the Child Mind Institute Board of Directors.View Comments | Add Comment
The Rock Names His Toughest Opponent: Depression
July 1, 2014 Harry Kimball
Dwayne "The Rock" Johnson isn't exactly weak, fainthearted, or indecisive. In fact, as described by Stephen Galloway in The Hollywood Reporter, he's "a 6-foot-5, 252-pound mountain of muscle, his arms hardened and honed, his chest as big as a bull's." He has quietly-well, not too quietly-come to dominate the box office with crowd-pleasing action spectaculars. And, like a lot of people, he has struggled with depression. Unlike some icons of masculinity, he is willing to talk about it.
We hear over and over that young people, particularly young men, lack viable role models who are open about mental illness and the need to get help. In this interview Johnson doesn't give specifics about how he recovered from episodes of depression, but his honesty is encouraging. "I didn't know what it was," he says of his first depression at age 18 following an injury that sidelined his football career. "I didn't know why I didn't want to do anything. I had never experienced anything like that."
Johnson places a high value on self-confidence, mastery, achievement. He describes the moment, as a child of struggling parents with a tough upbringing, when he decided to take control of his future. "What can I control with these two hands?" he asks himself. "The only thing I could do was train and build my body."
But despite his strength of purpose and success in overcoming challenges, he admits to being laid low by depression, and to depending on friends and family to get through it. And that's where his ambition and his honesty come together to make something special. He represents two kinds of strength-the strength to strive for outsized goals, and the strength to realize when you can't go it alone.View Comments | Add Comment
Is Sensory Processing Disorder a Real Condition?
June 25, 2014 Caroline Miller
This question is the headline on a story, surprisingly, in the New Republic. It's a good piece that lays out the overwhelming anecdotal evidence that some kids have problems processing sensory stimulation, leading to behaviors that range from irritability to inconsolable meltdowns.
It also lays out skepticism, in the psychiatric community, that these problems can best be understood as a disorder, and that the treatments that have been devised for them are legitimate or effective.
I'm glad to see this getting attention because I know many parents are frustrated by this rift, between the occupational therapists who diagnose and treat sensory processing problems and the psychiatrists and psychologists who may be treating these same kids for other conditions, like autism or ADHD. Among other things, it allows insurance companies to avoid paying for treatment.
As the article notes, what's needed is more standardization in how SPD is diagnosed, and more measurable outcomes for the interventions. Above all, what's needed is research, and that's kind of a catch-22. "It's hard to fund the studies because SPD is not a real diagnosis," notes Dr. Lucy Jane Miller, founder and director of the SPD Foundation, "yet it can't be a real diagnosis without more studies."
The story also lays out some of the more "out there" interventions that have been offered to parents. "A lot of it is myth and magic," notes Dr. Miller. What's real here is the need, both for understanding these kids and for helping them.View Comments | Add Comment
The Struggle to Find Treatment for Troubled Young Men
June 24, 2014 Harry Kimball
There is much in Benedict Carey's insightful New York Times piece on violently aggressive adolescent boys with psychiatric disorders that hits close to home for us. At the center of the story are an unnamed 15-year-old and his family, the Serpicos, all at wits' end despite high-class health insurance and proactive psychiatric care. He has attempted suicide and injures himself, attacks his mother, and abuses marijuana and prescription drugs. And he has no faith in treatment. "It's useless, all this stuff," he says. "It's a waste of my time."
Along with multiple diagnoses—from ADHD to bipolar to features of borderline personality disorder—he has been on multiple medications, including stimulants, antidepressants and antipsychotics, with little to show for it. Carey can't help but mention the possibility of a disastrous outcome for this teenager—another Newtown, another Santa Barbara—but to the reporter's credit he identifies a wider disaster that is already all around us.
"Most of these young men will never commit a violent crime, much less an atrocity," Carey writes, referring to the 1% of teens who are "young, troubled males with an aggressive streak." That doesn't mean they can be ignored, but how to pay attention eludes us. "The questions of how best to help them and how to pay for it are among the most intractable problems hanging over the system."
The Serpicos are lucky, or relatively so—they have secured coverage for their son's yearlong stay at a therapeutic boarding school. But a previous two-month stint at a residential facility seemed to do nothing for him. Although his parents seem optimistic—or must be optimistic—their son is skeptical. "Probably useless, too," he tells Carey.
We are heartened when we see families like the Serpicos who have recognized serious problems and fought tooth and nail to get their children help, but we are also aware of all we don't know about severely troubled young people. "Some kids may benefit from these extremely costly services," a health policy expert tells Carey. But "we don't know which ones they are, and we don't have a good model for distributing those services, no matter who's paying." For these kids, these families, and all of us, it's time we devote more effort to figuring that out.View Comments | Add Comment