The Child Mind BlogBrainstorm
Ryan Gosling Strips for Special Needs
Feb. 9, 2012 Rachel Ehmke
Lately it seems like mental health topics have been even more divisive than usual. Passionate arguments are circulating about what is and what isn't a disorder, how disorders are caused and whether popular medications are actually effective. Even Hollywood is getting pulled into the fray. As usual, families are on the front lines of these conversations, and it must be difficult to have the extremely personal issue of your child's mental health being tossed around for public debate. But families, take heart: Ryan Gosling is on your side. And he isn't wearing a shirt.
Enter Sunday Stillwell, a special needs mom who's seen it all and, luckily for us, has a sense of humor about it. Stillwell created the fantastic Special Needs Ryan Gosling meme, inspired by all the other Gosling memes out there. Through thick and thin, through sensory issues, IEPs, and interminable phone calls with the insurance company, Stillwell wants you to know that Ryan Gosling admires all your hard work and devotion, and he's happy to tell you himself, while gazing moodily off into space, or sitting suavely at the bar, or eating his morning Wheaties. Check out Stillwell's handiwork over at her blog Adventures in Extreme Parenthood.View Comments | Add Comment
Three Great Takes on the ADHD Flap
Feb. 9, 2012 Caroline Miller
There has been a lot of passionate back-and-forth in the last two weeks about the virtues of ADHD medication, kicked off by L. Alan Sroufe's broadside on the op ed page of the New York Times opposing medication and asserting that ADHD is caused by parental neglect or, oddly, its opposite, "patterns of parental intrusiveness."
Judith Warner put Sroufe's argument in perspective in Time magazine, noting that his essay was "like a ride backwards in a time capsule." That is, back to when autism and schizophrenia were said to be caused by cold or toxic mothers, and stigma prevented most parents from getting help for struggling children. A specialist in attachment who did his major work in the 1970s, Sroufe "wages what appears to be a late-career turf war with biological psychiatry," Warner writes, and accuses parents of giving the kids pills to get themselves off the hook.
Dr. Ned Hallowell also weighed in with an excellent analysis, wincing at Sroufe's charge that medication is being offered by drug-happy clinicians as a cure-all that prevents us from getting to the root causes of behavior problems. "Sure, some doctors over-medicate, while other doctors never medicate because they 'don't believe in ADHD' and 'don't believe in Ritalin,' " he writes. "But as long as we use it properly, it remains one of our most valuable—and tested—medications."
Finally Donna Wick at the Freedom Institute, which offers substance abuse treatment and prevention workshops for schools, speaks to the unacknowledged point here: that adolescence is a very perilous time for kids with ADHD, who are at substantially higher risk than other kids not only for problems in school but for substance abuse and other dangerous behavior. Studies show those risks are reduced when kids are being treated with ADHD medications.
"Parents have to make their own choices about stimulant medication for their child," Wick concludes. "But in my professional capacity at Freedom Institute, I would be remiss if I didn't draw parents' attention to the correlation between ADHD and substance abuse, as well as the studies that indicate that stimulant medication is a protective factor."View Comments | Add Comment
Tyler Clementi and Dharun Ravi: A Spy Cam and a Suicide
Feb. 3, 2012 Caroline Miller
You think you know the story: Tyler Clementi, a gay Rutgers University freshman, jumped off the George Washington Bridge after his roommate recorded a sexual encounter with another man on a spy cam in their dorm room, and broadcast it over the internet. Clementi's death became a rallying cry in the fight against anti-gay bullying and a wake-up call on the ways teenagers use technology to be cruel to each other.
The roommate, Dharun Ravi, is charged with a couple of complicated offenses having to do with hate crimes and invasion of privacy. His trial, coming up next month, is the occasion for an investigation by Ian Parker in the New Yorker. The resulting piece is very revealing—not only of how a bunch of college students, including Clementi, used social media to define and brand themselves, but how much more complex the lives of adolescents are than news accounts suggest.
Some of the eye-openers: There was, indeed, a spy cam (a remotely opened video chat), which Ravi turned on when Clementi asked to have use of their room for the evening, ostensibly for a sexual tryst. But no footage was recorded or posted on the web. Clementi knew about the spying because Ravi bragged about it on Twitter, and he knew that the spies saw nothing more titillating than a kiss. Clementi texted a friend about the spying, at first saying it was no big deal. He asked the opinion of posters on a gay message board whether he should file charges against Ravi, noting that if he asked for a new roommate he could do considerably worse.
