8 Special <strong>Education</strong> ■ EDUCATION UPDATE ■ NOV/DEC 2010Exclusive Interview with Dr. Harold Koplewicz, CEO, Child Mind InstituteTranscribed by Marissa SchainIs your child Dyslexicor experiencing school failure?If so, we may be the solution.We strive to help childrennot only have the skills neededto learn, but want to learn.TheSterlingSchoolWe take our commitment seriouslyOrton Gillingham trained staffSmall classes withindividualized attention<strong>Education</strong> <strong>Update</strong> caught up with Dr. HaroldKoplewicz, president of the Child Mind Institute,to discuss the latest issues in children’s mentalhealth care and what makes the Institute anunusual center.Dr. Pola Rosen (PR): What is the mission ofThe Child Mind Institute?Dr. Harold Koplewicz (HK): We’re a relativelyyoung organization. We just celebrated ourfirst anniversary. We have a very big mission.Our mission is transform mental health care forthe world’s children to fulfill their full potential.In this country alone we have 50 million childrenwho have a real psychiatric disorder and less thanhalf of them get help. We want to change theway we deliver the care, how we identify thesekids who have these problems, and we want toimprove the treatments. We want to improve thetreatments that are out there and also find newtreatments so that kids can really do well at work,which is school, at love, which is most of the timewith their family, and at play which is hobbies orsports, or activities with their friends. What everyparent wants for their child is to have full lives.PR: How do you plan to do identification?HK: Diagnosis in child mental health is stillbeing done the old fashioned way, which istaking a history. In medicine, history taking isclearly the most important instrument we have.If you’re speaking to a man in his 50s who haspain in his chest that is radiating down his leftarm, you are concerned it might be some heartattack, some kind of myocardial infarction; themuscle of the heart is not getting the right bloodsupply. There are many ways we can test thehypothesis because we have instruments that cantake pictures of the heart. We have ways of lookinginside the heart. We are getting there with thebrain and what we are looking for is a new wayof making these diagnoses.We started the Healthy Grain Network. It’s theidea of taking 10,000 kids and putting them into afunctional MRI, which is different than a structuralMRI. It is an imaging machine that can tell youhow the brain is functioning. We have figured outthat if you let a child stay at rest, the brains ofkids who have ADHD [attention deficit hyperactivitydisorder], or have autism or have anxiety,the brain talks to itself differently than a typicalchild. When the brain is at rest, we can see someArt, music, culinary arts andcomputers for a rich educationNOW AcceptING ADmISSIONScall 718-625-3502WWW.SteRLINGScHOOL.cOmRuth Arberman,Director of the Sterling School299 Pacific Street, Brooklyn, New York 11201Watch the CompleteLive Video Interviewwith the Child MindInstitute CEO, Dr. HaroldKoplewicz online at<strong>Education</strong><strong>Update</strong>.comreal differences. If we can get thousands of kidsacross the world, to lie in a machine and get thesekinds of pictures, this would be the equivalent ofwhat the growth charts are like when you go toa pediatrician. We need to do that to the brain.Then we have to find a group of kids who havedisorders and see how their brain developmentis different in the development than typical kids.PR: Will this change the face of mentalhealth care?HK: This is truly going to be a game changerin many ways. We are trying to encourage ourscientists to break down asylums. Traditionallyyou would have a scientist at Columbia, orsomeone from Harvard who wouldn’t sharetheir data until they had published it. We want agroup of scientists who are part of our scientificresearch council from ten different institutionswith expertise from many different areas to beable to collaborate with each other and to be ableto put their data online even before they use it, sowe can speed up the process.In many ways child psychiatric disorders is thelast frontier. If you think about heart disease, 30years ago people, who had a heart attack, becamecardio cripples. If they survived they were neverthe same. Today with stents, with new medication,with bi-pass surgery, we can really changethe world.We haven’t been able to do that yet with psychiatry.We also know that 75 percent of seriouspsychiatric illness occurs before the age of 24, 50percent before the age of 14.The biggest bang for the buck that we can getis finding treatments that will work on kids early.PR: Will there be financial benefits for thenation if you treat symptoms and illness early?HK: I think truly while child psychiatric illnessis misunderstood; there are many myths aboutit. It doesn’t really make a difference what yourpolitical affiliation is. This is good for our nation.Whether you are a liberal who cares desperatelyabout the good of children’s lives, mentalhealth is good for our children. They’ll do betterin school, more likely to graduate, less likely todrop out and get involved in illegal activities.If you’re a fiscal conservative, it is good for us tofind more solutions for good mental health for ourkids. Because if you do stay in school and you dograduate your chances of paying taxes and becominga contributor to society are much greater thanif you find school so frustrating because you can’tsit still in school, or you’re too anxious to attend,and frankly becoming someone