The Child Mind BlogBrainstorm
Heading Off Depression and Suicide Early
Nov. 29, 2011 Harry Kimball
Some sobering statistics from a recent University of Washington study: almost 40% of young people who attempted suicide in adolescence did so before high school age, with some reporting attempts as young as 9. In the study, the university reports, 9% of a sample of 883 adolescents aged 18 or 19 followed since childhood had tried to kill themselves at least once, a frightening statistic that is nonetheless in line with other research.View Comments | Add Comment
But the study did more than count suicide attempts: It matched the suicide attempts kids report in retrospect with assessments of their mental health and mood done in the years surrounding and including the attempt. And what the researchers found is encouraging: there are signs.
Lead author James Mazza found that young people who attempt suicide score higher on standard scores of depression than their peers who do not make an attempt, an unsurprising result. He also found that the same child had a higher depression score the year of the attempt than the year before or after, which is quite striking. "This study suggests that implementation of mental health programs may need to start in elementary and middle schools," Mazza says, "and that youth in these grades are fairly good reporters of their own mental health."
It's not as if Mazza's research can eradicate the vulnerability of adolescents to depression and suicide. As he says, "adolescence is a time when kids are preparing to be more independent from their parents or guardians, but lack the experience of how to do this. And their support network—their friends—doesn't have the experience either, especially in crisis situations." But it does make it clearer that caring adults can determine when a young person is heading for a crisis, even when the distress signals that kid is sending to peers or parents are getting lost in the busy, messy noise of growing up.
Flashback: Blocks Rule in School, Again
Nov. 28, 2011 Harry Kimball
A variety of concerns about children's education seem to have conspired to bring simple wooden building blocks back into vogue, at least in the upper echelons of New York City schools. Worried about too much "screen" time? Blocks. Worried about motor skills and clumsiness? Blocks. Worried your first-grader isn't learning enough corporate team-building skills? You guessed it: Blocks.
Are massive "block centers" with thousands of dollars worth of maple simply a cure-all fad, a panacea for a variety of modern ills? To be sure, Kyle Spencer notes in the New York Times, "as in fashion, old things often come back in style in education." But many progressive preschools and grammar schools have been faithful to blocks since their original popularity in the early 20th century.
Spencer paints a picture of a Luddite-ish resurgence of simple wooden blocks "amid worries that academic pressure and technology are squeezing play out of young children's lives." (Even the present block revival is not immune to these incursions; Spencer describes photodocumenting block projects, making documentaries, and even pulling design ideas from online photos and videos. One teacher describes this as a sort of "low-tech/high-tech" synergy.)
Is it just good, clean evidence-based fun? (Studies show a variety of benefits to block play, from better coordination and spatial reasoning to higher math scores and increased ease of language acquisition.) Not for everybody. At one school, kindergarten and first-grade students "toiled together on a grocery store and a fancy hotel," Spencer writes, "beneath a sign that read: 'When Partners Disagree They Try for a Win-Win Solution.'" Not necessarily a bad lesson, but one that seems more "boardroom" than "classroom."
But the pleasures of blocks, of trial and error, and of spending time with children can be straight out of the most up-to-date parenting guide. "Don't rush to help them with structural challenges," one "block consultant" tells Spencer. "You don't have to ask them a million questions. Just sit with them and notice." And you're on the way to setting the foundation for a great relationship—between you and your child, and between your child and the joys of learning.
Photo Credit: Flickr user Hans and CarolynView Comments | Add Comment
Nov. 18, 2011 Harry Kimball
When I was attending New York City public schools in the 80s and 90s, I thought that the sex education offered was pretty good—which is to say uncomfortable, frightening, and often informative. Even looking back on the experience, it comes through as comprehensive: We were told that the only truly "safe" sex was no sex, we were taught about anatomy and contraception, about STDs and pregnancy, and in one memorable class a male friend of mine claimed he had no refractory period.
But now I am faced with twin realizations—that sex ed for my generation was woefully inadequate, and that the meager but still uncomfortable, frightening, and informative experience that I thought was a rite of passage for all children is almost nowhere to be found. These shocks come courtesy of a must-read in the upcoming New York Times Magazine by Laurie Abraham called "Teaching Good Sex." It's mostly a profile of an English teacher in suburban Philadelphia, Al Vernacchio, who also teaches an elective class called "Sexuality and Society" to seniors.
