The Child Mind BlogBrainstorm
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
My Dad's Suicide Isn't 'Cool': Frances Cobain to Lana Del Rey
June 24, 2014 Beth Arky
When Kurt Cobain killed himself in 1994, daughter Frances Bean Cobain was just a baby. So when she read an interview in The Guardian in which singer-songwriter Lana Del Rey seemed to be glorifying the early ends of the Nirvana frontman and singer Amy Winehouse—and then shared her own death wish—Cobain took to Twitter urging her not to glamorize them.
"I wish I was dead already," Del Rey is quoted as saying. Cobain isn't having it. "The death of young musicians isn't something to romanticize," she wrote. "I'll never know my father because he died young & it becomes a desirable feat because ppl like u think it's 'cool.'"
"Well, it's f--king not. Embrace life, because you only get one life. The ppl u mentioned wasted that life. Don't be 1 of those ppl."
Both Cobain and Winehouse died at 27, from suicide and alcohol poisoning, respectively—the same age as Del Rey.
While The Daily Beast may feel Del Ray's statements are merely part of a ploy to sell her new album, Ultraviolence, and Rolling Stone reports that she expressed regret over the interview and claimed to have been misquoted, the damage may already be done. There are plenty of teens who pay attention to what high-profile entertainers say and are young enough to confuse marketing with meaning.
We hope Cobain's strong response drowns out Del Rey's casual fatalism, and that young people open their ears to the real effects of suicide and drug abuse and understand there is no glory in dying young.View Comments | Add Comment
The Trouble With Parenting Isn't the Kids
June 20, 2014 Caroline Miller
When Jennifer Senior (All Joy and No Fun) talks about parenting, she's not peddling another how-to-do-it-better manifesto (Tiger Moms, Panda Dads). She's taking a hard look at the stress and anxiety that are associated with parenting these days, and identifying some of the places the pressure comes from.
Senior focuses on the fact that some of the pain parents feel is relatively new, and some of it is culturally inflicted, including unrealistic expectations for creating perfect—and perfectly happy—children. It's also the result of profound changes in the economy that make preparing kids for the future an unusually fraught endeavor.
If you feel like taking a step back, not so much to smell the roses but to get a perspective on how we think about children, and how that affects how much we are able to enjoy being their parents, check out Senior's excellent TED talk here.View Comments | Add Comment
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