Dr. Henry Paul, MD

Psychiatrist, Author and Educator

LOOK THROUGH MY LENS

February 1st, 2016

I made a great video discovery on YouTube this week. I found this 14-minute video that explained autism. Most impressive was that this video was done, start to finish, by a 16-year-old high school student who wanted to let her peers know what it was like to have autism. No she doesn’t have autism, nor does anyone in her family. But, after she met her friend Jaime with cerebral palsy, she realized that we all need a better understanding of what it is like to live with a physical disability or learning difficulties. With her single YouTube video, she has helped thousands of teens understand a complex disorder.

Alex Jackman told Choices Magazine that it all began when out of curiosity she joined a girl for lunch at summer camp. Jaime was in a wheelchair and often ate by herself. Alex and Jaime became good friends. Alex tells Choices how that might not have happened had she not approached Jaime and sat down with her for lunch.

Jackman says that through her volunteer work at a local autism organization she was inspired to create the video, specifically targeted at teens, to help them better understand the developmental disorder. She told Choices, “I wanted to make something simple that put you in someone with autism’s shoes.”

After a year of interviewing kids she had met through her volunteering, interviewing experts on Autism, and writing, filming and editing – Jackman posted “A Teens Guide to Autism.” And, guess what? It took off. The video has been seen around the world and has won several awards! Kudos to Jackman for making a difference!

LINKS
The Autism Activist

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

THE FINAL SHOT – MENTAL ILLNESS

December 11th, 2015

A USA TODAY story out yesterday said, “At a time of heightened concern over police shootings, a new report estimates that people with mental illness are 16 times more likely than others to be killed by police.”

Why is this? The problem is a lack of treatment for those with mental illness, and I also think a lack of training of law enforcement to recognize it. Mental illness is still something that carries a stigma. People, in general, don’t want to talk about it. For years now, the main thing driving the conversation about mental health has been the mass shootings. People are arguing that mental illness is the reason behind the mass shootings.

Now, a new study out from the Virginia-based Treatment Advocacy Center is saying that about one-in-four fatal police encounters involve someone with mental illness. This study is moving beyond saying that not just those who decide to shoot others in a mass shooting have some mental illness, but that many victims of shooting by law enforcement may also have mental health issues that made them do something illegal that got them killed.

I agree, and this is why we need more dialogue and more solutions on how to help those with mental illness. There are over 8 million people in the United States who have a mental disorder that can alter their thinking and perception of the world around them. From paranoid syndromes to fear, loneliness and anger there are plenty of emotions, disturbances of judgement and other issues that are associated with mental illness that can cause a person to act out or sometimes simply not understand laws or social constructs. And, the disorders themselves ranging from bipolar disorder to schizophrenia to various personality and substance abuse disorders that increase vulnerability often go undiagnosed. For many, even if they are diagnosed, some just stop taking their medications and other forms of treatment.

So what’s the answer? Well, I think that Mayor de Blasio and #ThriveNYC is a start. I believe that having a dialogue and trying to develop programs that can help those suffering from mental illness is a good place to start. Look, people with mental illness are no more violent than others. A better understanding by all will help many to seek and get the help they need. America has to embrace this conversation before change can ever really take hold.

Join me on Facebook and let’s have a conversation about this. Ideas and change come from collaborative thinking and open discussion.

LINKS
“I Called the Police for Help, Not to Kill My Son”
Groups call on Congress to reform mental health system

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

VICTIMS OF CHILDHOOD BULLYING & THE IMPACT ON THEM AS ADULTS

August 24th, 2015

I have counseled plenty of children over the years who have been the victims of childhood bullying. Now, a new study says that childhood bullying has effects that last long into adulthood. I came across an article this week in MedicalNewsToday.com that says, “Research is now attempting to understand why victims of childhood bullying are at risk of poorer outcomes in adulthood, not only for psychological health, but also physical health, cognitive functioning and quality of life.”

Bullying comes in many forms, but intimidation, teasing and the threat of violence are often involved. The article in MedicalNewsToday.com references studies by the US Department of Health & Human Services (DHHS) that said that the most common types of bullying are verbal and social:

Name calling – 44.2% of cases
Teasing – 43.3%
Spreading rumors or lies – 36.3%
Pushing or shoving – 32.4%
Hitting, slapping or kicking – 29.2%
Leaving out – 28.5%
Threatening – 27.4%
Stealing belongings – 27.3%
Sexual comments or gestures – 23.7%
Email or blogging – 9.9%

In children, it has been shown that persistent bullying can lead to depression and anxiety. These disorders are often why parents finally call me. The bullying itself may go away with intervention from parents and school administrators, but the scars are deep and can last a lifetime.