When Clementi scheduled a second evening encounter in his room two days later, he found that Ravi had gone into what Parker calls "full impresario mode," tweeting "Anyone with iChat, I dare you to video chat me between the hours of 9:30 and 12. Yes, it's happening again." Seeing this, Clementi disabled the computer and reported the incident to his RA. On a message board he wrote, "I turned off and unplugged his computer, went crazy looking for other hidden cams . . . and then had a great time."
The story is fascinating because neither Clementi nor Ravi fits the stereotype we have of them. In a way the saddest thing in the story is that in the three weeks they shared a room, there was barely a word spoken between them. Clementi told friends he couldn't see how he could talk to Ravi about what was happening, and Ravi made no effort until he was visited by the RA—just about the time Clementi was taking his life.
This is a reminder that adolescents are volatile, that it is dangerous when technology mitigates human interaction whether you are 2 years old or 20, and that college is a place where we form our identities even as our sense of self is challenged. In the article, Clementi comes off as needy and impulsive, and Ravi as stunningly thoughtless. Maybe they weren't meant to be friends, but if they'd at least made contact, this might have ended differently.View Comments | Add Comment
Does Asperger's Exist? Can Emily Post Fix It?
Feb. 2, 2012 Harry Kimball
Asperger's self-advocates and parents were a bit stunned and more than a bit angered by twin op-ed pieces published in the New York Times Monday. Separately and together they argued that many people with a diagnosis of Asperger's are simply introverted and quirky, which is why it's a good thing that a lot of them may no longer qualify for the diagnosis of autism spectrum disorder under the proposed "narrowing" of criteria in DSM-5.
Benjamin Nugent was a "clumsy, lonely teenager," he writes in the Times, "a spectacular social failure" with "stereotyped and restricted patterns of interest," e.g., he "memorized poems and spent a lot of time playing the guitar." His mother, a psychologist and Asperger specialist, diagnosed him. Years later, once he got "to New York City and became a writer" and met some likeminded people, he realized that he didn't have Asperger's at all. His mother agreed, and off the spectrum he went.
"My experience can't be unique," Nugent writes. "Under the rules in place today, any nerd, any withdrawn, bookish kid, can have Asperger syndrome." No and no. I have no idea about Nugent's mother's qualifications as a diagnostician (Is it really kosher to be diagnosed by a family member?) but competent clinicians don't hand out Asperger's diagnoses to any "clumsy, lonely teenager." And if it's happening, it's bad clinical work, not the fault of a diagnosis that has gotten many people with real impairment the help they need.
In the "companion" piece, as it were, psychiatrist Paul Steinberg seems to have a problem with the whole concept of a person with "no language-acquisition problems" being on the autism spectrum. That is, he doesn't believe in Asperger's and thinks the diagnosis does a disservice. "Children with social disabilities," he writes, "diagnosed now with an autism-spectrum disorder like Asperger, have lower self-esteem and poorer social development when inappropriately placed in school environments with truly autistic children."
In fact, Steinberg writes, these kids are going to be fine—they're just beyond their years, as it were. "Children and young adults with significant social disabilities tend to grow quite effectively into their adult lives," he soothes. "Their seriousness and singularity of focus fit more compatibly with the interests of older adults rather than the interests of their childhood or young adult peers."
Would that it were so for all kids. Obviously children should be educated in whatever setting they learn best in; if kids with Asperger's can function in a mainstream classroom, that's where they should be. Calling them Aspies doesn't doom them to spend time in a setting that's too restrictive for them. A diagnosis should open, rather than close, a doorway. But Steinberg's solution is to get rid of the diagnosis and related services. An "Emily Post course" in etiquette should be sufficient, he suggests.
Steinberg also displays Nugent's habit of blaming a diagnostic category for the accidents of childhood, the irresponsibility of people, or the callous disregard of the culture. "Many of us clinicians have seen young adults denied job opportunities, for example in the Peace Corps, when inappropriately given a diagnosis of Asperger syndrome instead of a social disability," he writes. Whose fault is that: Hans Asperger's?
Unsurprisingly, the autism community is aghast at these off-kilter attacks. Lynne Soraya gauges opinion at Psychology Today, notably that of critic Tim Page, the genesis of Steinberg's Emily Post comment. Landon Bryce at thAutcast brings his reliable wit and fury to bear. His headline: "New York Times Runs TWO 'Asperger's Is Fake' Editorials."
