The Child Mind BlogBrainstorm
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
Is the Victim the Key to Stopping Bullying?
Nov. 4, 2011 Harry Kimball
The New York Times points us today to an Atlantic article on a novel approach to bullying prevention. "Fix the Victims," the title calls out, and already the comments sections on both sites are abuzz with "blaming the bullied" accusations (and some exhortations to toughen up and fight back). Is this yet another admission that bullying is impossible to stop, that we'd just better accept it as a fact of life and teach our children to weather the storm? Not really.
The Atlantic article is actually about a study of elementary schoolers, their social attitudes, and how constructively they responded to bullying behavior. The kids who weren't particularly interested in pursuing popularity or being "cool" but rather in building relationships were the ones who tried to ease tensions and build rapport. Other children escalated the encounter or avoided acknowledging it. The idea seems to be that talking to kids about social interactions and helping them develop healthy attitudes could help them cope adaptively with the more unseemly side of the classroom and the schoolyard.
But what people bristle at is the idea that kids who are bullied are somehow responsible for the pain it causes them—and though this study is about younger kids, it isn't hard to expand the argument into teens who kill themselves after relentless cyberbullying, say, are at fault for that tragic end.
But there is truth on all sides of this issue. The fact is that suicide, or depression, or withdrawal, or social anxiety, are maladaptive responses to the rigors of adolescence and development. Most kids who are bullied don't react in that way, and we need to help the ones who will to manage their emotions and responses better. This is not blaming the victim—we are just more immediately concerned with the mental health and safety of the bullied.
(This of course does not mean that we should not try to reduce the bullying behavior, which has become more complex, or at least more sensational, with the advent of social media. And we also know that bullies have a lot of the same sort of risks down the line in terms of their wellbeing that the bullied kids have.)
In the Atlantic, Hans Villarica writes that the "study shows that kids who are able to respond with care have better mental health than those who respond to stress thoughtlessly." If we're concerned about the mental health of our children, and we are, we'll take improvement anywhere we can get it, and as early as possible. For, as Villarica points out, "the politics of bullying becomes infinitely more complicated as kids get older."View Comments | Add Comment
Bad Reactions to Medication
Nov. 1, 2011 Caroline Miller
When a kid has an adverse reaction to a psychiatric medication, it can be a nightmare for both the child and the parents. Shannon de Roches Rosa tells such a story about putting her son, who has what she calls "intense autism," on anxiety medication, with disastrous results. Leo lost a great deal of the hard-won progress he'd made over the last few years—getting dressed, riding the school bus, etc.—and his repetitive behaviors took over a great deal of his life.
But the story doesn't have the ending you might expect. Because once Leo's parents weathered the weeks it took to get the Zoloft out of his system, and Leo re-emerged from the devastating akathisia, or restlessness, that can be a side-effect of Zoloft, they didn't give up on anxiety medication. Shannon wiped away her own tears and prepared to go back to the psychiatrist to discuss trying something different.
Parents who haven't found themselves in this sort of situation may think that the tough question is "to medicate or not to medicate." In fact, when a child is desperately unhappy or desperately out of control, and behavioral interventions just aren't enough, they may have to try several different medications, and several different doses of those meds, before they find something that really works. In can be a long process of trial and error, and we see it all the time with children who have ADHD, autism or OCD.View Comments | Add Comment
ADHD Medications Do Not Increase Heart Risks
Nov. 1, 2011 Caroline Miller
Good news from a new study on children taking stimulant medication for ADHD: they are not at a higher risk for heart complications than other children. This despite warnings about heart complications that have accompanied the drugs since a 2006 study raised concerns.
The new study, funded by the FDA, examined medical records of 1.2 million children and young adults and found no increased risk for those who were taking Adderall, Ritalin, and Concerta. In the group overall there were 81 cases of heart attacks, strokes and sudden deaths.
"We believe this provides a lot of reassurance about the safety of these medications," the lead researcher, a professor of pediatrics and preventive medicine at Vanderbilt, tells Bloomberg. "We found no increased risk for current users of ADHD medications."View Comments | Add Comment
Will Sweet Talking Ken Break Hearts?
Oct. 28, 2011 Rachel Ehmke
Hey girl, there's a new Ken doll on the shelves, and you better take a seat because this one is big. He's called the Sweet Talking Ken, and he is being marketed as the ultimate boyfriend because he says everything you want a boyfriend to say. It works like this: you press the heart on his shirt and talk into the microphone hidden in his (chiseled) abs. Then Ken repeats your words in his own voice. The perfect man! No wonder Barbie took him back.
