The Child Mind BlogBrainstorm
Do Meds Mean We Don't Know Who 'Me' Is?
July 3, 2012 Harry Kimball
Katherine Sharpe was in college, in the late 1990s, when she had a "prolonged anxiety attack" that left her laid out with panic and despair. A visit to the campus health center led to a prescription for antidepressants. Did they work? "Work they did," she writes in the Wall Street Journal. "My dread burned off like valley fog in the sun, and my tears dried up as decisively as if someone had turned off a spigot. Soon I felt less anxious and more sociable than I could ever remember being."
Since then, she notes in her piece titled "The Medication Generation," kids with psychiatric disorders are being identified younger and getting treated earlier. But this gives Sharpe pause. "These trends have produced a novel but fast-growing group—young people who have known themselves longer on medication than off it.
This is an insight not to be taken lightly. We know from research and clinical experience that properly monitored medication can make all the difference for kids with crippling anxiety, impairing impulsivity, or depression that can shut a person down—that it can change the trajectory of lives. Sharpe does not dispute this. "Drugs undoubtedly help many young people who are genuinely struggling," she writes. What she worries about is over prescription.
"The expanding use of psychiatric medication in youth over the last 20 years has meant that the drugs are now prescribed in less and less severe cases," she writes. "In fact, it's tempting to see the rapid spread of these medications less as evidence of an epidemic of youthful mental illness than as part of a broader social trend toward aggressively managing risk in the lives of children and teens."
Here is where we must part company with Sharpe. There is absolutely nothing wrong with "aggressively managing risk in the lives of children and teens." In fact, we owe it to the next generation to intervene early and stave off the often dire effects of untreated mental illness later in life. Yesterday, we read that spanking may slightly increase the risk of developing a psychiatric disorder in adulthood. Do you know what confers a greater risk? A psychiatric disorder in childhood.
Sharpe is right to look critically at the use of medication in children, and to wonder if there are augmentative or alternative therapeutic interventions. These are the thoughts of any caring and competent mental health professional. And, as she notes, the need to continue medication should be reassessed periodically. A good clinician is always alert to the fact that kids who've been treated with medication, as they develop, may no longer need it.
For those who do take medications long term, she sees the risk that, "lacking a reliable conception of what it is to feel 'like themselves,' young people have no way to gauge the effects of the drugs on their developing personalities."
No one should be dissuaded from recognizing this risk, and the difficulty of forming a clear identity when you're growing up with a psychiatric disorder. But we have another saying around the office. "Yes, there are risks to treatment. But there also risks to not treating." In the end, we must weigh the risk with the reward.View Comments | Add Comment
Special Needs Parents vs...Patent Law?
June 21, 2012 Harry Kimball
Parents of a nonverbal four-year-old with developmental delays have had a very painful lesson in patent law recently. First, the background: an iPad app called "Speak for Yourself" enables their daughter Maya to speak to them for the first time in her life.
"We are hanging on her every word." her mother blogged. "We've learned that she loves talking about the days of the week, is weirdly interested in the weather, and likes to pretend that her toy princesses are driving the bus to school (sometimes) and to work (other times). This app has not only allowed her to communicate her needs, but her thoughts as well. It's given us the gift of getting to know our child on a totally different level."
The trouble is that the upstart developers of Speak for Yourself, a couple of speech pathologists, are being sued by a more established firm, the Prentke Romich Company, for patent infringement. The Speak for Yourself app isn't cheap, at $300, but it is much, much more affordable than the four-or-five-figure dedicated hardware the Pretke Romich sells for what is called alternative and augmentative communication (AAC). Speak for Yourself is also very, very similar in function to the hardware Prentke Romich sells, according to the suit. Though it hasn't worked its way through the courts yet, Apple pulled Speak for Yourself from the App Store last week, according to Disability Scoop and Ars Technica.
Maya's mom, Dana Nieder, describes on her blog how her family tried many different communication methods for Maya, including Pretke Romich products, before finally finding success with Speak for Yourself. Now she's terrified that the lawsuit might rob her daughter of a very important, if not all-important, tool. Nieder now has two iPads loaded with the offending program on airplane-mode-lockdown, worried that it might go missing into cyberspace.