"Grand slam," "orgy," "grass on the field," "landing strip." Vernacchio shies away from no topic or euphemism. This may seem shocking to some readers, but what's even more shocking is that seemingly every parent of the students heartily approves. True, Friends' Central is a progressive Quaker private school—but remember, sex ed of a similar quality was available when I was in middle and high school not so long ago. But do we need this sort of honesty?
We recently wrote about the declining prevalence of teenage sex. So how is this happening if the kind of sex ed that Vernacchio teaches is rare, verging on extinct? Abraham tells the other side of the story—teachers skirting abstinence-based curricula, using "code" and guerilla tactics to teach young adults what they need to know but aren't allowed to learn.
But what Vernacchio offers is something more, encouraging his students to think about sex as more than just a mechanical transaction. Just because more teens are abstaining from sex doesn't mean they have better attitudes about it. My experience with sex ed didn't teach me to be more compassionate or to really respect other people, other genders, other orientations. But listen to what one of Vernacchio's students tells Abraham about learning a salient fact he probably wouldn't have gotten anywhere else. "It's almost like a wake-up call. To not just please yourself."
Sex has emotional consequences—good and bad—in addition to physical ones. So talking about sex clinically (or not at all) misses the mark.
Abraham describes a talk Vernacchio gave to parents. He "didn't imagine that his audience, who gave him an enthusiastic ovation when his presentation ended, wanted their 14- and 15-year-olds to go out tomorrow and jump into bed or the backseat," Abraham writes. But "sex education, he and others point out, is one of the few classes where it's not understood that young people are being prepared for the future." This is real life, with real consequences. So let's educate our children.View Comments | Add Comment
Why Don't We Trust Teens About Sex?
Nov. 16, 2011 Harry Kimball
In the New York Times, KJ Dellantonia casts a suspicious eye on new numbers from the Centers for Disease Control indicating a significant decrease in the sexual activity of teenagers. (42% of boys and 43% of girls aged 15-19 say they've had sex at least once, down from 60.4% and 51.1% in 2002.) Dellantonia writes that she might be a little "caught up in that difficulty with the self-reported data. Maybe I'm cynical, but I put more credence in a truly anonymous Internet survey than in one that involved an adult sitting in your bedroom."
Or maybe the message is getting through to kids. Perhaps sex education (where it is available) is working. Though Dellantonia isn't particularly impressed, these days the second most important reason boys don't have sex is because they haven't found the right person; it used to be that they didn't want to risk getting someone pregnant.
Humbug, says Dellantonia. "That's either very sweet," or more likely just evidence that teens "have the birth control thing down." (As the Times reports in its article on the CDC study, contraception use is rising steadily while the birth rate for the age group is the lowest ever recorded in the US.)
OK-but that's a start, right? As we've pointed out, teenagers are sexual beings. Of course, every parent, teen, and family is different. But, as we've suggested before, the only way to pass your values about sex on to your children is by talking to them, early and often and in ways they can understand. That's why it's heartening when one commenter on Dellantonia's post offered a corrective to what another called the "apocalypse" of adolescent sex that leads to psychic disaster.
"I think it would be useful to challenge the misguided and unhelpful myth that teenagers having sex automatically equates to 'emotional mess,'" writes Bill Randle. "The way to avoid that is for parents to have frank, wide ranging discussions with their children about sex and sexuality so they're not surprised by the ramifications, be they emotional or physical. Unfortunately, however, many parents just can't bring themselves to talk to their kids about sex."
Of course, many parents do find it difficult, but wishing and pretending these conversations away is the surest road to "apocalypse." As Randle so eloquently puts it: "How is it that some adults managed to get through adolescence and yet still pretend that teenagers aren't sexual?"View Comments | Add Comment
Brain Differences in Kids With ADHD
Nov. 14, 2011 Caroline Miller
Two compelling pieces of research about ADHD have been released by neuroscientists in the last couple of days. Using scans that show a picture of brain activity, a study at Wayne State University found that an area of the brain that helps organize mental activity works unusually hard in children with ADHD. It's called the dorsal anterior cingulate cortex, and the findings suggest that differences in this region's functioning could be an underlying cause of the inattentiveness and impulsivity that characterize the disorder. "Our findings suggest that the function as well as the structure of this brain area is different in children with ADHD," the biologist who reported the team's findings told the Wall Street Journal. "It might explain the cognitive problems we see in the classroom."
