The Child Mind BlogBrainstorm
Depression Is Mysterious. Treatment Isn't
April 20, 2012 Harry Kimball
In an intriguing New York Times article on antidepressant medications—whether and why the increasingly controversial SSRIs like Prozac actually work—Siddhartha Mukherjee arrives at a key question, one that we have heard over and over. If you don't really know what causes depression, if you can't prove the theory, now under assault, that it's caused by low levels of serotonin, why would you treat it with these chemicals that raise serotonin levels? Mukherjee, an oncologist, gives the example of a cancer patient so despondent about her life-threatening illness that she cannot take care of herself and retreats ominously inwards. A psychiatrist prescribes her an antidepressant.
"Any sane reader of this case would argue that a serotonin imbalance was not the initiating cause of Dorothy's depression," Mukherjee writes. "It was, quite evidently, the diagnosis of a fatal disease. Should we be searching for a chemical cause and cure when the provocation of grief is so apparent?"
In fact Dorothy's mood does improve some on the antidepressant, despite her dire diagnosis. In the rest of the article, Mukherjee deftly explains a great deal about current thinking on depression. But the kernel of his argument, at least for me, is this analogy to Dorothy's situation:
Pause for a moment, though, to consider the physiology of a heart attack. A heart attack can be set off by a variety of causes—chronic high blood pressure or pathologically high levels of "bad" cholesterol or smoking. Yet aspirin is an effective treatment of a heart attack regardless of its antecedent cause. Why? Because a heart attack, however it might have been provoked, progresses through a common, final pathway.
This sets the stage for an investigation of that "final pathway" of depression, which may or not lie deep in the brain with the hippocampus and the subcallosal cingulate. (I enthusiastically recommend the article.) But I couldn't help but fixate on the aspirin and the idea of the heart attack as a valid malady no matter the trigger. These days, the struggle over the validity of psychiatric diagnosis increasingly involves discounting a disorder because it is supposedly caused by bad parenting, or because symptoms are just "normal" reactions, or because we simply don't understand its origin. What if we just thought about real, significant impairment as cause enough to treat?
It is more than likely that a better understanding of depression in the brain will lead to better treatments. And as Mukherjee explains, even if the serotonin hypothesis is wrong, the medications developed according to it have given us a much more detailed picture of the brain than before. But for people who suffer, it doesn't matter why they've gotten where they are—they are there, and they need help. For the time being, the tools we have to change mood, however the brain manufactures it, are evidence-based psychotherapies and antidepressant medications. Mukherjee quotes a professor of his: "Aspirin does not particularly care about your medical history."View Comments | Add Comment
Ashley Judd's Puffy Face and Being a Good Role Model for Girls
April 17, 2012 Rachel Ehmke
For those who missed it, Ashley Judd had a pretty bad sinus infection last month. You might not think the state of her health is particularly newsworthy, and you'd be right, but the puffy face she got from treating the infection with steroids is a different story. Her fuller-than-usual face happened to coincide with a media appearance, which was bad luck for her because the gossip blogs and people on Twitter and even supposed news sites like MSNBC and the Huffington Post reported on her face, with many volunteering their opinion as amateur celebrity plastic surgery experts: Ashley had work done. Probably botched cheek implants.
Judd chose to set the record straight in an op-ed for the Daily Beast, clearing up the cheek filler rumors and, amazingly, turning the whole thing into a feminist conversation. Now the same sites that were running judgy accusations of plastic surgery are quoting her editorial and doing interviews with the actress.
Judd writes that she felt compelled to respond because the chatter about her face was "Pointedly nasty, gendered, and misogynistic and embodies what all girls and women in our culture, to a greater or lesser degree, endure every day, in ways both outrageous and subtle." If you want proof look at the HD makeup for sale at Sephora or see how carefully young girls prep and pose for Facebook photos. As Randye Hoder pointed out in Motherlode last month, 13-year-old girls now feel they have to look their best anywhere they might be photographed—which is just about anywhere.
