The Child Mind BlogBrainstorm
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.View Comments | Add Comment
Talking Teens Out of Pot Abuse
June 28, 2011 Harry Kimball
Though marijuana is an illicit drug, we understand that there are worse things than occasional experimentation. But "experimentation" isn't the only thing that the staggering number of kids with access to pot are doing, and some young people can develop a very unhealthy habit—one that seriously interferes with their intellectual and social development. How do we get kids off what they weren't "supposed" to be able to get hooked on in the first place?
One promising answer comes out of a recent study that gave high school volunteers who smoked marijuana regularly just two doses of structured education or a therapy for addiction called motivational interviewing. This approach begins by "meeting the teens where they are," in the words of one therapist we know. After just an hour or two of talking over two weeks, the study shows, use was down 20% three months later, and 15% a year later.
"Lots of people who use it do so without problems," a study author tells Science Daily. "But there are others who use it regularly—almost daily—and want to stop but aren't sure how." Lucky for them there is a way out, and it starts with an adult taking interest—non-judgmentally.View Comments | Add Comment
No Girls or Boys at ‘Genderless’ Swedish School
June 27, 2011 Harry Kimball
The battle against restrictive gender roles has moved to the schoolhouse, particularly the Egalia—"equality"—preschool in Stockholm. Teachers don't say "him" or "her"—"han" or "hon" in Swedish—when speaking with the students, aged one to six. They use the genderless "hen," which is actually not part of the language, but hey.
The school gives students "a fantastic opportunity to be whoever they want to be," one teacher tells Jenny Soffel, writing on the Huffington Post. This includes juxtaposing classically "male" or "female" toys. "Lego bricks and other building blocks are intentionally placed" near a toy kitchen, Soffel writes, "to make sure the children draw no mental barriers between cooking and construction."
Again, like with "genderless" Canadian baby Storm, we are faced with a noble, egalitarian urge that nevertheless seems a bit wrong-headed. Kids should be able to play with what they want to, and neither cooking nor construction is "better" than the other. But they certainly are different, much like girls and boys tend to be different. Instead of teaching three-year-olds that gender and sexual identities are somehow harmful or limiting, perhaps we should make an effort to accept them as they are.View Comments | Add Comment
A Therapist Channels Her Own Suffering
June 23, 2011 Caroline Miller
It's always moving and impressive when a prominent person—writer, actor, politician, doctor—shares his or her personal struggle with mental illness. It shows confidence and generosity, and it belies the false stereotype that psychiatric disorders don't strike people who are talented and accomplished. Today's New York Times story about Dr. Marsha Linehan, a pioneering behavioral therapist, is remarkable, and important, for several reasons.
Dr. Linehan was a teenager when she experienced severe and inexplicable emotional distress, attacking herself brutally by cutting and burning her body—if weapons were denied her she'd bang her head against the wall. "I was in hell," she said. "And I made a vow: when I get out, I'm going to come back and get others out of here." And she did.
Using the insight gained from her own suffering, she developed what's called dialectical behavioral therapy, or DBT. The first step out of hell for her was accepting who she was, despite the despair-inducing gulf between that reality and the person she wanted to be. She calls this "radical acceptance," and it's the basis for DBT's techniques for enabling patients to channel or change the emotions that are driving suicidal urges.
DBT has proven to be a powerful tool, but in a larger sense the most powerful tool is acceptance by a broader public of the reality of psychiatric illness. That's what enables people who are struggling to get help, and that's why what Dr. Lineman is doing now—one colleague at the Child Mind Institute called it "coming out"—is so important.View Comments | Add Comment
The 9/11 Fund Ignores Mental Illness
June 22, 2011 Rachel Ehmke
It seems that the 9/11 Victims' Compensation Fund, while still trying to iron out who will be covered, has concluded that one population of New Yorkers won't: the ones with mental illness.
In announcing this remarkable exclusion, the fund's "special master" noted that it was intended to help those who were unable to work after 9/11. Apparently she thinks having a psychiatric disorder doesn't interfere with work. Can't help wondering what she thinks disorder means.
