The Child Mind BlogBrainstorm

  • Junior Seau and the Future of Football
    May 4, 2012 Rachel Ehmke

    In some ways, the worst thing about Junior Seau's suicide earlier this week was put into words by former Giants linebacker Harry Carson: "When I heard it, I have to say in the past I would have been shocked. But I'm not shocked anymore."

    Seau was a beloved player, known for his passion and for being on the 1994 San Diego Chargers team that won the AFC championship. Along with mourning there is obvious speculation that Seau may be yet another casualty of chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to concussions and characterized by dementia and depression.

    Seau's suicide was chillingly reminiscent of fellow former NFL player Dave Duerson who, like Seau, shot himself in the chest. Duerson also left a note requesting that his brain be given to the NFL's brain bank for evaluation, and researchers later confirmed that Duerson was indeed suffering from CTE. Seau's family has agreed to have his brain studied, too.

    But the list of professional football players who have committed suicide is increasingly horrifying; Carson, who says he still suffers the effects of concussions he sustained during his career, cited Andre Waters and Ray Easterling, who killed himself on April 19.

    We may find that Seau was suffering from CTE at the time of his death, or we may find that he wasn't. His suicide is a tragedy either way. And the connection between the disease and football is well established, and shouldn't be ignored. We are able to help people suffering from depression, but we can't undo the brain damage once it has happened. This is why it's important for us to focus on the children in upcoming generations who will be playing football: let's make sure they inherit the sport but not the disease.

    For a great memorial of Junior Seau, check out Deadspin's story "The Night Junior Seau Picked Up A Marine Captain's Tab And Serenaded Bar Patrons With A Ukulele".

    For more about concussions, read What Parents Should Know About Concussions.

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  • Occupy May, Mental Health Month
    May 1, 2012 Harry Kimball

    Riding to work on a New York City bus this morning, I was surprised to hear an announcement over the PA system: "Due to the Occupy Wall Street and May Day protests, customers can expect service delays today. Please plan accordingly."

    Now, there are many different ways to feel about these protests. But my point isn't about the politics or taking sides. It's that economic realities and the financial crisis have sparked a serious national conversation, and today, May Day, people are going to be thinking about the issues, if only because of a traffic jam, or reminders like the one on my bus.

    But May is also Mental Health Awareness Month. And next week is devoted to the mental health of our kids. I couldn't help thinking that a national conversation needs to be sparked about that, too.

    I like to think the mental health of our kids isn't as controversial as Occupy Wall Street, and there's certainly no dichotomy like the 99% and the 1%—psychiatric and learning disorders are common in all income brackets and demographic groups. Helping kids is in everyone's interestnot just struggling children themselves and their beleaguered parentsbecause they are the future. But getting people to recognize the importance of early intervention for psychiatric illness is an uphill battle. Unfortunately, it's easier to blame parents for kids with disruptive behavior, to blame teachers for kids failing in schools, to write off kids as bad apples that can't be helped. When we do that the costs to the child, and to the rest of us, only climb.

    And still, when it comes to children's mental health, there are no announcements during the morning rush.

    Today, I saw about 100 people be reminded that there is an Occupy movement, that many working people in this country struggle to put food on the table, that some are taking the issue to the streets. I imagine that this was happening on buses around the city. Thousands of people today will at least consider their opinions.

    Wouldn't it be wonderful if tomorrow morning the PA crackled to life with a simple message? "If you see something, say something. And by the way, have you thought about mental health care in this country lately, particularly for kids? Don't worry, this shouldn't disrupt public transportationnot this year, at least."

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  • Hand Sanitizer: The New Zima?
    April 25, 2012 Harry Kimball

    Today, the Internet is "on fire" with stories about California teens getting drunk on hand sanitizer, a bellwether of what CBS News says "may be a fast-growing dangerous trend." We know of six teens who ended up in the emergency room with alcohol poisoning after drinking the stuff, and no wonder: it is 62% alcohol, much more potent than even hard liquor.

