The Child Mind BlogBrainstorm

  • Dr. Bubrick Speaks Up for Anxious Kids
    May 8, 2012 Harry Kimball

    Yesterday, as part of Speak Up for Kids, Dr. Jerry Bubrick gave a talk at the 92nd St. Y in New York, just as hundreds of other mental health professionals are doing nationwide. Dr. Bubrick, director of the Child Mind Institute's Anxiety and Mood Disorders Center, focused on the dos and don'ts of childhood anxiety disorders—how do we know when to intervene? And what's the best way to help a child who is in distress?

    Anxiety in children, whatever the cause or specific disorder, is a problem when it impairs a child's ability to do everyday things, when it is pervasive and out of proportion, when it is difficult for a child to recover from, and particularly when it leads to avoidance. Avoidance can be defined roughly as dramatic changes in habit or routine for the express purpose of skirting anxiety-provoking situations. While we want to temper the impairing effects of an anxiety disorder, Dr. Bubrick told the attendees, anxiety itself is not really the enemy.

    92 street Y "Anxiety is actually a good thing," Dr. Bubrick said. "It is protective and adaptive, and it helps us be successful. We don't ever want to 'cure' anxiety—we want to manage it." For parents, teachers, and professionals, that means first thinking about their own responses, and their desire to keep kids from suffering. A parent who shields a child from anxious situationswho enables avoidanceis perfectly understandable, said Dr. Bubrick. "There are good intentions there, but the whole idea of not allowing our kids to feel anxiety actually hurts them more than it helps them."

    Instead, continued Dr. Bubrick, adults need to encourage the development of more functional coping skills. "We don't want to eliminate the stress; we want to figure out ways to help kids cope with it. We want to reward them for trying to those things they are anxious about, rather than trying to pull them away from them." One way of encouraging this "engagement" with their anxiety is setting up a reward system that brings kids more frequently into distressing situations with continual support.

    "Jump into the water on a cold day, and you feel cold for awhile before you adjust," Dr. Bubrick said. "The same thing happens with anxiety. If we allow our kids to experience anxiety without pushing it away, without trying to avoid it, they actually learn how to adapt to it and overcome it."

    The audience included concerned parents, mental health professionals, and educators who all had questions for Dr. Bubrick covering a wide variety of subjects. Fretta Reitzes, director, of the 92nd Street Y Goldman Center for Youth & Family, said that the collaboration between professionals and parents and teachers is representative of the Y's mission and demonstrates why the Y and the Child Mind Institute are a "good fit." She is happy that we can all work together to "spread the word."

    You can help too! Please join us at our online events this week, and at another 92 Y talk this Thursday evening at 7:30. Dr. Steven Dickstein will address raising children in the digital age in "Parenting 2.0."

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  • Maurice Sendak Sails Away at 83
    May 8, 2012 Harry Kimball

    When we heard that Maurice Sendak died today, at 83, my first thought was of all those teenagers obsessed with The Hunger Games and the rest of the current crop of post-apocalyptic young adult fiction. Not because Sendak wrote young-adult fiction—he'd have been appalled at that thoughtbut because for so many of those kids, Sendak's weird and wooly Wild Things were their first taste of the fictional dark side. Sendak was stunningly and unapologetically tuned into children's desire, and, indeed need, to acknowledge the feelings that make their world more fraught than we'd like to remember. And still, Where the Wild Things Are appears immortal. Few books I know of so consistently span generations in their appeal.

    Where does that appeal come from? "There's a cruelty to childhood, there's an anger," Sendak told the AP in 2009. "And I did not want to reduce Max to the trite image of the good little boy that you find in too many books."

    Where the Wild Things AreIn an interview with Stephen Colbert that aired earlier this year, Sendak managed to further elucidate his philosophy between a surprising number of one-liners and dyspeptic glee. (I heartily suggest watching it, though a predilection for Colbert's style of satire is probably a prerequisite.) In response to a leading comment from the comedian on the "simple" task of being a child, Sendak says: "There is something in this country that is so opposed to understanding the complexity of children. It's quite amazing." We have to agree. In his weird and wonderful way, Sendak never stopped speaking up for kids.

    Margalit Fox, in the New York Times obituary for Sendak, writes that he portrayed "a luminous world, at once lovely and dreadful, suspended between wakefulness and dreaming. In so doing, he was able to convey both the propulsive abandon and the pervasive melancholy of children's interior lives." This doesn't mean that he encouraged sadness or carelessness. But he plumbed the depths of the childhood psyche and found a mirror to reflect it. His books have this message for children: "I understand." 

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  • Speak Up for Kids Live
    May 7, 2012 Child Mind Institute

    We kicked off National Mental Health Awareness Week today with a live Speak Up for Kids webinar on our Facebook page. More than 300 people around the globe tuned in to Dr. Kurtz's talk, "Is It ADHD or Just Inattention?"

    If you missed it, you can watch it below.


    Or click here to download the slides from the talk.

     

    Also join us for:

    • A live tweetchat on Tuesday, May 8th with Common Sense Media and our expert, Dr. Ron Steingard on "Parenting 2.0: Parenting in the Digital Age."
    • A live Facebook talk will also take place on Friday, May 11th with Dr. Melanie Fernandez. She will present "The Difficult Child:  Managing Behavior."  

    Visit us on Facebook at http://www.facebook.com/ChildMindInstitute and watch the talk live on the day of the event.

    View the full event details and other Speak Up for Kids events.

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  • 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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