In a study in the UK in 2014, “researchers found, at age 50, participants who had been bullied when they were children were more likely to be in poorer physical and psychological health and have worse cognitive functioning than people who had not been bullied.”

The study also said that “Victims of bullying were also found to be more likely to be unemployed, earn less and have lower educational levels than people who had not been bullied. They were also less likely to be in a relationship or have good social support. People who had been bullied were more likely to report lower quality of life and life satisfaction than their peers who had not been bullied.”

In working with children of bullying, I find that many of these kids suffer from severe anxiety with features of post-traumatic stress disorder (PTSD), depression and often, suicidal ideation. These children may find that they will need to seek counseling for an extended period to learn to handle their anxiety and depression. Psychotherapy is the treatment of choice and, in some cases, medication is necessary. These children also may find that they will need to seek counseling throughout their life to learn to handle their anxiety and depression. For many, lifestyle changes and talking about their childhood experiences with bullying will help. Sadly in some cases medication will be necessary. The sooner a child begins to deal with their bullying the better the outcome.

PROBLEMS IN SCHOOL? ONE OF THE TOP REASONS PARENTS CALL ME

July 16th, 2015

“Under the Individuals with Disabilities Act, or IDEA, public school districts nationwide are required to provide a free and appropriate public education to all students diagnosed with a disability. The mandate requires schools to identify students who may have learning impairments, and to develop a plan to educate them appropriately at no extra cost to parents.” Public Schools Delay or Deny Special Education Services for Most Vulnerable Students (NBC News)

Schooling and education are a major focus of adolescence and are one of the most frequent reasons that parents call me for a psychiatric consultation for their children. Teenagers spend most of their time during the day at school. It is easy to understand why problems at school then become such a major focus for parents – not to mention the anxiety that the teen is feeling. It is also easy to understand that problems in school are often an indicator of problems elsewhere, and it is important that parents be able to differentiate the two. As with athletics in some families, school performance becomes a major focus of parents’ anxieties, ambitions, and vicarious living. Also, they may project problems in their lives on their children’s performance.

It is normal for teenagers to experience some problems at school that are not particularly serious, especially during what are called the transition years, moving from middle school to junior high school or from high school to high school. It’s unusual to find teenagers who don’t experience some degree of stress at these times. But when school problems persist long past these transitions and become more deeply entrenched, there is a problem.

Here are some simple things to do if you suspect problems at school:

Contact your teenager’s guidance counselor and set-up a meeting. If there is a specific clas, that seems troubling for your teenager you should contact that teacher and ask to meet. You may want to set-up this meeting to include the guidance counselor.
Often an undiagnosed learning disability may be the underlying factor. Learning disorders can have a serious impact on a teen’s performance and their self-esteem. Many of you have most likely heard the terms ADHD (Attention Deficit Hyperactivity Disorder), ADD (Attention Deficit Disorder), PTSD (Post-traumatic Stress Disorder), OCD (Obsessive Compulsive Disorder), ODD (Oppositional Defiant Disorder), Spectrum Disorder (including Autism), and many more.

Special education is part of the public school system in the United States, and its function is to make sure that children who are diagnosed with learning disorders or medical conditions that affect learning get the services they need. Navigating the waters of the special education system can often be complicated for parents. There are both Federal and State mandates that affect special education services. Key players in making sure that your child gets the proper services include the child’s pediatrician and/or psychiatrist, the school CSE (Committee on Special Education), the school’s guidance office and teachers, and you. Sadly, there are schools who will fight or delay the services. In that case, you may need to hire an attorney or seek out a special education advocate.
Here are some resources to help you understand the rights of children with disabilities.

Robin’s blog. She was the mother Jarrod in the NBC story.

The Disability Rights Education and Defense Fund (DREDF), founded in 1979, is a leading national civil rights law and policy center directed by individuals with disabilities and parents who have children with disabilities.

SNAP WHAT?

June 22nd, 2015

SnapChat is a video messaging application that allows users to take photos, record videos and add text and drawings to messages that they send to their personal lists. The appeal? These conversations are disposable and temporary. The fact that the message “self-destructs” after seconds is what is so appealing to teenagers. How appealing? According to Snapchat CEO Evan Spiegel, he said at the 2013 All Things D Dive into Mobile conference that “…there are about 150 million photos shared via Snapchat daily.” Wow! And that was in 2013!