Prentke Romich may have legitimate claims against Speak for Yourself. And Apple has reserved all sorts of rights to summarily pull things from the App Store. But as far as I know they've involved things like racy picture apps, not a device critical to the well-being of people with communication deficits. This is a different ballpark, and I have to assume the parties are hard at work on a resolution to avoid the suffering, not to speak of the backlash, that will result if these businesses don't figure out a way to work together.
Neider will be making as loud a noise as she can to see that that happens. "The fact that my daughter's ability to speak is becoming a casualty of a patent battle between two businesses is beyond my comprehension," she writes on her blog.
Emma Stone Controls Panic by Baking
June 19, 2012 Jessica Wakeman
Gearing up for the release of The Amazing Spiderman, Emma Stone is making the media rounds. The gregarious and animated comedic actress revealed in the July issue of Vogue that while filming, she came up with a creative way to counter-balance panic attacks that she has experienced since the age of eight.
Stone, 23, spoke in detail about feelings of isolation that the fear of an attack can produce in a child. "I was just kind of immobilized by it," she said. "I didn't want to go to my friends' houses or hang out with anybody, and nobody really understood."
She started therapy and at age 11 found that her best coping method was acting or, more specifically, improv comedy. She said it taught her to roll with the punches and helped her see that, "failure is the same as success when it comes to comedy because it just keeps coming. It never stops."
It takes courage to act, be spontaneous and funny in front of an audience and critics. It also takes courage to meet panic attacks face to face and to move past the building anxiety, to tolerate it until it fades.
Stone joked about using baking in order to sustain a feeling of control while she was filming the next Spiderman installment:
"I think I felt really out of control of my surroundings. I was just baking all the time. There were stacks of things in the kitchen that nobody could possibly go through. It seemed like it made me feel, if I put these in, I'll know what the outcome is ... I was overbaking."
It is great to see a young actress acknowledge the liberating role performing plays for so many people wrestling with anxiety, and feeling comfortable sharing her own quirky strategies for managing it. She may have felt alone as a kid, but she's not any more.
Find out more about panic disorders, with these quickfacts.View Comments | Add Comment
Mets Consider Adding Quiet Section for Fans with Autism
June 19, 2012 Rachel Ehmke
How about those Mets? We recently learned that the team with centerfielder and ADHD role model Andres Torres is considering adding a quiet section in the stands at Citi Field for kids with autism and their families. The Mets first began shopping the idea in an email survey, describing the area as a "designated quiet seating section with lower volume PA announcements and no music or cheerleading."
Many people on the autism spectrum have sensory processing issues, making them especially sensitive to loud noises and other kinds of overstimulation that are common in most live entertainment. Citi Field is the first ballpark we've heard of offering special seating arrangements, although other teams including the Mets are already hosting Autism Awareness days.
If the team moves forward with their plans they'll be joining Broadway and AMC Theatres, who are already offering special performances designed for audiences with sensory processing issues. To learn more about these shows, check out our first person account from one mom who attended a special autism-friendly performance of the Lion King on Broadway with her kids.View Comments | Add Comment
Harvard/Autism Speaks Brain Bank Compromised
June 12, 2012 Harry Kimball
It is a common lament in autism circles that research is presently inadequate and not accelerating at anywhere near the pace of, say, the prevalence of the disorder. (In just the last couple of months we've gone from 1 in 110 to 1 in 88, according to the CDC.) And so it is devastating to hear when a major resource is compromised, as appears to have happened about two weeks ago when more than 50 brains taken from deceased young people with autism were damaged in a freezer mishap, the Boston Globe reports. The specimens were part of Autism Speaks' Autism Tissue Program, housed at the Harvard Brain Tissue Resource Center.
Apparently, an administrator checked on the particular freezer unit—which also housed brains of people who had had Alzheimer's, bipolar disorder, and schizophrenia—in late May. Although the thermostat read out an acceptable temperature, and no alarms had sounded, when he entered the unit it was about as cold as your standard refrigerator—not nearly cold enough to preserve the brains. Researchers don't yet know what they can salvage and of what use it will be, but suffice it to say that the largest collection of autism brains in the world has been reduced by a third. One researcher says the loss could put research efforts back 10 years.