who takes fromsociety than someone who is able to contribute.PR: In re MRIs: Will that research andthose tools be able to tell us that a child hasADHD or has autistic tendencies? Will thoseMRI’s be able to differentiate between some ofthe diagnoses we have out there now?KH: The Holy Grail has always been the bloodtests. If you have a cough and you are hackingaway and it bothers you tremendously and you goto the doctor, before he even takes a chest x-ray,if you have a fever and a cough and he takes ablood test, we can tell whether or not you have avirus or a bacterial infection. If you have a virus,we can tell the patient, “drink plenty of fluids andstay in bed, you will live longer than the virus.” Ifit’s a bacterial infection, there are specific antibioticsyou can take and have to take to make sureit doesn’t get worse.You’re not going to be able to get that specificblood test. But what we will be able to get arebiomarkers. If we can be able to tell the differencebetween the brain of a child who is typicalversus the brain of a child with autism tendencieson the Asperger and Autism spectrum versus thebrain of a child with ADHD, that becomes theconfirmation of a diagnoses. That in itself wouldbe very reassuring for parents. One of the hardestthings that parents have is A) accepting their childhas one of these disorder and B) the treatment.Very rarely has there been more controversythan the idea of medication for psychiatric disorders.Instead of embracing them and saying thatwe have a wonderful group of medications thatcan help children sit and focus…many people inthe public think that’s cheating or that’s teachingchildren to use drugs. The facts on this are completelyagainst that. In fact they say we know thatkids that are adequately medicated for ADHDearly are less likely to use drugs later. Kids thatare properly medicated for depression are lesslikely to self-medicate later.The truth is that psychiatric illness in children isnot only common but it’s quite treatable and childrenwho have these disorders can go on to livenormal lives if they get the treatment they deserve.PR: Are you planning outreach programsin schools?HK: More importantly than local schools, likeWilly Sutton said, the reason he robbed banksis that’s where the money is, and the reason wework in schools, is simply that’s where the kidsare. Teachers know children better than anybodyelse. If you talk to a group of parents who havethree children, their sample size is three. If agood teacher has 25 kids in her class every yearof third grade and she has been teaching for tenyears, she knows 250 eight-year-olds; she’s goingto tell you a lot.More importantly today because of all thebudget cuts, many schools are eliminating specialeducation or exclusion programs so teachers morethan ever really have to have skills in classroombehavior and classroom management. And if theycan’t do that, they end up spending so much timeon the child who’s making the most amount ofnoise and the other kids end up suffering. Schoolis supposed to be a place of learning, not a placeof psychiatric treatment. Teachers have to havethese kinds of skills.We’re now working on a pilot program for Teachfor America. We’re working on a program with theBoard of <strong>Education</strong> here in New York City to seeif we can establish programs that can be replicatedacross the nation. One of them, which I think ismost interesting, is a program called Parent ChildInteraction Therapy. We work with kids who aredisruptive and are off task. That program wasstarted by a group of people at the University ofFlorida. We are becoming the largest training site inPCIT. We train parents about what behaviors theyshould ignore, what behaviors they should actuallystop, and what behaviors they should praise. If yourkid is doing lots of things that you don’t like, whenthey do something that you do like, you tend notto praise it and you tend to ignore it and that’s notgood. And we train parents about these skills, weevaluate the child by observation, sometimes wego to school and observe then, and then we givethe parents a receiver they put in their ear. Eitherthrough a one-way mirror or through a camera, weare able to tell parents when they should ignorethings, what they should praise, and if they’re notpraising enough and to stop behavior that is reallydisruptive. It works fast in 6 to 10 sessions.Now we are transforming that teacher interactiontherapy. We ask them to take the most difficultchild they’re having difficulty managingout of the class and to work with that child infront of us. We give them skills to work with themost difficult child in praising them, in ignoringcertain behaviors and stopping certain behaviors,[and] they can generalize those skills for thewhole class.A good example of that would be if one childis constantly raising their hand and the other childrenin the class don’t raise their hand. If you concontinuedon page 9
