One of the toughest parts of raising children is helping them leap the emotional and intellectual hurdles of life. As parents, we try to ease their pain when friends snub them. We console them when their fears keep them awake at night. We scold them when they behave badly, and counsel them after they forget their homework or lose their cell phone.
But most of us have no idea what we are doing. The frustration from being unable to solve a child’s emotional problems or mental lapses is greater the more out-of-the-ordinary those problems seem to be. School counselors can address some issues, pediatricians others, but true experts in our children’s mental health and development are hard to find. How do we nurture our children’s brains and how do we know when they in trouble and need professional help?
In an ordinary-looking Park Avenue office tower in New York City, an extraordinary cluster of professionals are working to understand, improve and advise the rest of us about the mental health of our children. The Child Mind Institute, founded just three years ago, is the only nonprofit organization in the U.S. dedicated solely to children’s mental health. Their mission includes diagnosing and finding better treatments for childhood psychiatric and learning disorders, gaining an improved understanding of healthy brain development, and helping families deal with issues ranging from school transitions to serious anxiety disorders and behavior problems.
Our kids need help. According to the Institute’s website, more than 15 million children in America have psychiatric disorders and at least half of them will never receive treatment. Lots of other children, no doubt, have psychological troubles that may fall short of a disorder but that parents do not know how to handle.
Allaying A Child’s Fears
One of the Institute’s areas of focus is childhood anxiety, which afflicts 13 percent of kids in its assorted forms, according to Ronald Steingard, a psychopharmacologist there. Some kids have severe separation anxiety, others panic or post-traumatic stress. In pediatric obsessive compulsive disorder, children have intrusive and repetitive thoughts—say, that something will happen to mom and dad—and attempt to stamp them out with an irrational ritual they perform compulsively. They might have to wash their hands six times before bedtime or perform a triple-tap on the front door before leaving the house. In some cases, the anxieties and behaviors become so numerous and pervasive that they essentially take over a child’s life.
The gold standard therapy is exposure with response prevention, in which the child repeatedly confronts the objects, thoughts and situations that prompt his or her anxieties without being allowed to perform his or her rituals. Most kids receive this remedy in short weekly doses in a therapist’s office, but the Child Mind Institute also offers an intensive program in which a child spends a better part of a week, four to five laborious hours a day, trying to beat back his illness. With this approach, therapists spend time with the children in the places that elicit the troublesome responses. If a child believes that stepping on a crack will really break her mother’s back, the child and the therapist might take a walk and step on cracks and together confront the associated angst. The program has seen considerable success, leading to a 40 to 90 percent reduction in symptoms for all participants, according to its director, Jerry Bubrick. Families from London, Hong Kong and across the U.S. have come to the center to get concentrated help for their kids.
Selective mutism is an extreme form of social anxiety in children. Kids with this problem will only speak to certain people—mom and dad, for example—and only in a certain environment, say inside their home. Everywhere else, they fail to utter a word. The cause of the condition is not defiance but extreme self-consciousness. Children want to chat with their pals at a party or answer a teacher’s question in class, but their fear muffles them.
As one answer to this silence, Institute offers a week-long day program called Brave Buddies for children ages four through nine. The program features a mock school setting in which children practice talking in front of a group, with a counselor at their side. It includes parts of a typical day that require lots of talking such as morning meeting and field trips to parks or museums. Children earn points and prizes for each instance of “brave talking.” By the end of the week, words and whispers fill a room that had once been soundless. The vast majority of children, who were mute at the start of the week, can, by the end, go to an ice cream shop and request their favorite flavor. Children speak on their own accord three times as often as they did before.
The Institute also offers behavioral intervention for attention-deficit hyperactivity disorder and disruptive behaviors such as oppositional defiance disorder. An approach called parent-child interaction therapy (PCIT) is directed less at difficult children themselves than at teaching their parents how to deal with problematic behavior. When Steven Kurtz, who directs the ADHD and Disruptive Behavior Disorders Center, first described it to me, it sounded useful as a general parenting strategy, even if your kid is just difficult in all the normal ways. Supposedly it works best on kids ages two to seven, but it seemed to me that some of the tips could be adapted to older children as well.
In the formalized therapy, a parent leads her child or children in a series of tasks while a therapist watches through a one-way mirror. Though not part of the action, the therapist guides the parent by speaking instructions into a microphone that the parent receives by way of an earbud. Kurtz told me about a case in which two siblings were playing a game that involved slamming a door. Concerned that the game would result in a broken finger, the mother did what most of us would do: She told the kids that if they kept slamming the door, the game would have to stop. But the therapist had different advice. Instruct the children to practice closing the door carefully, the specialist said, advancing a positive behavior rather than trying to block a negative one.
In this “school,” parents graduate after 14 to 17 weekly sessions. Studies show that the program leads to more compliant and less disruptive children, shifting their behavior into the typical range. Parents’ stress levels also drop dramatically. According to a 2003 study, these improvements last up to six years.
In its effort to reach more children, the Institute is increasingly sending its tentacles into the community. According to Steingard, emerging pathology shows up primarily in two places: at school and in the pediatrician’s office. As a result, the Institute is trying to connect with both. For instance, it maintains an access line for pediatricians to call with questions about children’s mental health. “I want to see kids early on, before they even have a diagnosis,” Steingard says. In its efforts to reach into schools, Institute therapists have adapted PCIT to a classroom setting to help teachers control disruptive students. They tested the approach last year in 11 kindergarten and first grade classrooms in three New York City public schools. Preliminary results indicate that the therapy greatly improves class management. The teachers who used the techniques they learned referred fewer children to special services than did untrained educators in comparison classrooms.
Aside from its efforts on behalf of troubled kids and the adults in their lives, the Institute offers a plethora of advice for all parents. It provides support for families in the throws of separation or divorce. Its website also suggests solutions to conundrums from school transitions to teen sex and substance abuse.
Perusing the website, I immediately encountered three articles I found helpful. The Secret to Calm Parenting highlighted the dangers of being overprotective of children, perhaps making them overanxious and afraid to explore or tackle challenges. In Family Dinner: How Much Does It Matter? I learned that I wasn’t harming my kids irrevocably by not regularly wrapping us all around a table. As long as I gave my son and daughter the attention they craved by talking and hanging out with them in other settings, they (and I) would be OK. And in Back-to-School Dos and Don’ts, I got some good advice for transitioning my kids for the new school year. I’m lucky that my own children do not seem to have significant psychological troubles, but I still need a lot of help.
Next: I will describe the Child Mind Institute’s efforts to map the structure and function of the developing brain and discover what this progression means for behavior, personality and mental illness.