The Child Mind BlogBrainstorm

  • Conflating ADHD and Creativity (and Beating Up on Parents—Again)
    Feb. 21, 2012 Caroline Miller

    This weekend the New York Times published another op ed piece in what's become a de facto series of attacks on psychiatry—the fourth so far this year trivializing the impairment that can come with a disorder and the usefulness (in some cases) of medication. 

    The last two were about how kids with Asperger's are just "clumsy, lonely teenagers" who don't benefit from either a diagnosis or intervention. This one, "The Art of Distraction," is about how kids with ADHD shouldn't get medication, because distraction enhances creativity.

    One commenter, Dr. Leon Zacharowicz, nailed our feeling about this piece pretty succinctly: 

    Will the next series of articles be about asthma and how having shortness of breath every now and then is a good thing, kind of like falling in love?

    The piece is by Hanif Kureishi, a celebrated novelist, playwright and screenwriter, who uses his own success as a writer to argue that there's nothing wrong with being distracted and failing in school—It worked for him!—and that parents who give children medication for ADHD are strong-arming them into a narrow notion of achievement. He thinks they're driven by a fear of creativity, akin to a fear of sex. Seriously:

    Ritalin and other forms of enforcement and psychological policing are the contemporary equivalent of the old practice of tying up children's hands in bed, so they won't touch their genitals. The parent stupefies the child for the parent's good. There is more to this than keeping out the interesting: there is the fantasy and terror that someone here will become pleasure's victim, disappearing into a spiral of enjoyment from which he or she will not return

    This is one of the most weirdly insulting attacks on parents I've seen and, as Judith Warner wrote about another piece in the Times series, "was like a ride backwards in a time capsule." Kureishi frames psychotropic medication (and neurobiology itself) as a kind of Orwellian conspiracy. He sees the freedom to fail in school as a civil rights issue.

    The analogy to sexual repression might make more sense if you know that Kureishi got his start as a writer in pornography. And I'm tempted to argue that his hostility towards parents reflects his antagonistic relationship with his own. He writes movingly of his miserable childhood, of humiliations at his father's hand, of feeling "badly beaten" in school, of envying the competence of others, of his depressed teenage years.

    He also describes the gradual process by which he learned how to manage his own distraction effectively:

    In the end, a person requires a method. He must be able to distinguish between creative and destructive distractions by the sort of taste they leave, whether they feel depleting or fulfilling. And this can work only if he is, as much as possible, in good communication with himself—if he is, as it were, on his own side, caring for himself imaginatively, an artist of his own life.

    That's a great description of how many people with ADHD eventually learn to manage their impulsiveness and distraction (often with an assist from medication, I might add), and we're delighted that it worked for Kureishi. Indeed many people with ADHD describe their creative passions as their salvation. Acting, writing, music, dance, visual arts, and sports have become the focal point for countless people who have struggled to focus more broadly in their lives. Who wouldn't applaud them, and hope that every child will find that transforming passion?

    What we don't applaud is the romanticizing of unhappy childhoods: Just because some children with ADHD or other disorders become brilliant writers or actors doesn't justify watching children struggle and not trying to help them. It doesn't justify making the bogus leap that taking medication will prevent them from finding that passion. And especially it doesn't justify attacking compassionate parents as prudes who are afraid their children might have too much fun being distracted.

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  • Are Middle Schoolers Too Young for Facebook?
    Feb. 16, 2012 Caroline Miller

    It seems there are some 7.5 million children under 13 now on Facebook. Never mind that it's technically illegal—you're supposed to be 13 to sign up, but how hard is it to fudge your age? This explosion of middle school social media is the subject of a terrific piece for parents on redbookmag.com about the implications of Facebook for young adolescents.

    What's most compelling in this piece isn't the potential threat of sexual predators (real), or even the potential threat of 12-year-old mean girls (more real). "Girls lob words the way they slingshot Angry Birds," writes Susan Dominus, "but what comes crashing down is another girl's confidence."

    The more insidious problem she spells out is that even ordinary, seemingly non-toxic stuff on Facebook can put a lot of stress on the fragile ego of an average 12-year-old. The competition for "friends" and "likes" and cool pictures and status-building status-updates can amplify insecurities.

    "Just at the age when they are starting to figure out what a best friend means, and feeling desperately afraid of losing that friend, they are being exposed to lots of anxiety triggers," one educator tells Dominus. "Girls 'marry' and break up with each other over the course of a day, all in hopes of illustrating their popularity," says another. There are risks for boys, too, but Dominus cites evidence that "within middle school kids under 12, girls manipulate each other on Facebook much worse than boys."