Of course The Huffington Post had to ask, "Why is he the ultimate boyfriend rather than the ultimate friend? Do kids ages 5 to 10 really need a romantic, significant other to pump up their self-esteem?" No, clearly five-year-olds don't need boyfriends, but the bigger question is do they need anyone telling them everything they want to hear? There's been a lot of talk lately about how too much positive reinforcement for the wrong things can be damaging to young children. Sweet Talking Ken immediately reminded me of the recent Motherlode blog from Jenny Anderson that begins, "When I was 8, my mom gave me a self-esteem bear. It told me I was great." While the bear (and Ken) seem innocent enough, they are still part of the world of super-nurturing positive reinforcement that gives children dangerous expectations about life. Praising a child for her hard work is one thing, but complimenting her on her "brilliance" is quite another. Research shows that when kids get over-praised for everything they do, they develop a skewed perception of reality and, worse, won't build the coping skills and resilience needed for adulthood. Anderson summed it up saying, "the real world doesn't praise them for getting dressed in the morning."
It's ironic that we're cautioning parents against a Mattel product that could make your daughter feel too good about herself, but there you are. If parents are going to worry about Barbie's unrealistic body proportions then they should also be concerned about Ken's (and their own) sometimes unrealistic support. And since Straight Talking Ken probably won't be invented anytime soon, the job of nurturing our children responsibly is our own.View Comments | Add Comment
Treatments and Supports for a Successful Life
Oct. 24, 2011 Caroline Miller
Benedict Carey had another terrific piece in the New York Times yesterday in a series on people with mental illness who have successful careers and engaged, active lives.
One thing Carey's subjects seem to have in common is that they have defied the treatment protocols and lifestyle choices expected of people with their diagnoses. That is not to say that they haven't needed, or gotten, treatment and support, but that they've figured out (after being in and out of hospitals) what combination works best for them, and it isn't always by the book. Another thing they have in common is that they are open about their diagnoses.
This time his subject is the CEO of a nonprofit, a woman diagnosed with both schizoaffective disorder and OCD. Keris Myrick's winning formula (it's been working for 5 years) includes medication, a therapist who takes her calls (and texts), a job that allows her to express her creativity, a dog who can tell when she's down, and a routine for dropping out from time to time (checking into a nice hotel, not a hospital) when she needs to. And being open with friends and coworkers. "I'll just say, 'Excuse me, but is anyone hearing what I'm hearing?' " she tells Carey. "And if the answer is no—OK, it's no."
It strikes me that one of the toughest things for children with mental illness is that they often can't ask that kind of question. Sometimes they just don't know that the voices they're hearing aren't real, or the fears they are paralyzed by aren't realistic. Sometimes they do know other kids aren't having the problems they're having with schoolwork or suffering the way they're suffering, but they're too ashamed to talk about it. Helping them out of that isolation is a big part of treatment, which is why these stories of adult successes are so welcome.View Comments | Add Comment
This Is Your Brain on Facebook
Oct. 21, 2011 Rachel Ehmke
What if we told you that your brain has been growing ever since you first logged onto Facebook? A recent study suggests this may be the case, or at least some sensational headlines would have you believe it. Read them with a grain of salt.
What the study actually says is that the number of friends a person has on Facebook predicts grey matter density in areas of the brain associated with social perception and associative memory. The study also shows that the size of online friendship networks correlates with the size of intimate real-world social groups. But when reading these stories, it is important to remember that "correlation does not imply causation," a lesson taught in high school science but generally forgotten when it comes time to write a press release. There is no reason to assume that Facebook is growing our brains any more than, say, the invention of the telephone did (which is to say not at all). And thank goodness for that—as the only 24 year-old I know who isn't on Facebook, I would start worrying that my brain belongs in a carnival sideshow.
What this study does do is make an interesting point about the diversity of our brains in general. Some people really do have much larger aptitude (and appetite) for socializing, and this is apparently reflected in their brains. We immediately thought of Lois Weisberg, the Chicago woman whose extraordinary social network was made famous by Malcolm Gladwell in 1999, when he wrote about the phenomenon of people who somehow seem to know everyone. We'd like to see a picture of her brain.View Comments | Add Comment
Designing for Children With Autism
Oct. 21, 2011 Caroline Miller
The website archdaily.com posted a story this week surveying architects who have designed schools specifically for children with autism (and showing pictures of the results). The big issue is how to best manage lighting for kids who have sensory processing issues, and there's a sharp debate on whether creating a "sensory haven" is doing the children a favor in the long run.
There are those who advocate what the writer somewhat amusingly calls "subduing daylight" and decreasing or eliminating those distracting views of the world outside the window. The point is to make children as comfortable and as able to concentrate as possible, to maximize learning. Others point to study after study showing that sunlight and exterior views boost cognitive abilities, increase productivity, and decrease sick days and attrition rates. Whether these studies apply to kids with autism is an open question, but the story notes that they do apply to staff, and that may not be an insignificant factor in the equation. The writer, Christopher Henry, notes:
Nearly all the educational programs for individuals with autism depend on consistency, repetition, and structure. A daylighting design that makes even the smallest dent against attrition rates could make a noticeable difference, and be far more beneficial than a subdued environment that causes more staff sick days and higher attrition rates.
Shows how complicated tailoring learning and effectively measuring outcomes can be.
Image: Netley School Autistic Resource Base by Dennis GilbertView Comments | Add Comment