People claiming mental illness will be eligible for aid under a separate (and much less funded) section of the legislation that established the fund. But the message, that mental health isn't as important as physical health (and that a disorder such as PTSD somehow doesn't harm a person's professional and financial life) is disappointing, to say the least.
Commuters who took the New York subway today might have noticed the Metro newspaper's coverage of this issue—they made the decision their lead story. Kudos to the Metro for drawing attention to an issue that too many are still trying to ignore.View Comments | Add Comment
When Medication Mistakes End in Tragedy
June 21, 2011 Harry Kimball
The death of a 12-year-old New York boy in 2009 is back in the news after his family recently filed a lawsuit against his psychiatrist and the pharmacy that dispensed the medication that appears to have killed him. Phillipe Gallete had a prescription for bupropion (Wellbutrin is a common brand name) to treat depression, and while the details are unclear his family alleges that mistakes by both his doctor and Wallgreen's led to a dangerously high dose that ultimately killed him.
The New York Post has it that Dr. Marie St. Clair accidently wrote 2 prescriptions for bupropion, that the pharmacy filled the scrips without noticing the repetition, and that Gallete's mother says she simply followed the dosing instructions on the bottles. Over at the New York Daily News, the interpretation of the lawsuit is a little different; there is no mention of 2 prescriptions, only that the dose was apparently "seven times greater than what should have been ordered" and that Gallete was on the deadly dose for six days until he went into seizures and died.
Without all the information it's hard to parse this story; but the fact is that bupropion does carry a risk of seizure, though the drug is rarely life-threatening. Most accounts of overdose-some at 5, 10, even 50 times the clinical dosage range-are harrowing but ultimately not fatal. So what can we learn from this? Psychiatric medications, like any medication, carry the risk of side effects. Some of these we call "nuisance side effects," while others are more serious. When a medication is prescribed to a child, the first thing a doctor and the parents have to decide is whether the potential benefits of the drug outweigh the risks. And then the course of medication needs to be closely monitored-something that's especially critical in children, who are growing and changing.
The fact is that disastrous mistakes are often the result of small slip-ups by a series of people, any of whom could have prevented the outcome. In this case, the parents are busy blaming the doctor and the pharmacy; commenters online are busy blaming all three. All we can say is that more engagement and better information from any or all of those parties could have led to a boy receiving treatment for an illness instead of accidentally ending his life.
Exercise That's Not Organized Sports
June 20, 2011 Caroline Miller
Gwen Dewar, a biological anthropologist, has some interesting things to say about kids and exercise on babycenter.com. When we talk about how to get them moving more often, she notes, it's usually about geting them into sports or fitness programs. But historically kids weren't getting more exercise because they were playing soccer; they were getting more exercise because they walked or rode their bikes to school, to friends' houses, to do errands for parents. They did labor around the house and yard and (if they lived on one) farm. And they played outside.
Evidence suggests that the fittest children in North America, she notes, are the Amish and Mennonites. They're leaner and stronger. It's not because they live in the country—kids in some rural communities get even less exercise than urban kids do. "Amish and Mennonite kids are more active because they walk everywhere," she writes. "They chop wood and fetch water."
So not too many American kids are going to be chopping wood or fetching water any time soon, but the takeaway applies to families everywhere: "Physical activity isn’t a class or a game. It’s an integral part of daily life." For more from Gwen Dewar go to parentingscience.com.View Comments | Add Comment
10-Year-Olds Vomiting to Lose Weight
June 20, 2011 Caroline Miller
A new study of 16,000 children in Taiwan finds that it's become alarmingly common for kids to make themselves vomit to lose weight as early as 10 years of age. The behavior is said to be more frequent in boys (16 percent) than girls (10 percent), and it appears to be more prevalent in 10- to 12-year-olds (16 percent) than older kids (13 percent of 13- to 15-year-olds and 8 percent in 16- to 18-year-olds).
