Infant Mental Health

I was at a stoplight earlier. The car directly in front of me was an older model sedan with rust on the roof, expired tags and an obvious rattle. Through the back window, I could see the top of a little head of a child about 2 years old in a car seat. In the beat up car, I saw a mother in the backseat with her child, and it appeared the father was driving. The mother was leaning forward and looking into the child's eyes and smiling. The dad was occasionally turning around to smile and engage with both the mother and the child. The little family appeared to be singing and playing while stopped at the light. In this brief glimpse into this family's life, I could tell this kid was probably going to be alright for the rest of his life.

This reminded me of the importance of the emotional needs of the 0 to 3 year old population. There is no more critical time to bond with your child than the infant, toddler, and preschool years. A lack of attachment during this age can lead to profound problems in development of personality that will last a lifetime.

If you know a family with a new baby, remind them that eye contact, conversation, singing, and playing with their new baby is vastly more important than any new video or baby toy that has ever been marketed. Home should be calm, predictable, and routine. The simple interactions and connection with a small child through feeding, naps, and structure will provide all the stimulation necessary.

Razorback Aspie

This is Noah, a kid I know with Asperger's Disorder. Please take the time to watch his video. I am amazed by his bravery and self-awareness.

http://www.youtube.com/watch?v=1AyfL3cT1tQ

Internet Safety

I've had a rash of kids exposed to inappropriate web content lately. Parents must be so careful with any device that can access the internet. If a piece of hardware can't support parental control software, then I don't think kids should be using it. iPhones, iPads, PSP, Wii, XBox, PS3, and even some televisions can easily access any website. Old cell phones can still access WiFi even after the cellular plan is deactivated. Many times, an innocent search brings up inappropriate websites. All internet use should occur in a public part of the house with parental supervision. If kids can't abide by that simple rule, then they should be restricted from the internet.

Child Abuse Reporting

In the wake of the recent Penn State Abuse scandal, I feel that the breakdown occurred when responsible individuals didn't know what to do when they received information.

In Arkansas, reporting is centralized through the Arkansas State Police. The phone number is 1-800-482-5964. You will speak to an operator who will ask you questions about the suspected abuse or neglect. Your identity will be kept confidential unless a judge orders that information to be released which in most cases never happens. Even suspected cases should be called in. In most cases, the operator will generate a report and it will get checked out. Even if abuse is not occurring, these situations need to be checked out. My general opinion is that where there's smoke there's fire. If you have a question about whether something should be reported, it probably should.

Neglect is often confusing and people ask me if it should be reported, and it should. Neglect can come in many forms from not providing necessities like food and clothing, not providing appropriate medical attention, not providing adult supervision, and not requiring children attend school.

False Positives

False positives seem to be a big deal to me lately, like they really bother me. I get so many families requesting me to check a lab, run a test, do a scan. While I will do those when I feel appropriate, there's unfortunately little evidence that any tests really help with diagnosis of psychiatric disorders other than substance abuse. Most of the time everything comes back normal except for one teeny little thing and it gets you questioning "could that be a big deal?" Brain scans are the worst right now. There is no psychiatrist who can tell you what your kid has or what med they need based on a brain scan, and if they tell you they can, you are about to fork over several thousand dollars that your insurance company won't cover.

This got me thinking about false positives in typical diagnostic interviewing too. (Full disclosure: I am guilty of diagnosing kids incorrectly, I do it all the time I am sure). In psychiatry, we have a fairly standard interview that's designed to rule in or out several diagnostic categories: mood disorders, anxiety disorders, disorders that start in childhood, developmental disorders, psychotic disorders, etc... In the interview, we are asking all kinds of different questions to get a general idea about the diagnosis. It might take me 2-3 hours over a period of several appointments to come to a complete conclusion about this. But kids who get hospitalized get diagnosed with some pretty serious stuff all the time. The diagnosis du jour seems to be bipolar disorder (cue Jaws theme song). Lemme give a typical scenario- 8 yo gets really pissed off and threatens or harms someone, gets hospitalized, gets put on powerful antipsychotic medication, gets discharged with bipolar disorder. Pay particular attention to the order of those events.

False positives occur when the test comes back positive for a problem at a rate that is more often than the actual incidence of the disorder itself. Let's say there is a testing device called an anger-o-meter and it measures levels of anger (reference e-meter from Scientology) If you have a test that a lot of people show up positive for, then a lot of people are going to look sick. Anger level is often that test. Lots of clinicians have an internal amount of anger that they will consider normal or abnormal, and if a kid appears above that level, then they must have bipolar disorder. The problem is that anger is not specific to bipolar disorder. Using anger level as your measure of the presence of bipolar disorder is like using wetness on your driveway as a measure of whether it rained. That wetness could have come from a thousand different sources: sprinklers were on 5 minutes ago, pack of dogs peed on your drive, pipe burst in yard, someone emptied their cooler from tailgating, water balloon fight, squirt gun war.

Final note: I'm not saying an 8 year old can't have bipolar disorder, it does happen. But it's rare and the diagnosis should be made on the basis of the symptoms that are more precisely indicative of the disorder.

What's Negative Reinforcement?

Negative reinforcement took me forever to figure out. I always got the questions wrong in my college psychology class. I think it really took me learning about anxiety disorders in kids to understand what is going on. I will try to state the same thing a few ways:

A behavior is rewarded when something bad does not happen because you do the behavior.

The avoidance of a potentially negative outcome rewards a behavior.

You imagine something bad is going to happen, so you design your life to avoid that thing happening.

Basic Examples:

If you have crowd anxiety, your hermit lifestyle keeps you out of nervous situations, thus reinforcing your hermit behavior.

If you have a fear of flying, you avoid buying plane tickets, and you never have a panic attack on a plane.

If you hate to be judged in the checkout aisle, you immediately buy your kid something he wants to keep him from whining in front of other customers, thus avoiding a scene.

Avoidance behavior is the major problem for people with anxiety.

The key to reducing your anxiety is to stop avoiding things. Get out and do the very things that are going to make you nervous. That's right, you have to get nervous to improve your nervousness. You have to practice your weakness until it's no longer a weakness.

Pot drug screens

I'm seeing lots of kids with a pot problem. Contrary to the common belief, pot does not stay in your system for a month. Most teens are occasional users and can easily pass a drug screen within a few days. If you suspect your teen is smoking pot, drug screen early and often. My typical recommendation is to purchase several urine drug screens through a bulk supplier and test on Monday and Friday. There are multiple online retailers that will fill your order for just a few bucks per test provided you buy about 10 or more. Shop around for good pricing. If you are paying more than 5 bucks per test, check another site. There are simple tests for alcohol and tobacco as well. Most teens are going to lie about substance use if they can get away with it. Screening may be the only way a parent can be sure they know what's going on. Be mindful of headshops in town. They are selling multiple products that are labeled as "incense" but produce a potent high when smoked. Check your computer and child's phone for online ordering of products as well. A child who is rushing home to beat you to the mailbox is a sure sign of ordering one of these.

links:

http://www.americanscreeningcorp.com

http://www.medicaldisposables.us/home.php