The Child Mind BlogBrainstorm
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
Resilience: Making Kids Sesame Street Strong
May 31, 2012 Harry Kimball
The Sesame Workshop just launched a new online "Tool Kit" that aims to help parents foster resilience in young kids no matter what they face, called Little Kids, Big Challenges. The Child Mind Institute was on hand at a Sesame Street gala in New York last night. (That's CMI president Dr. Harold Koplewicz below, with, I believe, Oscar the Grouch.)
This is a great tool for parents of kids who have experienced any sort of disruption, from a move to the loss of a parent. But what really strikes me is how helping children with any challenge, or helping them develop any life skill, is all about communication, about conversation, and about cooperation. The tool kit, which I hope will grow in scope, includes simple activities designed to encourage kids to think about themselves—"How Am I Feeling?"—at the same time that they communicate this information. And it helps them visually understand their support network and the catalog of things they can and have done outside of their comfort zones. (This exercise, called "New Things Tree," is familiar to me from talking to Dr. Jerry Bubrick about treatments for separation anxiety disorder.)
Over on the Sesame Workshop blog, they lay out ambitious goals for the initiative, particularly since it is aimed at 2- to 5-year-olds. "Learning from mistakes; making new friends; resolving conflicts: these are the kinds of early childhood struggles with which Little Children, Big Challenges will help young kids cope." We like to say that kids under 8 are "more B than A;" that is, they respond much better to behavioral approaches than to cognitive ones. And learning from mistakes and resolving conflict are skills that elude many much, much older people. But if we can engage kids early with these tools and boost the resilience required to deal with life's challenges and come out a better person, why not? Best of luck, Sesame Workshop. Now, can you tell me how to get to Sesame Street?View Comments | Add Comment
The Mets' Andres Torres: Living and Succeeding With ADHD
May 25, 2012 Harry Kimball
Yesterday a colleague and I hopped on the 7 train in New York to head out to Citi Field, where the Mets play, and speak for a moment with Andrés Torres, a centerfielder who also happens to have ADHD. A movie is coming out soon, called Gigante, about Torres' life and ascent to the major leagues, which included a battle with poverty as well as with ADHD. In fact, even after he was diagnosed and prescribed medication, he waited years to take it regularly. That's when his life came together.
Amazingly, I thought, he told me that his colleagues in the MLB were all supportive of him as he went about his life with ADHD. "They're OK," he said. "I am who I am, I respect them," and in return "they respect me, they support me, and that's a good thing." And Torres is a sterling role model for kids with ADHD—or really any psychiatric or learning disorder—telling them, in essence, to accept who they are even as they accept the need for ongoing treatment. And to expect to succeed.
Of course, Torres' outlook and the tolerant attitudes of his teammates are not par for the course. While on the 7 train I thought of another ballplayer, the former Atlanta Braves pitcher John Rocker. In 2000 he said this to a reporter, about how he could not possibly play for a New York team:
Imagine having to take the 7 train to the ballpark looking like you're riding through Beirut next to some kid with purple hair, next to some queer with AIDS, right next to some dude who just got out of jail for the fourth time, right next to some 20-year-old mom with four kids. It's depressing...The biggest thing I don't like about New York are the foreigners. You can walk an entire block in Times Square and not hear anybody speaking English.
From the clip below, you can tell that Andrés Torres speaks English, but it's not his first language. However, from meeting him just once, I'm happy to say I'd be just fine sitting next to a role model like him on the 7 train. Here's to a future where people feel more like that, and less like John Rocker.
Check back soon for a feature story on Torres and Gigante.View Comments | Add Comment
Dyslexia-Ville: A New Website for Kids
May 21, 2012 Caroline Miller
Here's a cool project: Peggy Stern, an Academy Award winning filmmaker who calls herself "severely dyslexic," is launching a web site for kids called Dyslexia-Ville. She aims to make the site, which will be very visual, "the launching pad to success for the millions of dyslexics around the world." And she's raising funds the grass-roots way, using Kickstarter, which means that we can all help out.
The site looks exciting and Stern's story is, too. Despite struggling painfully with reading, she graduated from Harvard, and has directed and/or produced a wide range of documentaries, many of them about musicians and artists. In 2006 she won the Academy Award for best animated short for The Moon and the Son: An Imagined Conversation, about a troubled relationship between a father and son.
