Advice & Support

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 recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

I have a dental appointment today. More of how my mind works. There are three movies I can think of with dentists, The Boys From Brazil (scary, very scary), the original Roger Corman Little Shop of Horrors (hilarious, Jack Nicholson is the dental patient), and Mike Mills' Thumbsucker. A teenager sucks his thumb; his orthodontist (Keanu Reeves!) tries a little hypnotherapy; the boy takes stimulant meds and becomes an academic superstar. Those are the psychiatric aspects. There's a lot more. Funny and deep. And by the way, Tilda Swinton plays a choice little role. See it. 

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 recommends here a film for weekend viewing. Expect surprises, psychological twists, and a taste for emotional subtlety.

Just a little fun this weekend. Carl Franklins One False Move is a very tight little neo-noir about a trio of criminals, two men and a woman, on the run from LA to Star City, Arkansas, where the local Chief of Police realizes that the woman of the group is his ... NO. I wont give it away. Billy Bob Thornton co-wrote the screenplay. This one's an unknown gem. Its only redeeming value is that it is great art—which is the best redeeming value. Great acting, great characters, great story, lots of fun.

For the third April running, the parenting website Babble is doing its part to raise autism awareness—and acceptance—with its Top 30 Autism Spectrum Blogs of 2013. The bloggers run the gamut: neurotypical parents of autistic kids, autistic parents of autistic kids, and autistic adults who aren't parents but provide a window into what it's like to live in a world geared to the typically "wired." All offer insight, support and invaluable practical advice to parents of autistic kids and, increasingly, children, teens, and young adults on the spectrum.

About a third of the bloggers on this year's list are on the spectrum, about the same number as last year. However, Joslyn Gray, who wrote the Babble story and was one of the panelists who chose the list, says, "I think overall, we are seeing more neurotypical people reading blogs by autistic writers, which is great.

"For me as a parent of two children on the spectrum, I was definitely thrilled to see so many autistic writers included," adds Gray, who also blogs at stark. raving. mad. mommy. "I want autistic voices heard not just because that's what's right, and what's helpful for all of us, but because I want my children's voices heard, too." On that note, she is happy that the panel included Rachel Kenyon, an Army wife and autistic parent of an autistic daughter and a neurotypical (NT) son, who blogs at Welcome to Stim City.

Among the notable additions: three mom bloggers of autistic kids who are themselves autistic: Jennifer at  Asperkids, who Gray deems "an amazing resource, especially for parents of girls on the spectrum and tweens and teens on the spectrum"; Jean Winegardner at Stimeyland, whose "funny, honest, and self-deprecating" style led her to write, "I am like Buzz Lightyear: I am falling with style"; and Aussie Bec at Snagglebox, who offers up a blog that's "chock-full of resources, support, and information" for parents and teachers, including free downloads like 45 Ideas for Classroom Friendly Fidget Toys.

Julia Bascom of Just Stimming is one of the better-known autistic bloggers who prove you don't have to have children to provide valuable parenting advice. The newest entry in this category: The Third Glance. Gray writes that while the blog is written by a young autistic woman without kids who is working on her doctorate in science, it offers "powerful insights into growing up autistic." Because of that, "it's still one of our favorite parenting blogs because it helps you be a better parent."

Also represented, of course, are the neurotypical parents writing about their special-needs kids. Among those joining returning bloggers like Sunday Stilwell (Adventures in Extreme Parenthood), the anonymous Autism Daddy, and Erica and Lisa at Laughing Through Tears comes Jim Walter, author of Just a Lil Blog. Gray describes Walter as a "self-deprecating" neurotypical dad who writes a "hilarious and poignant" blog about his daughters—one autistic, one typically developing—and wife, who is recovering from breast cancer treatments.

Marj, who has two boys at opposite ends of the spectrum, is behind the ironically titled Domestic Goddess, another of the list's newcomers. The panel loved the fact that the blog "isn't entirely about autism," Gray writes. "Blog posts are about the whole of family life. It's a great reminder that even when it feels like everything in life revolves around ASDs, ADHD, SPD, OCD, and IEPs, there's more to your family and your kids than a bunch of acronyms."

I come from a family of talkers, so it was only natural that I would be the mom who couldn't resist providing a running narrative as I wheeled my son around the neighborhood in his stroller: "Look at the daffodils, buddy. Hey, there's a Lab!"

I didn't take all that random (and often ridiculed) kind of talk too seriously, but more and more, policy makers are doing just that. In "The Power of Talking to Your Baby," Tina Rosenberg notes that there's a huge disparity as to how much language children hear, and studies show that it divides along socioeconomics lines, with parents in welfare families speaking to their children dramatically less than their working- and middle-class counterparts. The low-income children's language deficit is already apparent at 1; by 3, the gap has grown exponentially, creating lags in language, understanding and learning. By high school, Rosenberg writes, "it becomes a chasm."

