The Child Mind BlogBrainstorm

  • Troubling Suspension Trend in Texas Schools
    July 19, 2011 Caroline Miller

    A whopping 55 percent of Texas students are suspended in the course of their six years of secondary education, a new study of school disciplinary patterns shows.

    The most disturbing thing about this report isn't the level of disruptive behavior it suggests—we know that disruptive behavior is one of the biggest obstacles to learning in some of our schools—but the fact that suspension is a very poor tool for improving that behavior. While it may get a disruptive child out of the classroom for a couple of days—an average of two, notes the Texas Tribune—and give the teacher and other students a reprieve, it appears to act less as an incentive to students to perform better than a disincentive to stay in school.

    Many of the children who are acting out in our classrooms have unaddressed psychiatric and learning disorders that lead them to find school very frustrating-frustration they aren't likely to overcome without treatment.

    But many more have behavior issues that could respond very well to less individualized behavioral interventions. Indeed, this is a perfect argument for programs like Teacher-Child Interaction Training, which gives teachers much more powerful tools for reining in, and, indeed, helping children themselves to rein in undesirable behavior.  At the Child Mind Institute we see kids who have been transformed by this kind of therapy-they weren't bad kids, in fact they were bright and talented kids, but they were out of control. There are millions more like them around the country.

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  • Vets With PTSD Have a Friend in Court
    July 18, 2011 Harry Kimball

    The New York Times has a hopeful story about mental health care and the military that still manages to harrow and illustrate the real problems facing our society as a whole when it comes to mental illness. Staff Sgt. Brad Eifert returned from combat tours in Iraq to a life in the US that seemed foreign and aggravating. He had nightmares and panic attacks which he tried to drown in alcohol even as he sought help from the VA that was not particularly forthcoming. "It's normal," he says he was told by a psychiatrist. "You'll get over it."

    That didn't happen. Instead, he was arrested after a standoff with police where he fired shots. As Erica Goode notes in the Times piece, "such stories often end in death or prison, the veteran in either case lost to the abyss." But through the almost-magical alignment of many factors—compassionate police, cooperative prosecutors, a forward-looking judge and an amenable military bureaucracy—and a new push to keep veterans with mental health issues out of jail, he is neither dead nor incarcerated. Instead, he is completing a rigorous course of therapy. "We're a long way from this being over," Eifert's mentor tells Goode. But "I'll put my money on Brad getting through this O.K."

    The takeaway here is that in at least one community in America, people are realizing that prison is not a good therapeutic model, and that if the symptoms of some mental illnesses like depression or PTSD are recognized for what they are, we can help people. "You increase public safety, you don't have a person reoffending," says the judge who created the first "veteran's court." "And hopefully, that person can become functioning and not suffer the invisible wounds of war." Hopefully, too, we can take this model into the general population, and make a serendipitous fluke a daily reality.

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  • Leiby Kletzky and Painful Choices for Parents
    July 14, 2011 Caroline Miller

    The abduction and murder of 8-year-old Leiby Kletzky in Brooklyn is something you don't have to be a parent to feel terrible about. But for every parent who's agonized—as Leiby's parents reportedly did—about when to honor a child's push for independence, the fact that he was abducted on the first day he was allowed to walk part of the way home from day camp by himself is a particularly painful detail. Leiby's parents felt that the very close-knit community of his mostly Orthodox Jewish neighborhood, Borough Park, made the walk safe—or to be more accurate about the way we think as parents, safe enough. No doubt some will criticize that decision. But every parent makes those kind of calculations a million times when deciding whether to let a child do something—especially something new—whether it's a child who wants to cross the street to go to a friend's house by herself or a newly licensed driver who wants to pick up a friend at the airport. There's simply no way to take the risk out of growing up, and that's what makes these decisions so difficult. You use the best judgment you can summon, and hope for the best.

    Some news reports today have described Leiby as a child who has autism. We don't know if those are accurate, but if so there's another source of pain for parents of children with autism, for whom the issue of independence is even more fraught than it is for typical children. Children on the autism spectrum are a good deal less predictable than other young children and notorious for getting lost or distracted, making a parent's job immensely more challenging. The confessed killer's report that Leiby asked for a ride, got into the car voluntarily, then seemed unclear about where he wanted to go, is simply heartbreaking, whether he was on the spectrum or not.