On Kickstarter she says she wants to help dyslexic children get some of the help and support she was lucky to get. "My grandmother intervened early on, and found an incredible teacher who helped me overcome my frustration, fear, and self-doubt," she writes. "It is from my own experience that I want to assist dyslexic children in achieving their goals."
This came to our attention just days after we heard Brian Grazer, the Oscar-winning producer of many of our favorite films (A Beautiful Mind and many more) and TV shows (Arrested Development and many more) talk about his own struggle with dyslexia.
Grazer, too, talked about his grandmother's role in helping him believe in himself as a child: "I was getting all F's, maybe an occasional D, but I had a grandmother, on the other hand, who was telling me that I was special," he said. "I'd be looking at the report card, and she'd be saying I'm special. And I thought, 'Does she not see this report card?' She just said, 'You're going to find your way through this. Think big, be big,' "
Recognizing how often kids with dyslexia feel discouraged in school, Stern says she wants to make Dyslexia-Ville a safe haven for them. "Dyslexics, especially in a classroom full of non-dyslexics, can feel like lonely travellers entering inhospitable terrain. No more."View Comments | Add Comment
Adam Jeffrey Katz Memorial Lecture
May 17, 2012 Child Mind Institute
Yesterday was the 10th Annual Adam Jeffrey Katz Memorial Lecture at Hunter College's Kaye Playhouse in New York City. The two-part program, designed to raise awareness and educate the public about ADHD and dyslexia, was attended by over 500 people.
Part one featured Dr. Stephen Hinshaw, co-chair of the Scientific Research Council and an expert on attention-deficit hyperactivity disorder. Dr. Hinshaw's talk on ADHD covered everything from causes, public health policy, and the persistent stigma associated with the disorder to treatment possibilities and the effectiveness of stimulant medication.
The lecture was followed by a question and answer session with Dr. Harold Koplewicz, president of the Child Mind Institute, and Academy Award-winning producer Brian Grazer. Mr. Grazer spoke about the challenges of growing up with dyslexia. He attributed his successes to being resourceful and pushing himself harder in other aspects of his life. Ultimately, his message was one of resiliency and the importance of championing the successes of children with learning disorders.
In his conversation with Dr. Koplewicz, Mr. Grazer described how his grandmother's belief in him set up conditions for his success in everything from reading to swimming to moviemaking, sounding much like a child treated at the Child Mind Institute might. "As much as all of the forces of reality, meaning empirical evidence, were showing that I wasn't, she was able to overpower me and make me believe that I was special," he said. "So any time I could have a success that was a unique success, I felt like Superman."
View photos from the event:
Read live-tweets from the event:
The lecture began in 2002 in memory of Adam Katz, who struggled with ADHD and dyslexia. The Katz family created this living memorial to raise awareness about psychiatric and learning disorders. This event is made possible by the generosity of Ellen and Howard Katz.View Comments | Add Comment
Psychopathy and Nine-Year-Olds
May 15, 2012 Rachel Ehmke
The most emailed article on the New York Times website right now is a story published in the magazine this weekend called "Can You Call a 9-Year-Old a Psychopath?" The title is alarming, as are the real stories related in the piece, and you can see why so many people are riveted by it. In an odd coincidence, This American Life also reaired its psychopathy episode this weekend, making the subject unusually popular (if you don't count nights when Dexter is on TV.)
The blunt answer to the question posed by the Times is no, you can't call a nine-year-old psychopathic since the DSM explicitly rejects anyone under 18. This is because psychiatrists and psychologists believe that children's minds are still malleable and continue to be shaped by a combination of biological and environmental factors even until young adulthood. As it is understood now, psychopathy—also called sociopathy but properly known as antisocial personality disorder in the DSM—is a label that can't be applied to a brain that is still developing. And while we all have some sociopathic characteristics, such as a tendency to lie and manipulate, or be impulsive and narcissistic, children can struggle in particular with these traits during their maturation, especially if they also have some other psychiatric disorder. According to a study by Lee Robins mentioned in the Times, almost 50 percent of the kids who scored high on antisocial qualities did not become psychopathic in their adulthood.