At Thinking Person's Guide to Autism, Sarah McLeod notes that while Nugent overstates the importance of his own misdiagnosis, Steinberg tries to play the "everyone has it" card both ways: He invokes Einstein, Buffet, George Orwell et al as people who might have had Asperger's, suggesting that therefore the diagnosis must be meaningless. "To be autistic, it seems, one must be unable to achieve."View Comments | Add Comment
Autism and Military Families
Jan. 31, 2012 Rachel Ehmke
Military families have it tough. Families need to cope with frequent relocation, a primary caregiver who is absent for long stretches of time, and the burden of knowing that what feels normal now might not ever feel normal again. All children crave the kind of routine that can be all too easily disrupted by military service, but for kids with autism who depend on routine just to function, having a parent in the military is that much harder.
You would like to think that military families affected by autism don't need to worry about health care. In fact, many servicemen and women initially signed up with the promise that their health care would be completely taken care of. My own father has said that he had an easier time "going the extra mile," in his words, because he knew that he was ensuring excellent health care for his family. Military insurance (currently called TRICARE) has gone through a lot of changes since my father enlisted, and while the quality of health care is still generally good, copays and extra services have gotten complicated.
Particularly for families dealing with autism. When asked to describe the process of getting autism treatment through TRICARE, Rachel, a military wife and blogger over at StimCity responded: “It amounts to jumping through flaming rings of fire while blindfolded with your feet and hands bound with duct tape while your child with autism is left spinning in a corner and your husband dodges IEDs in Afghanistan. Do you want to hear more?"
Actually, TRICARE alone does not cover autism treatment. To get supplemental insurance you first need to enroll in two different programs, the Exceptional Family Member Program (EFMP) and the Extended Care Health Option (ECHO). Unfortunately retired military personnel don't qualify for ECHO, so Rachel's husband, who has served for 24 years and been deployed overseas three times, can't retire because it would mean losing treatment for their daughter. Josyln Gray at Strollerderby points out that this also excludes medically retired personel who leave the service after being injured in wartime.
Assuming you do qualify for ECHO, claims are limited to $36,000 a year. Gray does the math and notes, "that’s about enough to get your child 11-12 hours of applied behavioral analysis (ABA) therapy a week, far below the 25-40 hours a week recommended for children (especially younger children or the more profoundly affected) who need ABA. Also, the dollar cap includes not just things like autism services, but respite services and durable medical equipment. So if your kid needs a wheelchair, that’s going to take away from the autism services you can access."
Today two Congressmen are sponsoring a military family briefing for members of Congress. The ultimate goal is to pass HR.2288, the Caring for Military Kids with Autism Act, which promises behavioral health treatment, including applied behavior analysis, for all military families affected by autism, including the retired ones. Military families have gone to DC, some to address Congress and others to help out backstage. We'll keep you updated on the future of HR.2288. For more information, or to get involved, visit www.cmkaa.org.View Comments | Add Comment
Setting the Record Straight on ADHD Medications
Jan. 31, 2012 Caroline Miller
Yesterday we posted a point-by-point response to the New York Times op ed piece that ran Sunday, "Ritalin Gone Wrong," by Dr. L Alan Sroufe. In our rebuttal Dr. Harold Koplewicz explains the stunning misreading of the research on which Dr. Sroufe bases his claim that ADHD medications don't work. Since we're getting a lot of distressed calls and emails, and in case you don't have time to read the long version, I wanted to give you the most important facts here.
Dr. Sroufe cites a 2009 study of children followed over 8 years that he says showed that medication doesn't work after the first two years. What he doesn't say is that they stopped treating the children in the study after the first two years! No one claims that stimulant medications cure ADHD; rather we know from incontrovertible research and clinical experience that it helps many, many children while they are taking it.
Dr. Sroufe also makes the mistake of conflating all children who have "behavior problems" with children who have been diagnosed with ADHD. Of course there are some kids whose symptoms look like ADHD—they're distracted, impulsive, have trouble self-regulating—but stem from something else, including stressors in their environment. The fact that ADHD medications don't work on all "problem children" doesn't undermine the fact that they work really well for many kids who really do have ADHD.