Research shows, Rosenberg notes in her piece in the Opinionator section of the New York Times, that "the greater the number of words children heard from their parents or caregivers before they were 3, the higher their IQ and the better they did in school." TV talk did not help; it hurt.

Providence, R.I., will soon be launching the first major experiment to see if increasing language exposure at home helps poor kids succeed in the classroom. Last month, it beat out 300 other cities to win the $5 million grand prize in Bloomberg Philanthropies' Mayors Challenge. The Providence Talks program will train a network of nurses, mentors, therapists and social workers who regularly make home visits to pregnant women, new parents and children to provide a new service: creating family conversation.

While we know that wealthier, more educated parents talk to their children more, there was no clear reason why, at least until researcher Meredith Rowe arrived at a new theory in 2008: that poor women just didn't know it was important to talk to their babies. Rosenberg writes:

No one had told them about this piece of child development research. Poorer mothers tend to depend on friends and relatives for parenting advice, who may not be up on the latest data. Middle-class mothers, on the other hand, get at least some of their parenting information from books, the Internet and pediatricians. Talking to baby has become part of middle-class culture; it seems like instinct, but it's not.

Providence plans to begin enrolling families next January. If the effort to teach parents to speak more to their young children proves successful, it could provide an exciting model that could be implemented elsewhere comparatively easily, at a low cost.  No one expects an even playing field in our society of ever-widening class differences, but we should be doing all we can to close the educational gap. So if it turns out that talking—not silence—is golden, I'm more than fine with that.

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.

Here's the way my mind works. I was thinking about Spring Breakers, which led me to think about Errol Morris's Tabloid, which led me to think about my favorite Morris film, Fast, Cheap, and Out Of Control. What I loved about that movie was the way he brought three seemingly disparate stories together into a kind of awe-inspiring unity. Which then led me to think of other movies where things come together like that, which led me to think about Atom Egoyan's 1994 masterpiece, Exotica. Your assignment this weekend is to see all these movies so you can tell me why my mind works the way it does.

Stories about overdiagnosis and over-pathologizing are popular these days, in part because the new DSM is coming out next month. But very little ink is spilled on the people who don't get a diagnosis when they should, or only receive one later in life, after years of living with their symptoms. Maria Yagoda, who was diagnosed with ADHD in college, is one such person, and she writes in the Atlantic Wire that her story is a familiar one—especially if you're a girl.

ADHD is something of a guy's club. When we think of ADHD we tend to think of boys who are hyperactive and impulsive, but the disorder actually comes in several forms. Some kids are more hyperactive, others are more inattentive, and many have a combination of the two. In general girls are more likely to have the inattentive type of ADHD, which means that they are regularly overlooked because their symptoms don't match our idea of what ADHD "should" look like. Dr. Ellen Littman, who wrote Understanding Girls with ADHD and spoke to Yagoda for her piece, estimates that a shocking half to three-quarters of all women with ADHD are not diagnosed. Dr. Littman suggests that part of the reason girls are underrepresented now is because boys were so overrepresented in the early clinical studies of ADHD, which were based on the symptoms of "really hyperactive young white boys who were being taken to clinics." Girls' symptoms also tend to tend to peak in puberty, which means that symptoms that might not have been impairing functioning in grade school (when most boys are getting their diagnoses) suddenly become a problem.

Because the signs of ADHD are more self-contained in girls, their symptoms are often considered traits or personal failings, as Yagoda considered her own extreme disorganization, forgetfulness, and poor concentration. She managed to get by until college, when she went off the rails:

I was wrongfully allowed a room of my own, leaving me with no mother to check up on "that space between your bed and the wall," where moldy teacups, money, and important documents would lie dormant. I maintained a room so cluttered that fire inspectors not only threatened to fine me 200 dollars if I didn't clean, they insisted it was the messiest room they had ever seen (boys' included!) in their twenty years of service. Throughout college, I would lose my ID and keys about five times a semester. I'd consistently show up for work three hours early or three hours late. I once misplaced my cellphone only to find it, weeks later, in a shoe. 

As Yagoda later learned, this is common theme. Sari Solden, author of Women and Attention Deficit Disorder, says:

Often, if girls are smart or in supportive homes, symptoms are masked. Because they're not hyperactive or causing trouble for other people, they're usually not diagnosed until they hit a wall, often at college, marriage, or pregnancy. A lot of the things that are simple and routine to other people—like buying groceries, making dinner, keeping track of possessions, and responding to emails—do not become automatic to these women, which can be embarrassing and exhausting.

