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The Child Mind BlogBrainstorm

  • 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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  • 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.

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  • 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.

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  • 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.

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  • 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.

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  • 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.

     

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