Even Landon Bryce, a steadfast antagonist of Autism Speaks and foe to any research that smacks of a "cure" for autism, noted the loss of the resource without editorializing. He added, darkly, that "officials have not ruled out the possibility that this was a deliberate criminal act." Though an investigation may be undertaken, some researchers in the field think an unfortunate accident is the more likely culprit. "I think this is just one of those glitches that sometimes happen,'' a brain scientist tells the Globe.
Now, this loss may turn out to be a real blow to the current state of autism research—but it also illustrates just how far we have come. Foul play or malfunctioning freezer units aside, this incident gives us insight into a coordinated research effort that teams a leading advocacy organization with a top-tier research university and federal funding. We see families affected by autism and other psychiatric and neurological disorders eager to turn their own personal tragedies into opportunities for others. It is sad that something went terribly wrong, but at least it happened in the context of things being done so right.
"The donors, they should be upset, they should realize that this shouldn't happen," another scientist tells the Globe. "But this shouldn't dissuade people from continuing to donate, because it is the most important resource that autism science has right now."View Comments | Add Comment
Abusing Adderall to Get Ahead
June 12, 2012 Rachel Ehmke
If the New York Times' disturbing Horace Mann investigation wasn't enough to turn you into a helicopter parent, over the weekend the paper also published a story about stimulant abuse happening at high schools across the country. We don't really know the extent of this abuse, since monitoring agencies report markedly lower numbers than anecdotes would suggest, but the story isn't anything new—students have been abusing stimulants purchased from a dealer or borrowed from a friend for decades now in hopes of improving their GPA. But this abuse does seem to be becoming increasingly common and even expected for students in some high-pressure environments.
Our first order of business here should be to emphasize the enormous difference between talking a prescription medication prescribed for a legitimate disorder and taking a prescription medication like it is a performance enhancing academic steroid. The two are not the same. And while the article suggests that stimulants might lead to future drug abuse, this simply isn't true for the kids who are using stimulants to treat their ADHD. In fact, these kids are less likely to abuse drugs because they don't feel the need to self-medicate with other substances when they are experiencing the stabilizing effects of their prescription. There's good research supporting this.
It's also important to clarify that Adderall and other stimulants are not actually "good-grade pills," as they're being called in the Times headline. Adderall will not give you good grades; Adderall will not make you smarter. Abusing Adderall might make you stay up for a really long time and think you are writing an awesome essay, but, as any English teacher will tell you, thinking you've written an awesome essay and actually doing it are two very different things. Even some parents seem confused over this. One primary care physician told the Times that many parents push for unnecessary prescriptions, saying, "My child is not doing well in school. I understand there are meds he can take to make him smarter."
That some parents don't seem to know the risks of encouraging their children to abuse a Class 2 controlled substance is alarming. That some doctors are aiding in the abuse is even worse. Several teens in the article described how easy it was for them to game the system and find a doctor willing to write prescriptions without first evaluating them for a real disorder. This isn't acceptable. Doctors have the responsibility to be better informed and take more time with their patients, and parents need to make sure they are getting good medical advice from a conscientious doctor who knows his stuff. A diagnosis should never be blindly given or accepted.
That isn't our only takeaway from the article, though. It is clear that our expectations need to be changed if we are creating an academic environment where teens are expected to stay up all night cramming facts like Mark McGwire hitting homers. Parents and schools can both play a role here. Douglas Young, a spokesman for a school outside Philadelphia, told the Times:
It's time for a serious wake-up call. Straight A's and high SAT scores look great on paper, but they aren't reflective measures of a student's health and well-being. We need to better understand the pressures and temptations, and ultimately we need to embrace new definitions of student success. For many families and communities, that's simply not happening.
Parents supporting their teens and encouraging healthy academic expectations can go a long way to changing this, but it won't always be enough. Too many high schools are pressure cookers, encouraging students to spend years working on their college applications. And the truth is that many of the kids abusing stimulants would be trying to stay up all night anyway; Adderall just makes it easier.View Comments | Add Comment
Is Imaging Safe for Kids?