My favorite part of Judd's editorial is her acknowledgement that misogyny should not be blamed on men. Men might participate, but women are generally the ones pushing these public takedowns. The "puffy face" gossip was largely reported by women, on sites that target women, and women wrote most of the scathing comments I read online. And, sadly, some women's sites like The Stir continue to accuse the actress of plastic surgery, even now. In her op-ed Judd writes that we need to "leverage strong female-to-female alliances to confront and change that there is no winning here as women," and she's absolutely right. We're sending an awful message to our daughters and to ourselves every time we contribute to objectifying gossip.
What Ashley Judd has done with her op-ed and subsequent interviews is impressive and fairly unprecedented. It's refreshing to see a celebrity who wants to be a real role model for girls and isn't afraid to use the word "feminism." Hopefully the conversation that Judd has started will stick around. To keep things going the actress is asking people to share their own "puffy face moments" to the Daily Beast. I think people will have a lot to say.View Comments | Add Comment
Teaching Teachers to Teach Challenging Kids
April 13, 2012 Caroline Miller
Disruptive behavior in classrooms is an extremely frustrating problem for teachers, as more and more kids with psychiatric and developmental challenges are mainstreamed into classrooms with one teacher and 25 or more youngsters. Michael Winerip, in the New York Times, reports on the unfortunate result when strapped school districts don't give these kids the support they need to succeed: outbursts and threatening behavior that ends with the out-of-control child being sent to the emergency room. In most cases the kids aren't admitted to the hospital—they're just calmed down and sent back to school the next day.
In the case of one particular boy, these violent outbursts happened over and over, until he got a paraprofessional, and then a teacher, who, Winerip writes, "has shown him how to control his behavior."
These words jumped out at me because I know, from what I've seen of parent and teacher training at the Child Mind Institute, that kids who seem out of control are not necessarily seriously disturbed kids or hostile kids or incorrigible kids—they're often kids who melt down and lash out because they're overwhelmed by other learning or social deficits that are not always immediately apparent. And they can learn better self-regulation, as well as learning more effective—less dysfunctional—ways to express themselves.
The situation in struggling schools is a very good argument for teacher-child interaction training (TCIT), a program that teaches teachers how to manage disruptive behavior that conventional teaching tricks don't work with. Child Mind Institute clinicians are test-driving a pilot program of TCIT in several New York City schools right now. And it's at the heart of a new book by Dr. Nancy Rappaport and Jessica Minahan, which outlines in detail the kind of behavioral psychology-based strategies teachers can use to prevent outbursts and respond more effectively to discourage undesirable behaviors.
The approach in the book—called The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students—starts with teachers recognizing that most kids would behave well if they could, and working to understand the deficits that are causing these kids to fail to do so. We'd like to see a lot more teachers equipped with the skills Rappaport and Minahan have been teaching a few teachers at a time for decades. In the meantime, a lot of kids are losing out on learning, causing other kids to lose out, and leading teachers to lose the satisfaction they can and should get from contributing so much to better the lives of children.View Comments | Add Comment
A Disturbing Look Inside Juvenile Lock-up
April 12, 2012 Beth Arky
A new Wired story features the work of photographer Richard Ross, whose project Juvenile-In-Justice exposes the appalling conditions of juvenile detention centers in the United States, where minors are detained at a shocking rate. The photographs, taken by Ross over the last five years in 350 facilities in more than 30 states, should sicken anyone who cares about children and teens. You'll see kids in windowless cement cells, and trays of food being passed through slots in locked doors.
Factor in the fact that many of the children have psychiatric disorders, and you can just see a head-bashing girl giving herself a concussion in the Pepto-Bismol-colored cinder block "time-out room" at the South Bend Juvenile Correctional Facility in Indiana. Another photo features a restraint chair for self-abusive juveniles at the Mendota Juvenile Treatment Center in Madison, Wisconsin, where "the average stay for the emotionally and mentally disturbed juveniles, some of which are self-abusive or suicidal, is eight months. Children must be released at age 18, sometimes with no transition options available to them."