    Still many parents feel sitting out Facebook isn't a viable option for their middle schoolers—that it would leave them socially and culturally isolated. Read the story for suggestions on how to guide tweens and young teens who are taking the plunge. The short version: Do insist on friending your child, so you can keep track of her activity. But don't post on her wall if you want to stay on speaking terms.

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  • Phoning In a Cure for Depression
    Feb. 13, 2012 Harry Kimball

    Yup, there's an app for that, or will be soon. At Northwestern University, psychologists are developing a phone smart enough to detect signs of an oncoming depressive episode and steer the user towards social behavior and enjoyable activities. Called Mobilyze!, the device will track everything from physical activity and location to the frequency of social communication via telephone or email. If the phone thinks your mood is depressed, it will suggest you take a walk or keep a date with friends.

    "It creates a positive feedback loop," inventor David Mohr tells LiveScience. "Someone is encouraged to see friends, then enjoys himself and wants to do it again." This prevents the opposite from happening. "Ruminating alone at home has the opposite effect and causes a downward spiral." 

    The admirable aspect of this approach is that it stresses early intervention, and envisions a world where clinical insight is more integrated into the lives and attitudes of patients. "If we can develop interventions that fit more smoothly into the fabric of life," Mohr says, more people will take advantage of them. Instead of waiting for depression to become clinically significant, he says, "we're developing systems that identify when people are at risk for feeling worse or when engaged in activities that are likely to help them, and contact them then instead."

    The flipside of this is that depression is a real illness that deserves the careful attention of a trained clinician, someone who is skilled at diagnosis and the treatment that can be so effective. That can't fit in a phone, no matter how smart it is, and some wonder if Mobilyze! might actually dissuade people from getting the help they need. 

    At Mashable, many comments were dismissive. "It cannot tell you if you are depressed or anything else about you," a psychologist writes, "and apps wont be able to treat mood disorders and psychological issues." Another reader raised the spectre of the false hope a device could provide. "Someone who relies on a bit of tech instead of visiting their doctor for professional treatment could be making a 'big' mistake."

    Still, the future of this concept is unclear. A small study found that Mobilyze! reduced symptoms in patients who already had diagnoses of depression, by helping them notice maladaptive behaviors. Whether or not it takes off, the inventors' hearts are in the right place, as echoed by another comment at Mashable. "If one person was helped because of this app, wouldn't it be a good idea?"

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  • The Secret Online World of Eating Disorders
    Feb. 10, 2012 Rachel Ehmke

    Anorexia and bulimia are generally considered lonely disorders. The girls (and boys) who struggle with them do so in secret, taking great pains to camouflage the destructive behaviors that everyone else considers unhealthy and alarming but to them feels essential. Attaining a low (and then lower and lower) body weight becomes an obsession, and an alienating one because when people don't understand the obsession it can feel like they don't understand the person—you. 

    But according to a new story from The Huffington Post, having an eating disorder isn't as lonely as it used to be. For some time now online communities have been popping up for people who want to talk about their eating disorder—or "extremely low-calorie lifestyle," as one girl puts it—and get support and encouragement from like-minded peers. The girls read each other's blogs and feel like they know each other because they share everything: their weight loss goals, tips for suppressing hunger, food diaries recording everything they've eaten that day and how many calories they burned at the gym. (New phone apps make calorie-counting, and sharing, easy.) They even Skype each other through rough patches when the desire to binge eat gets too strong. The blogging platform Tumblr has particularly taken off as a source for "thinspiration," or "thinspo," with lots of glam fashion photography and inspirational quotes.

    In keeping with the secretive nature of eating disorders, people keep "thinspo" lives private. "It's like we're all part of this secret community that most of our family and friends don't have the slightest clue about," a girl named Natalie tells Huffington Post reporter Carolyn Gregoire. Natalie wants her friends to think she has recovered from her past bulimia, so she hides the evidence, even from her other social networking outlets. "My Twitter and Facebook are personal," she explains. But "thinspo" is different.

    Treating eating disorders involves changing a person's very lifestyle and sense of self. We know that the most successful treatment starts at home, and involves the participation of everyone important in a child's life. But when all of your best friends are also anorexic, it makes recovery doubly difficult. Thankfully Tumblr and other major social networking sites say they are meeting with experts to try and end these secret communities that are making recovery so difficult—and relapse so easy.

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  • 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. Ryan GoslingEven 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.

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  • 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."    

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  • 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.

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  • 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."

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  • 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.

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