The Child Mind BlogBrainstorm
Treating Schizophrenia Early, and as a Family Affair
Aug. 8, 2014 Harry Kimball
Thanks to the American Academy of Child and Adolescent Psychiatry newsletter for pointing us towards a story about a radical intervention for schizophrenia: treating it early, comprehensively, and involving everyone in a young person's life, including family and teachers.
The Washington Post reports on a program developed in Maine that identifies pre-psychotic young people and enrolls them in "an intensive two-year course of socialization, family therapy, job and school assistance, and, in some cases, antipsychotic medication." "Pre-psychotic" means they exhibit certain symptoms, like hearing voices or experiencing disorganized thinking, but have not yet had a severe psychotic break. Research suggests that kids in the program are more likely to have jobs or stay in school, and that the program has even dramatically reduced hospitalizations for psychotic breaks in some areas.
There are still big questions about this sort of early intervention for severe mental illness, particularly in regard to pre-diagnosis medication treatment. "That is not a benign intervention," a NIMH scientist tells the Post, in a considerable understatement. And no one claims that schizophrenia can be cured, or even truly prevented. There are many heartening personal stories in the Post article, but it would be foolish to say that the young people profiled aren't still at risk.
Still, the big picture view of mental illness the program espouses—biology, environment, interpersonal relationships—seems like a welcome evolution. As the Post reports: "A large part of the treatment focuses on the family; the Eugene program even helped one mother get a job."View Comments | Add Comment
Childmind.org Reaches Out to Spanish Speakers
Aug. 5, 2014 Harry Kimball
We're pleased to report that we have launched the "pilot" version of childmind.org/espanol. We've translated more than 30 of our most important articles and guides into Spanish, focusing on resources that parents and educators have found most helpful.
Children's health and happiness is important to everyone, regardless of culture or language. But when it comes to emotional and behavioral health and learning problems, we found a shortage of dependable information in Spanish to help parents and caregivers make good decisions. We looked careful at what's available and identified areas we could offer the most helpful material to the growing Spanish-speaking population in the US.
Our goal is simple: to get evidence-based mental health information into the hands of families no matter the language they speak, and tailored in a way that reaches across any cultural barriers that may exist.
We need your help to get the word out. Please share the news and the link with anyone (individuals or groups!) you think might be able to use it or pass it along: childmind.org/espanol
We plan to continue adding content, but the first phase already contains basic information on common emotional and behavioral problems in kids, including ADHD, learning disorders, behavioral problems, anxiety, depression, and eating disorders.
We welcome any suggestions you might have as we keep developing childmind.org/espanol. We hope you will share the link and join us in helping parents and teachers give kids the support they need to grow into healthy, happy and successful adults.View Comments | Add Comment
Study Claims Video Games Can Help—or Hurt—Kids
Aug. 4, 2014 Caroline Miller
A new study out of Oxford purports to show that kids can benefit from a little video game playing, and be harmed by too much of it.
Researchers combed data on 5,000 10- to 15-year-olds in the UK who had filled out questionnaires that covered their gaming habits and general "psychosocial adjustment." They found that kids who reported playing video games less than an hour a day were happier and better adjusted than kids who didn't play at all, and kids who played more than three hours a day were less well adjusted. The kids in the middle, who racked up one to three hours a day, were indistinguishable from kids who didn't play.
But the author of the study, published in Pediatrics, acknowledged that the difference in behaviors among these groups was quite small. "High levels of video game-playing appear to be only weakly linked to children's behavioural problems in the real world," Dr Andrew Przybylski admitted to the Telegraph. "Likewise, the small, positive effects we observed for low levels of play on electronic games do not support the idea that video games on their own can help children develop in an increasingly digital world."
And if it that wasn't enough to deflate claims of video games being of either great benefit or great harm, he wrote this in the paper in Pediatrics: "Compared with factors shown to have robust and enduring effects on child well-being such as family functioning, social dynamics at school, and material deprivations, the current study suggest the influences of electronic gaming, for good or ill, are not practically significant."
Not surprisingly, that didn't stop it from being picked up by media outlets everywhere.View Comments | Add Comment
Can Kids “Beat” Autism?
Aug. 1, 2014 Beth Arky
At a time when 1 in 68 children are being diagnosed with autism, two studies have emerged stating that a small number of them can be expected to overcome their symptoms and their diagnosis.
In a feature titled "The Kids Who Beat Autism" in this Sunday's New York Times Magazine, a reporter covers the two studies as well as the stories of some of the children who do—and don't—leave their diagnoses behind. The stories of "positive" or "optimal" outcomes are riveting—some kids grow from being completely nonverbal and self-injurious to typical adolescence. But who will improve is difficult to predict.
According to both studies, higher IQ plays a role in these outcomes, and some (though not all) of these kids had comprehensive early interventions including applied behavioral analysis (ABA). That early and painstaking intervention is also the source of some controversy; in the article, advocate Ari Ne'eman criticizes the idea that these therapies can or should be used to alter the autistic brain or autistic behaviors: "Even if such a thing were possible, we don't think it would be ethical."