Another study, also based on functional magnetic resonance imaging, showed that adults who were diagnosed with ADHD as children still have less grey matter in the outer layer of the brain, the cortex. The areas that show thinning are involved in the regulation of attention and emotion, said Dr. F. Xavier Castellanos, a professor of child and adolescent psychiatry at New York University Langone Medical Center and a member of the Child Mind Institute's Scientific Research Council. Dr. Castellanos noted that these brain differences persist into adulthood even for those who have taken stimulant medication to help control the symptoms of ADHD.View Comments | Add Comment
Angry Parents and Unpredictable Children
Nov. 11, 2011 Caroline Miller
Kids, especially kids with psychiatric disorders, respond unpredictably to anger. Lisa Belkin, on her new blog over at Huffington Post, makes an important point about three young children recently killed by their parents. These cases have been linked by the fact that all had used the book To Train Up a Child, which advocates spanking children with rubber tubing and other disturbing forms of corporal punishment. As we noted earlier, all three children were adopted, and all the families had six or more children.
Lisa wonders whether adoptive children are more at risk for the kind of horrifying treatment these kids suffered. She notes that kids who are deprived as infants may develop what is called reactive attachment disorder, which makes them unable to bond, but also to feel. Her hypothesis is that the kind of punishment these parents had meted out to other kids in their very large broods might not have produced the kind of cooperation they were looking for from these children. So the parents may have escalated, until they were enraged and out of control.
I don't know how common RAD is, but it points to a larger issue that's very important in raising kids with psychiatric disorders: Children vary a great deal in how they respond to negative reinforcement. If you raise your voice, one child might immediately fall into line, but a child with ADHD might barely register the change, and might ignore you. Or he might escalate, and yell back at you. Anger directed at an extremely anxious child might cause her to shut down completely, rather than comply with your commands. When you lose your temper and yell at a child on the autism spectrum, rather than yield, he might go into a violent tantrum.
All of which is why positive reinforcement and consistent, unemotional consequences for undesirable behavior is a much more solid basis for raising children.View Comments | Add Comment
Penn State: If You See Something, Say Something
Nov. 9, 2011 Harry Kimball
These words are familiar to anyone whose been in an airport or taken public transportation in the last few years, an exhortation to report anything out of the ordinary: an unattended bag, say, or suspicious activity. As Maureen Dowd points out in a scathing op-ed column in the New York Times, this appears to have been largely lost on the many Penn State football coaches and administrators who allowed one of their own, Jerry Sandusky, to allegedly sexually abuse eight young boys.
The pyramid of silence Dowd outlines is staggering, and I'm sure we're all aware of the story by now: Both a graduate student and a janitor witnessed Sandusky having sex with boys in the showers of the football building, years apart. The grad student, Mike McQueary, told legendary coach Joe Paterno, who leisurely informed his higher-ups, all the way up to the president of the university, none of whom thought to alert the authorities. "You'd think a graduate student would know enough to stop the rape and call the police," Dowd writes. "But McQueary, who was 28 years old at the time, was a serf in the powerfully paternal Paternoland."
This episode is a disastrous illustration of how things can go wrong when fear motivates our decisions—not just fear of danger but fear of what other people think. Dowd calls Penn State "an arrogant institution hiding behind its mystique." But what I see is a group of men motivated by selfish fear of the repercussions of the untidy right action—to their positions, reputations, the school's standing—that they failed spectacularly to aid children in need.
It takes courage to move beyond fear and to do right by kids, but even though it might be difficult there is no other legitimate option. This is starkly evident in the case of Penn State and Sandusky, and the penalty for inaction is deservedly heavy. We could all do better to keep our eyes open for other situations that maybe aren't as obvious, but when saying something—or doing something, or even just acknowledging that something is wrong—could still make a difference in a child's life. This is true whether we're the parent of a struggling child or the classmate of someone who is being bullied.View Comments | Add Comment
Lack of Internships Pauses Psychology Careers
Nov. 8, 2011 Harry Kimball
We often point out that there are too few child and adolescent psychiatrists in this country—around 7,000, or 8.7 per 100,000 young people—because of training barriers and a dismal economic calculus that makes the field less than attractive for many doctors who might otherwise be fine clinicians. This is not good for our children, and the shortage particularly affects those that live in rural or economically disadvantaged areas.
But the New York Times today highlights a problem in clinical psychology that is equally detrimental in terms of patient care, but for a completely different reason. Call it the "internship crisis." There are a great many psychology graduate students—but not enough year-long clinical internships, required for graduation, employment, and not mention crucial to the educational process. Last year almost 25% of students who applied were not matched with programs in the first round; of those many took "unaccredited" internships that could seriously dim their future prospects, and others found themselves with no place to go.