Happily, Yagoda says that medication is now giving her a "more normal, settled life," which is another thing that makes her firsthand account so interesting. Not only is she a girl writing about her own experience with ADHD, she's also just plain writing about what it's like to have ADHD. We're used to hearing that ADHD isn't real, or that ADHD medications are academic steroids used for getting kids into the Ivy League and then law school. It's almost a novelty for the public to have a window into the disorder as it actually is, and see medication as it is actually prescribed and used. As a girl diagnosed with ADHD as an adult, Yagoda had to deal with a lot of preconceptions:

"Of course you don't have ADHD. You're smart," a friend told me, definitively, before switching to the far more compelling topic: medication. "So are you going to take Adderall and become super skinny?" "Are you going to sell it?" "Are you going to snort it?"

Yagoda, who was prescribed Concerta, was able to say no to all of the above. It's a refreshing counterpoint to the story you thought you knew. 

Parents who lost children in the Sandy Hook shootings were, not surprisingly, a bit hard to watch on 60 Minutes last night, as they struggled with tears and tried to use their loss to achieve some meaningful change. Mostly they were there to support gun control legislation, including universal background checks and limits on the size of magazines for automatic weapons. But one mother, whose 6-year-old daughter Ana was gunned down, also zeroed in eloquently on the lapses in our mental health care system.

Nelba Marquez-Greene, who said she is a licensed marriage and family therapist, noted that  the United States lags on the resources for psychiatric illness, compared to other countries where she has practiced. But then she added:

I think one of the barriers or one of the challenges is that there's a whole lotta stigma attached to getting help. The fact that you have to go to a therapist or a psychiatrist or a psychologist, and then get a diagnosis for your child, that can be very humbling and scary for parents. I can't speak specifically for what happened with Adam Lanza and his family. As a mother, my heart breaks for Adam Lanza's mother.

It's often lack of resources that keeps kids from getting care, but it's also often lack of connection and support. Nancy Lanza seems to have struggled for years to get her son into a setting that would enable him to thrive, but the two of them ended up appallingly isolated. And the consequences were tragic, for them and Lanza's victims.

Okay, it's probably not a question you contemplate every day (unless, that is, you live in Brooklyn, which is a hotbed of hipster taxidermy these days). But it's one way to put in perspective the dramatic barriers we face to getting all kids who are struggling with psychiatric disorders the care they need to reach their potential. And if you take our Children's Mental Health Quiz you'll find out the answer, along with some other rather surprising comparisons. Everyone who takes the quiz earns us $1, thanks to our friends at Hunter Boot, to help us help more families in need.

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.

I was walking down the street today, this beautiful day, and I thought about spring. And then I thought about Spring Breakers, Harmony Korine's brilliant new film. This one isn't for everyone. It's filled with sex, profanity, and violence—lots of each. But that's what the movie is all about, the way our culture has been coopted by tabloid view of the world, the way people focus on the material rather than the spiritual. You see it every day in the grocery aisles, on TMZ and Entertainment Tonight. Spring Breakers calls a spade a spade. In ten years this one's going to be a classic—maybe a midnight classic, but a classic. Think of it as a documentary about 2013 America—funny and ugly and profane and beautiful.

Yesterday, the Obama administration announced plans for a landmark initiative dedicated to transforming our understanding of the human brain. Referred to as the BRAIN initiative (Brain Research through Advancing Innovative Neurotechnology), the overarching goal of this effort is to discover "new ways to treat, prevent, and cure brain disorders", such as autism, dyslexia, attention deficit hyperactivity disorder and depression.  Yesterday's launch was marked by an initial White House pledge of $100 million in 2014 funding for research by the National Institutes of Health (NIH), the Defense Advanced Research Projects Agency (DARPA), and the National Science Foundation (NSF). This announcement comes as a breath of fresh air in a time when neuroscientific and technological breakthroughs are increasingly being tempered by budgetary realities and funding cuts.

The Child Mind Institute has championed the acceleration of scientific discovery through innovation and collaboration, and applauds the BRAIN initiative. It is our hope that investigators funded through the initiative will embrace the emerging open science philosophy in the neuroscience community, and freely share novel data and methodologies with the broader scientific community. For its part, the CMI will continue its efforts to generate and share large-scale brain imaging datasets through CMI-sponsored efforts such as the 1000 Functional Connectomes Project and International Neuroimaging Data-sharing Initiative (INDI), as well as the upcoming CMI Biobank. It is our hope that data generated through these efforts will help to facilitate and accelerate the efforts of BRAIN initiative investigators, as they speed towards the delivery of biologically-based solutions to mental illness.