Others in the autism community were more positive. Judith Ursitti, director of government affairs at Autism Speaks and mom to a 10-year-old autistic boy, says, "It's wonderful to read about individuals who are doing well—some who are still on the spectrum and some who no longer meet the criteria. This is not a pronouncement that every child can or should be recovered. It's a reflection of the different paths individuals on the autism spectrum can and do take."
But some parents have expressed concern. While the researchers remind caregivers that very few kids on the spectrum "recover," some wonder if the story will instill too much hope of a "cure" among mothers and fathers distraught over their child's diagnosis, and that the story casts a negative light on what they see as a neurological difference.
And others resent the idea that kids can "beat" autism. Jessi Cash, who blogs at Deciphering Morgan about being an autistic mom to an autistic 9-year-old, commented on Facebook, "You don't 'recover' from [autism] as if it were the flu. It's a neurological way of being. You can mask the presentation, but it's still there."
Alicia Hart, author of Foods, Moods & Isms and mother to a 12-year-old autistic son, wrote, "The article's takeaway message for a lot of people is that $40,000 a year for 40 hours a week of therapy will possibly move your child out of the diagnosis. Hello debt and goodbye childhood."
And muddy waters could have an impact on school-based services. Anna Perng, mom to two young boys on the spectrum, is worried that school districts will congratulate "confused parents on their kids 'losing' their autism diagnoses" and remove hard-won supports.
Autism can be a tough, lonely road for parents. It's easy to read this story's headline and miss the basic premise of these studies: Autistic kids can and do learn and grow, but at different rates and with different outcomes. One mother quoted in the story, who devised an education plan for her son that involved everything from Leave It to Beaver to robots, thinks he deserves respect, not skepticism. "Mark worked so hard," she says. "To deny everything he did to get this far isn't fair."View Comments | Add Comment
Mindfulness Aids Autism Moms
July 29, 2014 Beth Arky
We know the power of mindfulness. Past research has shown that Mindfulness Based Stress Reduction, a therapeutic meditation that focuses on breathing to pay attention to the here and now, reduces worry about the future and the stress, anxiety and depression that can follow.
It has emerged as a way of treating children and teens with challenges including ADHD, anxiety, autism spectrum disorders, depression and stress. It has also been seen to help parents of children with special needs. So we aren't surprised by the findings of a new study reported in Pediatrics that shows the positive effect of the practice among mothers of autistic children and those with other neurodevelopmental disabilities.
The study, which compared the benefits of mindfulness versus positive psychology, found that while both treatments resulted in significant reductions in stress, depression, and anxiety, and improved sleep and life satisfaction, mothers who practiced mindfulness had greater improvements during treatment.
Most services for such families focus on the child, but improving the mental health of parents is important, too, since researchers say they experience more stress, illness, and psychiatric problems. Getting help for parents is also likely to make them better caregivers, which, in turn, could improve their child's development. We support anything that encourages these caregivers to "put on the oxygen mask first." It stands to reason that calmer, happier moms and dads make for better, more patient parents, which in turn makes for calmer, happier kids, regardless of their greater needs.
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Avonte’s Law Passed
July 25, 2014 Rachel Ehmke
On Thursday, the City Council of New York passed a bill that will require select elementary and special education schools to install alarms on school doors.
The bill is called Avonte's Law after Avonte Oquendo, the autistic teen who slipped out of his school during a transition between lunch and class and was later found drowned. The search for Avonte galvanized New Yorkers, and led many to begin calling for higher security measures at schools.
Roc Conti, Avonte's uncle, tells the New York Daily News that "the bill is a giant step for parents and it will ease their worries and their insecurities about their children." But, he also notes, "this is just one step."
The Department of Education will be investigating schools and deciding which ones should get alarms, despite many advocates, including Conti, calling for them to be installed in all special education and elementary schools.View Comments | Add Comment
Donor Gives $650M for Mental Illness Research
July 22, 2014 Harry Kimball
Psychiatric research got a big boost yesterday with the announcement of a $650 million gift to the Broad Institute, the interdisciplinary research group at Harvard and MIT that simultaneously announced exciting new genetic research into schizophrenia. The money comes from Ted Stanley, a longtime supporter of treatment research who has intimate knowledge of mental illness—his son has bipolar, which went untreated for 2 years after diagnosis until a crisis landed him in police custody.
Happily, that encounter ended with mood stabilizer treatment that took Jonathan Stanley from what he calls "psychotic to normal." But the elder Stanley knows that we still haven't developed therapies that work for everyone struggling with mental illness. He aims to change that. "I would like to purchase that happy ending for other people," he tells the New York Times. We're happy that he has the means to try.View Comments | Add Comment
Spanking May Be Legal but It's Not Effective
July 22, 2014 Rachel Ehmke
A court in New York is saying that it's legal to spank children, but that doesn't mean that you should.