"There are people who are taking student loans and spending years in this training who could go out and provide a service to the public, and they're stuck," a professor tells the Times. This is even more unfortunate because the numbers and enthusiasm of these applicants happily indicate that there is a healthy interest in providing clinical mental health services and joining the field. Sadly, the system isn't set up to accommodate it.
The lesson here is that even while we see a crisis in mental health care for children in this country—for everyone, really, but most acute in the younger population—we must think strategically about the solution, for it isn't a quick fix. We can't succeed in encouraging and training the mental health professionals of tomorrow, only to hold their training up short just as they are ready to engage with the populations that so desperately need them. If an internship program "gets too big, we won't give out stellar training," says a program director, and we agree. But if the population of qualified professionals is too small, kids won't get stellar care.View Comments | Add Comment
Deaths Spark Furor Over Spanking Book
Nov. 7, 2011 Caroline Miller
The spanking debate has erupted again over a preacher's book on raising children with "the rod" that has been linked to the death of three youngsters at the hands of their parents.
The author is Michael Pearl, a fundamentalist pastor who's sold more than half a million copies on Christian websites of a book outlining a system of corporal punishment based, he tells the New York Times, on Amish techniques for training mules. He advocates striking children as young as 6 months, with escalating force (and weaponry) as they get older, from a starter switch to a 15-inch piece of plastic plumbing tube. "It's a good spanking instrument," he tells the Times. "It's too light to cause damage to the muscle or the bone."
It's the presence of this plumbing tubing, along with the book, that links these three cases of fatal child abuse. But there is more that links them: One couple was homeschooling 6 children of their own before they adopted another girl and a boy. The second couple had nine children, three of them adopted, also being homeschooled. And the third had adopted six children, some with emotional problems. Three children who died had all been beaten regularly.
What these parents obviously missed, or were too overwhelmed, out of control, or emotionally disturbed to implement, is the rest of the book's advice, that "parents should be loving, spend a lot of time with their children, be clear and consistent, and never strike in anger."
So it's not completely without justification that the Pearls claim their book can't be blamed for these obviously bad parents taking their advice about corporal punishment out of context.
Which brings us to the point: If you argue that what was wrong with these parents wasn't the spanking, then what is right about other parents who've used the book and raised happy successful children isn't the spanking either. Spanking isn't (usually) fatal, and if positive, engaged, consistent parents occasionally spank their kids, it's not surprising that they might turn out fine. That doesn't prove that spanking works.
Whatever you think of the Biblical exhortation against "sparing the rod," the scientific evidence is to the contrary. "As a behavioral neuroscientist that makes my living training animals to perform complex decision making tasks," one commenter wrote, "I can firmly assert that incentive reinforcement (reward delivery) is far more effective than negative reinforcement (punishment avoidance) at establishing habitual (long-term) behavior patterns."View Comments | Add Comment
Helping Teenagers Take Ownership of Treatment
Nov. 7, 2011 Caroline Miller
Treatment for teenagers with psychiatric problems can be a real tightrope walk, since teenagers have the tendency to see themselves as adults even when they're not acting like adults. This is especially painful when they have gotten into serious trouble with drugs or alcohol or with the law.
Kids don't do well in any therapeutic program when they're doing it because their parents are making them or, worse, a judge is making them. And when a teenager's family is very much a factor in his emotional or behavioral situation, because of violence or neglect or abuse, even defining the problem that needs to be treated becomes daunting.
That's where a new toolkit called Youth Guide to Treatment and Treatment Planning comes in. It's a step-by-step guide for teenagers and families to help define what the goals of a treatment plan are, what are the best strategies to get to that goal, how to play to the teenager's strengths, and who are the best people to have on the treatment team.
It may seem obvious that you need to identify what a child wants to or needs to change about his life before you plunge into trying to change it, but kids often feel that they're being "sentenced" to treatment or forced to get better, and the result can be unsatisfying for everyone.
This tookit is a smart, realistic document that acknowledges that when a teenager is heading for treatment, "maybe it's because you want to improve things, or maybe you're being forced to change by your parents, the courts, or community authorities."
It's a way to help kids and their families put their cards on the table about what they want and need, and take ownership of the process of getting help. If you have a teenager in trouble, and want to take a look, you can download it here.View Comments | Add Comment