The report that's being cited all over is too vague to inspire much credibility, but it stimulates our anxiety that children who are growing up on little-to-no exercise and way-too-much unhealthy food are getting the idea that this is a smart way to avoid the consequences. Not surprisingly, kids who said they were vomiting were more likely to eat fried foods, indulge in night-time snacks, and spend more than 2 hours a day in front of a computer, among other things linked to increased obesity in children. Which is not to say that all the children doing the vomiting were obese, or even overweight.
Whether or not the study has legs, we seem to be seeing younger and younger children who are image-conscious but are without the tools they need, and the structure they need, to develop healthy bodies. That's disturbing whether or not they're really vomiting.View Comments | Add Comment
Again, Death Focuses Debate on Piecemeal Mental Health System
June 17, 2011 Harry Kimball
A few weeks ago we were appalled at the story of Jonathan Carey, a teen with autism who was crushed to death by inadequately trained workers at a New York State mental health facility.
Today we see that the knife cuts both ways. In the New York Times we read about Stephanie Moulton, an eager young social worker employed in Massachusetts' patchwork mental health system, who was murdered earlier this year. The accused killer was a resident at the group home she worked at, a man with schizophrenia and a history of violence and incarceration named Deshawn James Chappell. She was alone in the home with Chappell when she was killed. He was apparently off his medication and has been deemed unfit to stand trial at least for now.
And we're talking about this issue the same week that congresswoman Gabrielle Giffords was released from a Texas rehabilitation hospital after sustaining grave injuries in the rampage in Tucson earlier this year. Her attacker, Jared Lee Loughner, who failed to kill the representative but succeeded in taking the lives of 6 others, has also been found unfit to stand trial.
These crimes, just like the death of Carey, are horrible. But we must stress that the incidence of violence in people with schizophrenia is roughly the same as in the general population. And unfit to stand trial also means in need of serious medical attention. In an earlier era, these men would have been locked up for life with little chance of a meaningful existence, little access to effective care, little hope for recovery. With deinstitutionalization, we may have put them in a similar spot—with a higher body count. It is becoming very clear that our solution to providing care to people with severe and debilitating mental illness, whether it is schizophrenia or autism, is just not working. And yet we're told that we need to cut even more funding. The fact is that the people closest to this system—the patients and the people who care for them day to day—are being served very poorly by it, sometimes to the point that lives are lost. There are victims on both sides, and the only winner seems to be the bottom line.
Trying Too Hard to Make Kids Happy
June 15, 2011 Caroline Miller
"If you've got 20 minutes a day to spend with your kid, would you rather make your kid mad at you by arguing over cleaning up his room, or play a game of Boggle together?" It's a question posed by a Harvard child psychologist in an excellent, provocative piece in the Atlantic on whether parents are undermining their children by trying too hard to make them happy. And whether, not incidentally, we do it to make ourselves happy. "We don't set limits," the psychologist concludes, "because we want our kids to like us at every moment, even though it's better for them if sometimes they can't stand us."
The piece, by Lori Gottleib, argues that lavishing too much praise and too few limits on kids can make them them fragile, insecure and noncommittal adults. But the "conflict or Boggle" choice reminds me of what I hear repeatedly from parents of children (lovely, smart, talented children, I might add) with disruptive behavior problems (not-welcome-in-preschool-level problems). The moms tell me they so wanted their time with their kids to be fun, to be nurturing, to be conflict-free, they found it very difficult to exercise authority.
That's where Parent-Child Interaction Therapy comes in, to teach parents how to restructure the relationship so that they're setting clear limits and enforcing them, unemotionally. It's amazing the effect it can have on children, who learn that whining, negotiating, and tantrums won't budge their parents, who are comfortably in charge. As one mom put it, her son has done a 180 in terms of his behavior. "He listens and responds appropriately most of the time. He has gained tremendous control over his behavior and emotions. And at home I have a lot more confidence as a parent, and I see that he responds to it. Whenever I have a weak moment, he might say, 'Mom, is that a direct command?' or 'Mom, should I really be able to do this?' "View Comments | Add Comment