According to the Wired report, the U.S.incarcerates children at more than six times the rate of all other developed nations. "With an average cost of $80,000 per year to lock up a child," the story notes, "the U.S. spends more than $5 billion annually on youth detention." And in its recent report No Place for Kids, the Annie E. Casey Foundation presents much evidence demonstrating that "incarcerating kids doesn't work: Youth prisons do not reduce future offending, they waste taxpayer dollars, and they frequently expose youth to dangerous and abusive conditions."
Ross interviewed more than 1,000 juveniles, who shared stories of parental abuse, homelessness, suicide attempts, addiction and illiteracy. Rather than incarceration, "many of these children should be out in the community getting better services and treatment where they stand a chance of rehabilitating and being corrected," Ross says. "From lockdown facilities we're not going to see a change in behavior. Maybe society needs this to gain retribution against kids that they think have gone wild? But for the most part, these are vulnerable kids who come from dysfunctional families. And, for the most part, the crime is a crime of lack of expectation, a crime of a lack of opportunity."
Ross hopes his photos will be powerful "ammunition" in the policy and funding debates regarding juvenile lock-ups. As part of his advocacy campaign, Ross is also offering them free of charge to nonprofit groups working actively to improve conditions within, and laws pertaining to, juvenile detention.View Comments | Add Comment
Mister Rogers Goes to Washington. Cue Tears.
April 9, 2012 Harry Kimball
I don't recall caring much for Mister Rogers when I was a kid. I watched it, sure, but it was milquetoast compared to the other things on TV that I really liked—GI Joe, He-Man, even Jem. Looking back, all I remember of Rogers is the changing of sweaters, the trains and the puppets—actually, I think Eddie Murphy's impressions on Saturday Night Live come in clearer, and those aired when I was an infant.
But boy was I wrong. A new documentary on Rogers is coming out, titled Misters Rogers and Me. I haven't seen it, and the only reason I know about is by half-listening to public radio. But during an exchange between guest and host (I guess I should give credit to Jesse Thorn and Bullseye) the show played an audio clip of Rogers' testimony before Congress in 1969.
What? Mister Rogers before Congress? And yes, it goes exactly how you think it would go, and it is one of the most moving things I have seen and heard in my life.
Rogers is testifying in support of a $20 million grant to the new Public Broadcasting System—you know, PBS. He speaks plainly and simply about what children need from adults, on TV and in person. It starts with what he calls a "meaningful expression of care."
Rogers reminds the committee of his perennial sign-off: "You've made this day a special day by just your being you. There's no person in the whole world just like you, and I like you just the way you are."
My wife remembers feeling those words as though they were spoken directly to her. Yesterday, when she heard them again via YouTube, she was in tears.
And he speaks of the importance of acknowledging real emotion. "We deal with such things as the inner drama of childhood. We don't need to have to bop somebody over the head to make drama on the screen. We deal with such things as getting a haircut. Or the feelings between brothers and sisters. And the kind of anger that arises in simple family situations. And we speak to it constructively."
Without a lot of opposition from the panel—who could resist Mister Rogers' level, sonorous delivery?—he concludes: "If we in public television can only make it clear that feelings are mentionable and manageable, we will have done a great service to mental health. I think it's much more dramatic that two men could be working out their feelings of anger, much more dramatic than showing something of gunfire." He talks about helping children learn that they can channel and control their own emotions. And then he drops these song lyrics from the show:
Know that there's something deep inside that helps us become what we can. For a girl can be someday a lady, and a boy can be someday a man.
Old-fashioned, yes. But persuasive. "Looks like you just earned your twenty million dollars," says the chair. We second the ovation that followed. Even if kids don't watch Mister Rogers, parents can certainly learn a thing or two from the man.
Watch the video here:
ADHD Drug Shortage Should End Soon
April 6, 2012 Rachel Ehmke
The FDA is predicting an end to the shortage of ADHD medications that has forced families across the country to scramble to fill their prescriptions since 2011. An FDA spokesperson announced that drug makers will be releasing enough medication to end the shortage this month.