    We often hear about alarming trends in teen substance abuse. In the 80s and 90s, I remember hearing a lot about the dangers of mouthwash. Recently, we were inundated with stories about teens inserting tampons soaked in hard alcohol for an undetectable buzz. With all of these horror stories, it seems almost obvious that hand sanitizer would be next. In any case, these are all quite alarming, and for good reason—they are very well outside what we would consider normal or acceptable behavior for our children.

    And that is what is potentially harmful about this sort of story. As a society we like to pay attention to bizarre conduct on the part of a very few young people, at the same time that we turn a generally blind eye to the more widespread problem of "standard" teen drinking and the abuse of illicit drugs. The fact is that for many teens it is fairly easy to buy beer or marijuana or ecstasy. We should not let that fact escape us because of a sensational new "trend" that relies as much on media hype as on real world evidence for its existence.

    If you consider hand sanitizer a threat to your child, or something she might come in contact with as a drug of abuse, by all means have a frank conversation with her in the same way you would discuss alcohol, or marijuana. However, I cannot in good conscience ignore Gawker writer Caity Weaver's inspired rejoinder to the frenzy of attention and hand-waving that has accompanied this story: "If you are a parent who wants to prevent your teen from getting sloshed off Mr. Clean's Tears, the first thing you should do is make sure they are aware this even exists as an option in the first place."

    Just because this danger is likely inflated doesn't mean that the old stand-bys aren't still waiting for our kids. But at least parents can drop that old saw about the bridge. If your kid complains that everyone is doing something, ask him, "If everyone was drinking hand sanitizer, would you drink it, too?"

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  • Lady Gaga Says Pop Singers Don't Eat
    April 23, 2012 Rachel Ehmke

    Lady Gaga got a lot of negative attention from an irresponsible tweet last week. The pop star wrote, "Just killed back to back spin classes. Eating a salad dreaming of a cheeseburger #PopSingersDontEat #IWasBornThisWay."

    There are a few ways to look at this. The first is that it's interesting to see a celebrity admit the lengths to which she has to go to look the way she does. For a lot of people, being as stick-thin as Lady Gaga would be impossible without extreme dieting and exercise. It turns out this is also true for Gaga herself, which isn't surprising since she has spoken publicly about struggling with her weight in the past, saying she wanted to look like a ballet dancer but instead was a "voluptuous little Italian girl." Most celebrities don't discuss how hard they work to maintain Hollywood standards of beauty, and Gaga's candor could be considered refreshing.

    Could have been, that is, if her tweet hadn't made it sound so glamorous. Gaga knows that she is a role model for adolescents, and she is enormously influential—over 20 million people follow her on Twitter and many more received that tweet after the media picked it up. Hearing "pop singers don't eat" sends a very clear message to any kid who dreams of fame (which is probably most kids, at one time or another): Starving yourself goes with the territory. It's especially sad because Gaga is famous for being so spectacularly creative and disciplined, not because she's skinny. Her body isn't as interesting as the outrageous clothes she puts on top of it. You want a celebrity like her to inspire girls to pursue their own unique talents and interests, not the lowest possible body mass index.

    Of course, it's not just pop singers who aren't eating these days. Crash diets and "cleanses" are quickly becoming as casual as getting a manicure or having your hair done. The New York Times recently did a highly disturbing story about brides who go on radical diets before their weddings. One woman decides to use a feeding tube for eight days instead of eating before she goes shopping for her wedding gown. Seeing her gazing serenely off into space with a feeding tube going up her nose is shocking, but it's also sad. After all, she's not doing this by herself; she's just an extreme example of a culture that really believes nothing tastes as good as skinny feels. 

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  • 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 workSiddhartha 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 causeschronic 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."

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  • 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 reportedAshley Judd 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. 

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  • 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 kidsthey'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 effectiveless dysfunctionalways 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.

    See Dr. Rappaport speaking about behavior management strategies in this video.

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  • 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.

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  • 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 panelwho 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:

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  • 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.

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