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  • Beyond Asthma: Secondhand Smoke Linked to ADHD, Dyslexia
    July 11, 2011 Harry Kimball

    Everyone knows that secondhand smoke is bad for everyone, in particular kids, who can go on to develop serious physical ailments because of exposure to nicotine and tobacco products. But a new study suggests that the brains of young people are also vulnerable to the assaults of secondhand smoke, and that a smoky home can have lasting neurodevelopmental effects.

    No SmokingThe researchers, who published their results in Pediatrics, write that "more than twofold-increased rates were observed in parent-reported childhood neurobehavioral disorders" in kids exposed to secondhand smoke at home compared with kids who hadn't been exposed. The disorders with elevated risk include ADHD, disruptive behavior disorders, and learning disorders. They also found, according to a report in the Los Angeles Times, that secondhand smoke exposure was linked to a 50% greater probability that children would develop two or more of these illnesses.

    The researchers caution that they have not identified a concrete causal relationship between secondhand smoke and childhood mental illness. And they don't yet know exactly how they could be connected. But this study, coupled with research into the link between tobacco/nicotine exposure and physical illness, addiction, and anxiety, should give parents another reason to pause before lighting up at home.

    Photo Credit:  Flickr user Mykl Roventine

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  • Autism Linked to Antidepressants, Environment
    July 6, 2011 Harry Kimball

    Two studies out this week have revived the concern that the environment around us—and even the medications we put in our own bodies—could be to blame for the development of autism spectrum disorders.

    One, described at CNN, looked at medical records and concluded that pregnant women with prescriptions for selective serotonin reuptake inhibitors (SSRIs) for depression were twice as likely to give birth to a child with autism. Indeed, some have said that because the current uptick in autism diagnosis mirrors somewhat the popularity of SSRIs over the past 20 years, the medication is to blame. Other research has suggested that serotonin might play a role in autism. (To be clear, the researchers do not know whether the women were actually taking the antidepressants.)

    The second study, of identical and fraternal twins, concludes that contrary to popular belief the onset of autism depends more on environmental factors than on genetic ones. These would of course include prenatal exposure to medication, the New York Times reports.

    But just a few weeks ago the scientific community was abuzz with new research pointing towards the clear genetic basis, and even heritability, of the disorder. So, while some scientists hedge on the fresh studies, saying not to worry about SSRIs (including the authors, to a certain extent), and others see in the drugs a clear culprit in the "autism epidemic," the real takeaway should be increased vigor in research and a reminder not to forget about the children who have autism now.

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  • Wash. Inches Closer to Covering Autism Therapy
    July 6, 2011 Harry Kimball

    Two recent rulings by Washington state agencies and courts hold promise for parents seeking applied behavioral analysis (ABA) therapy for children with autism. One, by a state health care committee with power over reimbursement policy for state employees and Medicare recipients, has approved two of 6 forms of ABA outright provided that families who receive care enroll in studies. This of course points to the reason that coverage is often denied, the Seattle Times reports: though ABA's efficacy is supported anecdotally and experimentally, the individual character of the therapy means general evidence is not as robust as it could be.

    Applied Behavior Analysis
    Applied Behavior Analysis

    The other decision, by a Superior Court judge, could be even farther reaching. The ruling states that by refusing to cover ABA at all, the state's health care apparatus is violating the Mental Health Parity Act, which mandates that mental health treatments be considered no different than those for physical illness. With so few proven therapies, and the very costly burden of the ones that have shown promise, it is nice to see state officials thinking about the heroic parents and children in families struggling with autism spectrum disorders.

    Dr. Bryan King, head of the Autism Center at Seattle Children's Hospital, testified in support of coverage before the committee. Watch video of him here discussing other interventions that can help children with autism.

    Photo Credit: Ministère du Travail, de l'Emploi et de la Santé on Flickr

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  • White House to Acknowledge Military Suicides
    July 6, 2011 Caroline Miller

    We're glad to see that the White House has decided to reverse a disturbing and damaging policy, dating back several administrations, to deny a presidential condolence letter to the next-of-kin of servicemen and women who commit suicide while deployed in combat.