It was up for debate after the father of an 8-year-old boy was declared by a family court judge to have abused his son by spanking him (and possibly also using a belt on him). The dad denied using a belt, and an appeals court found that his spanking was "a reasonable use of force."
Legal decisions aside, parents should know that there are more effective ways to discipline kids, so focusing on how much violence constitutes abuse misses the mark.
Research shows that giving kids attention-even negative attention-for misbehaving can backfire. For one thing kids want to get attention from their parents, so it can actually be reinforcing when they get a rise out of mom and dad. Also parents often don't give consequences for bad behavior consistently enough, or they delay the punishment, making it less effective.
Instead, experts who work with kids who have disruptive behavior recommend ignoring minor misbehavior and using consistent timeouts when consequences are needed. And, just as important, experts stress trying to prevent misbehavior before it happens and rewarding good behavior when you see it. For more on this read our ABCs for parents trying to manage problem behavior.View Comments | Add Comment
Jack Antonoff's New Anthem: I Wanna Get Better
July 17, 2014 Jessica Kashiwabara
Jack Antonoff is best known as the guitarist of fun., the band responsible for the hit song "We Are Young," and some might know him as Lena Dunham's boyfriend. But this week he stepped out on his own with the release of a debut album under the name Bleachers. The lead single, "I Wanna Get Better," is not only catchy, but also serves as an autobiographical account of Antonoff's darkest moments and how he's struggled with anxiety.
In an interview with Time magazine, Antonoff discussed the painful experiences surrounding his youth: he was bullied in school, his younger sister died of brain cancer, and a cousin was killed while serving in Iraq. He developed a severe panic attack disorder and hypochondria, and in 2006, anxiety so severe he rarely left his home. For a long time, he suppressed his grief, but eventually found the therapy and medication that works for him.
Through his songs, he explores those feelings of loss and now with Bleachers (the name is a nod to high school), Antonoff keys in on his lost teenage years. As he says, "I feel like I had a childhood that I'm constantly mourning."
Sharing those feelings, Antonoff has struck a chord with fans and gained more than just success. In fact, he says his biggest reward has been the connection his fans have to his music and to him. The musician frequently hears from fans about their own struggles with anxiety and depression. To Antonoff, this is much more profound than being a teen idol. As he puts it, "Who would want to be the kind of artist that's worshipped by fans when you can be the kind of artist that's comforted by fans?"
With "I Wanna Get Better," Antonoff gives back to his fans a hopeful message and a mantra to keep with them through the hard times.View Comments | Add Comment
Jail's Mentally Ill Are Targets of Violence by Guards
July 14, 2014 Caroline Miller
Rikers Island is a New York City jail and a New York City problem, but anyone who worries about the mentally ill will find this story in the New York Times stunning. The piece is the result of an investigation into violence perpetrated against inmates with mental illness by correction officers.
For starters, the brutality is shocking, often including beatings inflicted on handcuffed inmates, resulting in a litany of broken noses, jaws, and eye-sockets, along with internal injuries. The incidents that prompt violence include insults to guards, minor provocations, and predictable outbursts of anger—especially predictable in inmates with schizophrenia, bipolar disorder or depression who have been kept in solitary confinement. In five cases last year, inmates were beaten after making suicide attempts.
The numbers are shocking: Last year, 129 inmates suffered what the Times classified as "serious injuries" —ones beyond the capacity of doctors at the jail's clinics to treat—at the hands of corrections officers. And 77 percent of the seriously injured inmates had a mental health diagnosis.
Their numbers, unfortunately, are only rising. Inmates diagnosed with mental illness make up nearly 40 percent of the Rikers population; that's up from 20 percent 8 years ago, the Times reports.
Even in a cell block apparently reserved for inmates with mental illness, the officers seem to have deep skepticism that mental illness is real. "About half are faking it," one officer tells a Times reporter.
To be fair, guards are enormously frustrated, too, and inmates with mental illness are responsible for what the Times calls "an overwhelming majority of assaults on jail staff members." The story details some of the reasons why corrections facilities don't have the right tools to manage inmates with mental illness who lash out. But guards are rarely punished for what appears to be a clear pattern of retaliation.
And finally, it's shocking how little transparency there is in correctional facilities. It took four months of reporting, obtaining a secret internal study, and many interviews with current and former inmates and staff members to put together this report. One of them was Daniel Selling, the director of the jail's mental health services until 2 months ago. As he sums up for the Times, "There's lots of brutality. Horrible brutality."
Does it need to be said again how important it is to get treatment to people with mental illness as early as possible, before the trajectory of their lives leads to incarceration? Rikers right now may be an unusually bad place to be mentally ill, but a correctional facility is rarely a place to get the kind of help and support that can turn lives around.View Comments | Add Comment