It is still unclear how the shortage originated. Most ADHD medications require controlled substances, either methylphenidate or amphetamine salts, and the Drug Enforcement Administration tries to minimize abuse by regulating how much of the substances manufactures receive. Drug makers blamed the DEA for the shortage, claiming their drug allotments were too strict. The DEA stood by their quotas, suggesting that manufacturers focused production on expensive branded pills instead of making enough generics to satisfy demand.
Regardless of how the shortage happened, the children and adults who rely on ADHD medication will be glad things are getting back to normal. Hopefully it will stay that way.View Comments | Add Comment
Civil Rights and the Death of Daniel Corby
April 5, 2012 Rachel Ehmke
A four-year-old autistic boy named Daniel Corby died earlier this week after being drowned, allegedly by his mother. While local news in California is covering the tragedy, no major media source has picked up the story, which seems surprising, particularly since it comes so soon after the death of 22-year-old George Hodgins, an autistic man who was murdered by his mother last month.
The details we have are few. Daniel's mother Patricia has pled not guilty, but earlier she confessed to the murder, telling police she thought Daniel "did not have a life or a future without her."
We don't know whether Patricia thought that statement somehow justified her action—or just explained what she was thinking or feeling when she did it. And again we don't know whether the police representative who described Patricia as a "stay-at-home mother pushed to the edge" meant to justify the act either. But we do know that the challenges of parenting don't justify denying a child his civil rights.
Self-advocates and parents in the autism community, already wounded by the tendency to blame autism for George Hodgins's murder instead of the person who pulled the trigger, are noting a pattern of misplaced sympathy in the media. Instead of speaking up for the victims, people speculate on how they must have frustrated their caretakers, driving them to murder. Lydia Brown, who blogs Autisic Hoya, notes, "This is the same thing as blaming a woman for her rape because she wore a short skirt or had a low neckline on her shirt."
April has been dubbed Autism Acceptance Month by many in the autism community who are set on recognizing the humanity and civil rights of people who have autism spectrum disorder. Not blaming Daniel Corby and George Hodgins for their own murders would be a step in the right direction.View Comments | Add Comment
Autism Tied to Gene Mutations
April 5, 2012 Caroline Miller
In three new studies published yesterday in Nature, researchers at three different institutions identified gene mutations that are tied to autism.
The studies focused on children on the autism spectrum whose parents do not have autism. Researchers were looking for mutations that occur spontaneously in egg and sperm cells in genes that affect brain development. These mutations, called de novo, are said to occur more frequently as parents age.
What's the takeaway from this breakthrough?
Obviously it helps researchers learn more about how autism develops. But it also strengthens our understanding that autism, like cancer, comes in many different forms. And identifying a specific gene mutation that is linked to some children with autism helps identify a subset of people on the spectrum.
As Dr. Evan Eichler, a professor of genome sciences at the University of Washington and one of the study authors, tells Bloomberg, "We've identified a subset to study more intensely, and we could apply therapies if there are any down the road." Since kids on the spectrum vary so dramatically in their symptoms, he notes, it could be helpful for parents to connect with others whose children share a similar pattern of developmental delays.
And Dr. Matthew State, a Yale neurogeneticist and psychiatrist and the author of another of the studies, underscored how big a breakthrough this is: In 200 children with autism diagnoses, his researchers found two unrelated children with autism who had de novo mutations in the same gene—and nothing similar in those without a diagnosis.
"That is like throwing a dart at a dart board with 21,000 spots and hitting the same one twice," Dr. State told the New York Times. "The chances that this gene is related to autism risk is something like 99.9999 percent."
It's also significant that more mutations were found in children with older parents, especially fathers, who, Dr. State said, contributed four times the mutations that mothers did.View Comments | Add Comment
New Short-Term Therapy Helps Kids Deal With Trauma
April 3, 2012 Caroline Miller
There's good news for children who have had a traumatic experience (and for the caregivers who watch over them). A study released today found that a brief therapeutic intervention greatly diminished the symptoms of post-traumatic stress kids often develop after experiencing abuse or violence or witnessing something deeply disturbing.