That doesn't mean that some kids don't seem to make a good case for it. The Times story centers on Michael, a boy who scored nearly two standard deviation points outside the normal range for callous-unemotional behavior. Michael is manipulative and alarmingly canny for a nine-year-old. He also seems to lack empathy. His behavior is extreme and certainly indicates a problem, but whether that problem is budding psychopathy is still unclear. His parents have received a laundry list of diagnoses for him over the years, although none seemed to fit exactly.
The tangled and complicated nature of psychiatric symptoms often makes getting a good diagnosis difficult. According to Dr. Alan Ravitz, a Child Mind Institute psychiatrist, what often appears to be antisocial and insensitive behavior is actually a manifestation of another psychiatric disorder. Dr. Ravitz says he has treated patients who seem to be sociopathic, but after treating their underlying disorder (depression, paranoia, oppositional defiant disorder, ADHD) the apparent sociopathy is gone. When I spoke to Dr. Ravitz he emphasized the importance of recognizing true antisocial personality disorder and applying the best resources available to treating it, but he noted, "I think we should be slow to diagnose sociopathy because it can sometimes be a stand-in for past failures in treatment. It can distract us from the real psychiatric disorder for which we already have effective treatment."
Of course, the other piece to this story is how badly we need more research on antisocial personality disorder. Some work has already been done, but not enough. This is partially because psychopathy is incredibly rare, but it's also because it often leads to criminality. As a psychologist told the Times, "No one is sympathetic to the mother of a psychopath."
But thoughtful media coverage is the enemy of stigma, and this article has inspired many supportive comments on the Times website. Hopefully the story will help humanize an often inhuman-seeming disorder. So many psychiatric disorders in children have proved responsive to early intervention that we can't stop pushing for some way to help these children and their desperate families.View Comments | Add Comment
The TIME Breastfeeding Cover Brouhaha
May 14, 2012 Caroline Miller
It was quite the Mother's Day cover, a hot-looking young mom posing with a kid in camo pants nonchalantly standing on a chair, attached to his mother's breast. It didn't even need the provocative headline—"Are you mom enough?"—to cause a sensation (and of course be knocked off all over the web, with stand-ins for the mom from John Boehner to Steven Tyler). It's as if TIME magazine wanted to simultaneously offend those who might find the image tasteless and those who might find the parent-baiting offensive. A double whammy.
The story itself revisited the pros and cons of what's called "attachment parenting," the extreme child-rearing philosophy that has been around for 20 years and has gradually worked its way, at least in watered-down form, into the mainstream. The three key tenets, writes TIME's Kate Pickert, "are breast-feeding (sometimes into toddlerhood), co-sleeping (inviting babies into the parental bed or pulling a bassinet alongside it) and 'baby wearing,' in which infants are literally attached to their mothers via slings." The theory is that the more time children spend in physical contact with their mothers in the first few years the more secure and happy they will be later.
As the story notes, this theory has been knocked about a great deal over the years, and there is no evidence whatsoever to back the notion that this literal closeness has any advantages for a child's development over other forms of parental love and attention. It's interesting to visit Dr. William Sears, now 72, who, with his wife Martha, hatched the philosophy, along with seven children of their own.
Seems harmless enough, except for the obsessiveness with which it's being wielded in this era of perfection parenting—no effort is too great to create the ultimate child. If it's possible to be self-sacrificing and narcissistic at the same time, this would be one way to do it.
Above all the story illustrates the downside of competitive parenting, with manifestos like this being used to achieve superiority over other families in which women don't choose, and/or can't afford, to be stay-at-home moms.
As Donna Wick writes on the Freedom Institute's blog, it's important to resist letting passion for your children be manipulated into a judgmental stance about other parents. It's one of the things that makes parenting in the 21st century harder than it needs to be, whether or not you buy into attachment.View Comments | Add Comment
Managing Behavior: Tips for Parents and Teachers
May 11, 2012 Child Mind Institute
Our second facebook event was a presentation by Dr. Melanie Fernandez where she presented tips and strategies for parents and teachers on managing difficult behvaior.
If you missed our live facebook talk, you can view it here:
Or download the slides here.View Comments | Add Comment