June 7, 2012 Harry Kimball
The Wall Street Journal today reports on a paper in the medical journal Lancet with some alarming results: people who receive multiple CAT scans of the head in their earlier years are 3 times more likely to develop various cancers, including leukemia and brain cancer. According to the study, just 2 CAT, or CT, scans can dramatically increase the brain cancer risk, while it takes quite a few—5 to 10—to tip the odds when it comes to leukemia. So...no more CT scans for kids, right?
Wrong, for a variety of reasons. The actual incidence of these cancers is still low. The study, which looked at 10 years of British data, found that CT scans likely contribute to one new case of brain cancer in 10,000 people over the course of the decade. But there is another reason, one that we run into all of the time in the field of child mental health: the risk to reward ratio. When discussing treatment options, we often say, "There is a certain risk to treatment, but there is also a risk to not treating." The same is true in this diagnostic situation. As Shirley Wang writes in the Journal, "the immediate benefits of the scans, such as in detecting head injuries, still outweigh the risks."
There is another lesson to be learned here, one that depends on another kind of imaging technology, MRI. Magnetic resonance imaging can in some cases be a substitute for CT scans—but it is also widely used as the preferred tool of the neuroimaging research the Child Mind Institute is working to coordinate and promote around the world. MRI does not use ionizing radiation and thus poses no cancer risk. So, if a competent doctor recommends a CT scan for a child after an accident, or in the course of diagnosis, chances are the benefits outweigh any increased cancer risk. And an MRI your child has, perhaps during the course of contributing to our understanding of brain science, poses no cancer risk at all.View Comments | Add Comment
Facebook for Tots?
June 4, 2012 Harry Kimball
The Wall Street Journal reports today that Facebook appears to be considering changes in its age restriction policy with an eye to letting previously excluded under-13-year-olds sign up for a (supervised) account. This isn't opening the floodgates, as it were—it is a response to the online reality that 7.5 million kids under 13 are already on the site, albeit under false pretenses (and often aided and abetted by their parents).
In the Journal, Anton Troianovski and Shayndi Rice write that the social networking giant is testing ways of "connecting children's accounts to their parents' and controls that would allow parents to decide whom their kids can 'friend' and what applications they can use." Oh, and of course, a mechanism for "Facebook and its partners to charge parents for games and other entertainment accessed by their children."
Although the changes are by no means a sure thing, many of these kids are already on Facebook, operating in a world of more "adult" privacy settings even if their parents are close by providing guidance. So what's the harm in granting some sort of "amnesty" to these "illegal aliens" of the Web 2.0 world? You might stand on principle, as Common Sense Media chief James Styer does. "We don't have the proper science and social research to evaluate the potential pros and cons that social-media platforms are doing to teenagers," he tells the Journal, not to mention the tweenage set (or younger!) "The idea that you would go after this segment of the audience when there are concerns about the current audience is mind boggling."
OK, but isn't that naïve? So says Larry Magid, more of a digital pragmatist, who commented on the story over at the Huffington Post.
Whether we like it or not, millions of children are using Facebook, and since there doesn't seem to be a universally effective way to get them off the service, the best and safest strategy would be to provide younger children with a safe, secure and private experience that allows them to interact with verified friends and family members without having to lie about their age.
As you can see, there are good arguments on both sides of this issue. But even if Magid is right, and the wall Styer seems to want to build is an impossible dream, it does mean that families have no option but to submit. I am sure parents will welcome new ways to monitor their children's experiences online. But the same parents would also do well to make sure there are experiences offline to monitor, too. That's just good, even necessary, for kids—particularly the young kids who appear to be entering the fray.
In the end, however, there is the bottom line to think about, and it's hard to stand in the way of those sorts of thoughts. In the past, Facebook CEO Mark Zuckerberg has been incredibly ambivalent about peddling his wares to kids under 13 because of the hassles posed by numerous federal statutes. But there is money to be made from young users, so apparently his company is ready to take the pre-teen plunge.View Comments | Add Comment