After just four to six structured sessions with a trained clinician—one with parents or caregivers, one with the child, then two sessions with them together—children who had suffered sexual abuse or violence were 73 percent less likely than those in a control group to have later developed partial or full-blown PTSD.
During each session, a trained counselor offered reassurance and support, and measured progress. Dr. Steven R. Marans, professor of psychiatry at Yale and director of the Childhood Violent Trauma Center at Yale University, explains how the new approach works, and why it's so important to include caregivers, not a traditional part of trauma treatment:
When children are alone with and don't have words to describe their traumatic reactions, symptoms and symptomatic behaviors are their only means of expression. And caregivers are often unable to understand the connection between the traumatic event and their children's symptoms and behaviors. To heal, children need recognition and understanding from their caregivers.
The current study, which included nearly 500 children, corroborated the results of an earlier study of 176 kids. Evaluated three months later after the treatment, those who received the intervention were 54 percent less likely to develop symptoms of PTSD in children, including sleep disturbances, intrusive thoughts, depression, anxiety, tantrums or feelings of helplessness or hopelessness.
Click here for a story by Dr. Steven Berkowitz, one of the coauthors of the earlier study, about what makes an experience traumatic for a child.View Comments | Add Comment
Autism Month: Awareness to Acceptance
April 2, 2012 Caroline Miller
Today is the start of the fifth annual Autism Awareness Month, packed with events and publicity about autism. But for some activists who've been on the front lines for some time, the frontier has moved beyond "awareness" to "acceptance." In fact there's an alternate Autism Acceptance Month movement.
Steve Silverman, a Wired reporter who has a blog called NeuroTribes, explains the shift from "awareness" to "acceptance" this way: "The lion's share of the money raised by star-studded "awareness" campaigns goes into researching potential genetic and environmental risk factors—not to improving the quality of life for the millions of autistic adults who are already here, struggling to get by."
Noting the recent CDC report that one in 88 children in a sample of 8-year-olds were found to have autism spectrum disorder, he writes, "When kids on the spectrum graduate from high school, they and their families are often cut adrift—left to fend for themselves in the face of dwindling social services and even less than the meager level of accommodations available to those with other disabilities."
For other passionate explanations of why advocates think it's important to "take back" April, check out a site called Autism Acceptance Day. Paula Durbin-Wesby, an autistic adult, explains what it means to her this way: "Acceptance means accepting yourself as you are, even in the face of persistent attempts throughout your life to get you to be what you are not. Especially in the face of persistent attempts throughout your life to get you to be what you are not."
In her essay she hints at something that is becoming a movement in itself, to see neurodiversity as a civil rights issue.
You have the right, or should, to grow in ways that are good for you, that you think are good for you. You have the right to make changes in your life that you think are the correct ones for you. If stimming helps you get through the day, you have the right to do it. If making eye contact is a goal of yours, go for it! You get to choose. When others choose for you (in the case of children or in some support roles) let it be not in the vain attempt to "normalize" you, but to help you be your best, Autistic, self.
We'll be hearing a lot more about this in the days and weeks ahead, and we'll feature here some of the excellent pieces that are on offer as the month progresses.
For starters, check out the piece by Beth Arky on childmind.org about parents of autistic children struggling to find, or invent, independent but supported living situations for their children "aging out" of educational services. With an estimated 200,000 coming of age in the next 5 years, we see it as the next big frontier in autism.
With this in mind, Thinking Person's Guide to Autism today posted the first of a series of "Slice of Life" conversations with "autistics of all ages" that will be running all month. First up is Aisling Alley, a budding anime creator and Nintendo fan. "We'd like to help our non-autistic readers get to know autistics as people who have interesting, complicated lives," writes Shannon Des Roches Rosa, "and who are as diverse and varied as any other random population united by a label."View Comments | Add Comment