Snapchat is all about pictures and conversations. Snapchat always starts with a “flash.” Simply, you take a picture. You add text. You set how long before the picture self-destructs – between one to ten seconds. You choose recipients from your private list. You hit send!

But, something that appears so simple has raised a lot of questions and concerns for parents and educators. Social media is a parents’ greatest online fear. We all know that bullying, sexting, sexual predators are just some of the dangers that immediately come to mind when we think about kids and social media. In response to the growing concerns, Snapchat created the Snapchat Safety Center. I highly recommend that you check it out.

Parents should be aware that in accordance with the U.S. Children’s Online Privacy Protection Act (COPPA) that the minimum age for using Snapchat is 13 years old. If a child younger than 13 tries to access the system (assuming they put in their real birth date), they will be redirected to a kid’s version called SnapKidz. This allows the users to save their photos only to their devices and doesn’t allow for them to send them.

Teenagers are drawn to Snapchat because of its ease of use and the fact that the photos do NOT live online forever. Something that not only teens, but all of us should think about when posting online. Never assume that something has truly vanished forever. Reports stemming back to 2013 confirm that you CAN retrieve deleted Snapchat’s on Android devices. Where there’s a will, there’s a way!

Look, I always recommend to parents to keep the line of communication open with their kids. So, talk with your kids about Snapchat. Let them know that you know about it and that you have concerns about their safety. Talk with them about what is appropriate to “snap” and what isn’t. Let them know they should report inappropriate use that they see (i.e. bullying, sexting, etc.) either to you or to a school official or another adult they trust. As much as it is fun to “live in the moment” there are precautions to take.

For more on safe guidelines for Snapchat visit A Parent’s Guide to Snapchat. Here is also a link to COPPA and links to the Forbes stories that explain both SnapChat and SnapKidz.

What is Snapchat and Why do Kids Love it and Parents Fear It? Forbes 2013

Snapchat Creates SnapKidz — A Sandbox For Kids Under 13 Forbes 2013

Disclaimer

This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT YOU’LL NEED TO KNOW BEFORE STARTING YOUR CHILD ON MEDS (Part 3)

May 29th, 2015

If you have been told that your child would benefit from taking medication there are some things you need to know. In my latest book, “When Kids Need Meds; Everything You Need to Know about Psychiatric Medication and Youngsters” I have prepared a 13-step guide that will help you alleviate some of your concerns and answer your questions about the medications. I am sharing the guidelines in a three blog series this week. This is the third, and final, blog in the series. Below is a link to the first two blogs. Please share the series with others who have concerns about medications prescribed for their children and teens and email me your questions and concerns.

(The guidelines listed are a continuation from my two previous blogs).

10. Tell your child’s doctor about any other medications, supplements, or home remedies your child is receiving to be sure there are no adverse interactions with the prescribed medication. Remember even natural remedies can cause interaction problems.

11. Never compare dosages in milligrams between medications; they all differ and cannot be compared because of potency differences in the manufacturing process. Thus, one milligram of one medication might equal in efficacy ten milligrams of another. For example, I recently had to explain to a patient that the new medication I was giving was measured in one-half to two-milligram dosages and was replacing one that measured about thirty milligrams. It was simply another compound whose potency was measured differently.

12. Be prepared for your child’s doctor to recommend more than one medication. This use of multiple medications has become more common, as it sometimes gives better results. There are, however, risks to this practice that your doctor will need to explain. Risks include medication interaction, increased safe side effects, as well as decreased compliance because of the difficulty some patients have with multiple prescriptions. Always find out why your doctor is prescribing multiple medications and ask specific questions about the benefits and risks of such prescribing.

13. Always trust yourself and all the knowledge you have about your child. No one knows your child better than you! Making you the best resource for observing side-effects, therapeutic effects, and the overall well-being of your child. Don’t be intimidated. Call your psychiatrist with any concerns.

This is the final blog in a three-part series.
Link to blog 1
Link to blog 2

As part of National Mental Health Awareness Month I am offering free copies of my book. Please email me if you’d like a copy.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT YOU’LL NEED TO KNOW BEFORE STARTING YOUR CHILD ON MEDS (Part 2)

May 27th, 2015

If you have been told that your child would benefit from taking medication there are some things you need to know. In my latest book, “When Kids Need Meds; Everything You Need to Know about Psychiatric Medication and Youngsters” I have prepared a 13-step guide that will help to alleviate some of your concerns and answer your questions about the medications. I am sharing the guidelines in a three blog series this week. This is the second blog in the series. Below is a link to the first blog. Please share the series with others who have concerns about medications prescribed for their children and teens and email me your questions and concerns.