NOV/DEC 2010 ■ EDUCATION UPDATE ■ Special <strong>Education</strong>9Dr. Harold Koplewiczcontinued from page 8stantly call on the child who raises their hand, theother children won’t answer. They will give up. Ifyou ignore the child who is raising their hand, thenthat child will stop raising his hand also. What’s ayoung teacher to do? We teach that teacher to slapthat hand and say “That’s a good hand! I like thathand, can you show me some other hands?”And so it’s not the question or the answer we’relooking for, it’s the behavior of raising your hand.We’re trying to teach teachers that just by changingsome of their behaviors, they can get more oftheir kids to raise their hands and then figure out ifthe kids are giving the right answer or not.If you think about the traditional way of psychotherapy,we used to play with children on the floorand hope we would get a better understanding ofwhat the child is thinking or feeling. Unfortunatelymany times the child would behave very well onthe one-to-one and you wouldn’t be able to generalizein the outside world. What we’re planning iswe’re wiring our new center. It’s going to consist ofover 23,000 square feet of space. If you treat a childintensely, if the child has terrible OCD, they can flyto New York, they can stay in a hotel with their parents,the can get 3 to 5 hours of intensive exposureand response prevention and medication. And theygo home, and how do we see them? We use Skypeand they get a booster session a week later so theydon’t have to come 100,000 miles. That’s what Imean by transforming the mental health care of ourchildren. How do we change the delivery and howdo we train you? Most importantly parents needto know more. Our Web site, which will launchin November, will be the destination of noncommercialinteraction that will give scientific soundinformation about mental health. Not only fromthe Child Mind Institute personnel and faulty, butfrom Columbia [University], Harvard, UCLA, theexperts in the world on our Web site.PR: What would you say is the prevalentmental illness among children today in thiscountry?HK: There are two, I think it depends on the age.In very young children, it’s disruptive disorders.About 5 percent of the population has ADHD. Wecan show you differences on MRIs versus a groupof typical kids. These are children who are clearlymore inattentive, more impulsive, and more hyperactivethan a child their age. Unfortunately it’sa lifetime illness. It doesn’t mean you can’t payattention, it means you lose your attention spanvery quickly when it becomes boring for you.The other common illness which I think is minimizedby the public is anxiety disorders. Anxietyis something we all experience. But in anxietydisorder…it lasts longer than two weeks. It’s a setof illogical worries that we can’t shake and affectsour behavior. It happens between 6 percent of thepopulation between the ages of 7 and 16 at anytime. That’s a conservative estimate. Very oftenthese kids don’t come to see a child psychologistor a mental health professional and they end up in apediatrician’s office because they have headaches orstomach aches. We can’t find the organic cause buttheir stomach ache and their headache is still realbecause it’s caused by their anxiety or this misfiringof the amygdale. Unfortunately this often is mislabeledor minimized with the hope that children willoutgrow it but unfortunately kids will either treat itthemselves or they will limit their lives.The good news is that there are so many psychosocialinterventions that work. Children whoare selectively mute who have a form of socialanxiety will not speak to strangers. They willonly talk to mom and dad. With intensive behavioraltherapy, within 5 days, you can get thosechildren to relax and [speak well]. We call it thebrain buddies program to do it in a fun way andto make parents feel less shameful or guilty thatthey’ve done something.PR: Is there a national program that youadmire that would serve as a paradigm forthe nation?HK: I think one of the reasons we decided tostart the Child Mind Institute, after spending 12years at NYU…is that typically what happensis that these programs are always a “PS” [postscript]. At Child’s Hospital, they were alwaysterrific at taking care of childhood cancer, atdiabetes or seizures, but it’s always a post script.When you think about mental health and whenyou think about psychiatry, child psychiatry isalways the afterthought. It became clear to us thatthe same way St. Jude’s truly tackled childhoodleukemia, we needed to create an institution thatis exclusively dedicated to transforming childmental health care. If we don’t have that, thenunfortunately whenever there is a cutback, orwhenever there are financial problems, there isLindamood-Bell® New York Learning Center<strong>Education</strong> <strong>Update</strong> - December 20101/2 Page Horizontal - 10.25” x 6.75”always something that may appear to be more lifethreatening or more important.Since this is in many ways the last frontier, thebrain is, in my opinion, the most exciting way to doexploration. But if you think about the bang for thebuck … there is just a tremendous amount of potential.And clearly everyone realizes that if you turnaround a child that was going to drop out and staysin school, or a child that was literally so unable tofocus or was unable to calm themselves down toattend school, you could really make a difference.Kids who have separation anxiety or school phobiaare significantly more likely to have panic attacks.Unfortunately we’re the only place that clearlycares about child mental health in a way that’sexclusive. Not to say that other things aren’timportant but we think this is the most importantthing we have to offer the nation. #L INDAMOOD B ELL ® L EARNING C ENTERSWe Teach Reading,Comprehension, and MathOur research-based individualized learning programgoes beyond traditional tutoring.The Right Evaluation The Right InstructionThe Right Learning Environment“After just a few weeks mygrades went up! Thanks!”Call now for information and to reserve your space:212-644-0650110 East 55th Street in New Yorkwww.LindamoodBell.com©Lindamood-Bell Learning Processes
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