    It isn't just that the hard-line policy against acknowledging those deaths was hurtful to military families who have already sacrificed and suffered for their country. It also amounted to an official denial that combat can have devastating mental health consequences—not only these tragic deaths but post-traumatic stress disorder, which can destroy lives, and families, long after the tour of duty in Iraq or Afghanistan is over.  

    Refusing to acknowledge those deaths reinforced the stigma attached to mental illness—the same stigma that keeps soldiers from seeking help for emotional distress and, in the most extreme cases, impels them to choose suicide instead. The irony is appalling.

    CNN notes that suicides in the Army and Marines, the branches of the armed services most involved in combat in Iraq and Afghanistan, have been rising steadily since 2004, and have now surpassed the national average. And a new study of military children reported by Reuters shows that mental health problems of kids 5 to 17 increase with the duration of their parent's deployment.

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  • Turning Around Job Prospects of Adults With ASD
    July 1, 2011 Harry Kimball

    People with Asperger's syndrome and other so-called "high functioning" types of autism are often skipped over when the discussion turns to helping those on the spectrum as they grow into adulthood. Because they tend to have excellent language skills and sometimes above-average intelligence, it's assumed they'll be fine, if a little awkward.

    But in reality the social deficits of Asperger's and other forms of autism can make day-to-day activities, like holding down a job, quite difficult. That's why a Danish father, upon learning that his young son had autism, decided to start a training and job-placement organization for people on the spectrum. "We had to come up with a new plan for our family's future," Thorkil Sonne tells the New York Times. And so Specialisterne was born, and has since placed over 30 workers on the spectrum at high-tech firms that value their focus, attention to detail, and comfort with repetitive tasks.

    In addition to providing employment, the project is also changing attitudes. "I now see you have to look for special things in people," says one manager. "It's easier to accept people's differences if you can see them more fully." Sonne plans to expand soon to other countries, including the US.

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  • Alarming Poll on False Child Abuse Accusations
    June 29, 2011 Rachel Ehmke

    During a live chat this afternoon about the ProPublica report on parents and caregivers wrongly accused of abusing or killing a young child, a shocking 58% of people who responded to a poll said they know someone who has been wrongly accused. The story focuses on poor forensic reports that attribute things like bruises and bleeding to violence and sexual abuse when they are later found to be the results of illness. 100% of responders agreed that death investigators should be required to obtain board certification. While the responders make a group that is too self-selective for a scientific poll, their testimony is alarming nonetheless.

    For more on the ProPublica report, read our previous blog post Babies' Deaths and Wrongly Accused Caregivers.

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  • Babies' Deaths and Wrongly Accused Caregivers
    June 29, 2011 Caroline Miller

    The death of babies at the hands of parents and caregivers is the subject of a searing investigative report from the non-profit news site Pro Publica, which found nearly two dozen cases in which people were accused of killing children on the basis of flawed forensic evidence and later cleared. Some spent years in prison before they were exonerated; all had their lives, and livelihoods, damaged irrevocably.

    The story, and a PBS documentary you can watch here, explores several heart-breaking cases of adults accused of abuse, assault and shaken-baby deaths, highlighting why miscarriages of justice are more likely to occur than in other deaths.

    One caregiver was sentenced to life in prison for a shaken baby death; the baby was later found to have died from sickle cell anemia, and bruises under his scalp were caused by emergency-room staff trying to insert a probe. Another was convicted  in the death of a 6-month-old named Isis, on evidence of bruises and bleeding that overlooked lab tests linked to a blood condition. 

    Why the flawed forensic work? Morgues are often staffed with doctors who aren't board-certified in forensic pathology, and they're rarely trained in pediatrics, so they misread evidence that means something different in very young children. And they often get "caught up in the anger, the emotion, the despair," one pathologist tells Pro Publica, so a child's death is treated as a "homicide until proven otherwise." Since forensics—and who was with the child in the hours leading up to the death—are often the only evidence used as the basis of a conviction, the potential for mistakes is frightening.

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