It's certainly true that parental patterns influence children's behavior, and that changing those patterns can help a child learn to rein in his own impulsivity. That's why parent-child interaction therapy (PCIT) can make a big difference. But PCIT doesn't cure the core symptoms of ADHD; in fact kids with severe ADHD usually have to be on medication to be able to focus enough on the training sessions to learn effectively from them. We agree with Dr. Stroufe that knee-jerk medication isn't the answer for all kids with problematic behavior, but denying that it helps many kids isn't a good way to make that case.View Comments | Add Comment
Another ADHD Denier (and Parent-Basher)
Jan. 29, 2012 Caroline Miller
There's a stunningly uninformed piece on the op ed page of the New York Times today that opposes the use of Ritalin and other stimulant medications for children with ADHD. This piece is so bad it hurts me to link to it. The writer, a psychology professor emeritus at the University of Minnesota named L. Allan Sroufe, claims to have analyzed the available data and found that medication doesn't do these kids any good except in the very short run.
It will take some time to work through all that's wrong with his analysis of the research (which, believe me, we will do). But it doesn't take a lot of time to explain what's wrong with his other outrageous claim: that parents cause ADHD.
He argues that the brain differences neurobiologists have identified in kids with ADHD could have environmental causes, including poverty and bad parenting:
Plenty of affluent children are also diagnosed with ADD. Behavior problems in children have many possible sources. Among them are family stresses like domestic violence, lack of social support from friends or relatives, chaotic living situations, including frequent moves, and, especially, patterns of parental intrusiveness that involve stimulation for which the baby is not prepared. For example, a 6-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath. Or a 3-year-old is becoming frustrated in solving a problem, and a parent taunts or ridicules. Such practices excessively stimulate and also compromise the child's developing capacity for self-regulation.
This would be laughably bad if parent-bashing wasn't such a popular activity among people who don't have direct experience with families of children with psychiatric and learning disorders. If there's anything the parents struggling to do the best for kids with real problems don't need it's nonsense like this. This guy probably still thinks autism is caused by cold mothers.View Comments | Add Comment
Cooler Heads: the Association for Science in Autism Treatment
Jan. 27, 2012 Harry Kimball
Science and the diagnosis and treatment of disorders like autism go hand in hand (in hand, I guess). That doesn't mean the relationship between researchers and the autism community isn't often rocky. Breakthrough treatments have been frustratingly slow in coming, as has real understanding about what causes the disorder. This is not to say that people aren't dedicating their lives to answering these questions and helping children and adults with autism—it's just easy to see why parents of kids with real and limiting impairments will look anywhere for help and answers.
And that's why we're glad that the Association for Science in Autism Treatment (ASAT) is around and has a website full of information on every variety of treatment and intervention for autism. It is not judgmental and does not wag a finger. The site simply lays out all the information and suggests that "professionals and families may wish to obtain additional information about this approach" in some cases. In others, a therapy may simply be "not recommended." Every entry is backed up by citations and summaries of the relevant research.
In a corner of the world where the volume can get turned up way too high, and critical messages get lost in the static—take the recent uproar over changing diagnostic criteria—ASAT is a refreshing and focused voice. If you or someone you know has autism, is caring for someone who has autism, or is interested in the science behind proven interventions, the site is an incredible resource.View Comments | Add Comment
One More Thing Brad Pitt and George Clooney Have in Common
Jan. 26, 2012 Caroline Miller
It's not often we stumble onto something on the New York Post's Page 6 that contributes to our understanding of mental health, but never say never. How could we resist this headline: Brad Pitt: 'I was smoking way too much dope'? Turns out that the actor went through a period of being depressed, in the late 1990s, and talked about in an interview in the Hollywood Reporter.
"I got really sick of myself at the end of the 1990s. I was hiding out from the celebrity thing, I was smoking way too much dope, I was sitting on the couch and just turning into a doughnut and I really got irritated with myself," he says. "I got to: 'What's the point? I know better than this.' "
Brad Pitt turning into a doughnut is a little hard to picture, but that's the point: It's immensely valuable to have a guy with just about everything imaginable going for him, not even counting Angelina Jolie as his partner, admit that he was seriously depressed. Depression doesn't respect (or reflect on) your talents and assets; it can strike down the best and the brightest, including the sexiest man alive.
In fact, two of the sexiest men alive: George Clooney also recently acknowledged his own bout with depression, the Post notes."Clooney recently revealed his battle with hopeless feelings after being injured while making Syriana. Clooney told Rolling Stone in November that he considered suicide."
We'd give you a link to that story, for more details, but it's behind a paywall on the Rolling Stone site. At any rate, this is the kind of admission that has the potential to help other people acknowledge their own profoundly negative feelings, especially teenage boys. Seriously depressed adolescent boys who are hiding their pain are the most at risk for suicide, Dr. Alan Apter notes in this video, and what they need most, he says, is role models who make it clear that it isn't unmanly to acknowledge dark feelings.View Comments | Add Comment