(Read blog 1 for steps 1 – 4)

5. Make sure your child’s doctor, or a covering professional, is available twenty-four-hours-a-day, 365 days a year, for any concerns you have about your child. Anything less is unacceptable.

6. Understand why the great majority of psychotropic medications given to young people are off-label, which means they haven’t been specially approved for use by children. You will want to ask your prescribing psychiatrist what their particular experience is with the medication, as well as what studies have shown about the medications use in children and teenagers.

7. Find out from your doctor what time of the day and how to give your child the medication – with meals, all pills at one time, on a full or empty stomach? Although many pharmacies now include a written summary of various aspects of the drug, follow the prescriber’s recommendations over those of the pharmacy. Call the doctor if there is a difference.

8. Determine what the mediation will cost. Are there ways to cut the cost? Your pharmacist is the best source for that information. Cost should never force a decision. Sometimes insurance companies make it difficult to get medication. Be persistent and get help from your psychiatrist to be sure your child gets exactly what the doctor ordered; generic or brand, the correct quantity, and refills, too.

9. Ask if there is a difference between generic and brand name drugs. I have not seen much of a difference between their effectiveness. Generic is usually okay. Some patients demand brand name medications, and I go along with it, but with the caveat that these will cost more money with little research showing a beneficial effect.

This is the second blog in a three-part series.
Link to Blog 1

As part of National Mental Health Awareness Month I am offering free copies of my book. Please email me if you’d like a copy.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT YOU’LL NEED TO KNOW BEFORE STARTING YOUR CHILD ON MEDS (Part 1)

May 26th, 2015

If you have been told that your child would benefit from taking medication there are some things you need to know. In my latest book, “When Kids Need Meds; Everything You Need to Know About Psychiatric Medication and Youngsters” I have prepared a 13-step guide that will help you resolve your concerns about the medications. I will share it with you in a series of three blogs this week. Please share it with others who have questions and concerns and email me with questions.

Have your doctor explain your child’s diagnosis in as much detail as possible. Is there a known cause for the difficulty? What course might the disorder take if not treated? For example, if a child with ADHD doesn’t get treatment, the chance of substance abuse increases as the teenage years approach. Teenagers not treated for depression have an increased suicide risk. What positive effects of the medication will the psychiatrist be looking for? How long should it take? What will he do if it doesn’t work? While there is no medication which totally cures everything, your child’s prescription should target specific symptoms.
Make sure your child gets other forms of treatment along with medication. What does your doctor recommend? Individual talk therapy? Special school interventions? Behavioral therapy? Family counseling? Be wary of the practitioner who simply gives you a pill and wishes you good luck.
Make sure you child is physically healthy. If not, then the prescribing psychiatrist needs to be familiar with a medical condition. To this end, the doctor should take a detailed medical history of your child. Also, I like to see a report of a recent physical examination from the child’s pediatrician. I also suggest a routine 12 lead electrocardiogram in most cases. The blood tests and EKG will not only give signs of present conditions but will serve as baseline readings. Some medication affects blood tests and the EKG, and if we don’t have a baseline it will be difficult to know if future abnormal readings are caused by a medication or were always present.
Have a clear understanding of the medication’s side effects. Most side effects are fleeting and mild and don’t interfere much in your child’s life in any way, but they can be specific depending on the medication. You should know what they are so you don’t get worried. Serious or long lasting side effects for child and teenage psychotropic drugs are rare, but again, you should be told of the signs. If you read information from the Internet, be careful about the websites you choose. Don’t jump to the conclusion that the information you find online is more accurate than you psychiatrist’s years of clinical prescribing experience.

As part of National Mental Health Awareness Month I am offering free copies of my book. Please email me if you’d like a copy.

SHOULD I WORRY ABOUT THE MUSIC MY TEEN LISTENS TO?

March 30th, 2015

“Music lyrics have undergone dramatic changes since the introduction of rock music more than 40 years ago. This is an issue of vital interest and concern for parents and pediatricians.” American Academy of Pediatrics

As an adolescent psychiatrist for over thirty years, I have been asked over-and-over about the influence that music has on teenagers. The concerns that parents have about today’s music are very real. Parents worry about the suggestive nature of the lyrics and the influence it will have on their children. Even worse, parents are scared that the music might be harming their children.

For the most part, listening to music is a healthy, relaxing and very natural thing. Teenagers listen to music for a host of reasons. For many of them music is at the center of their lives socially and culturally and listening to music is important to fitting in.

I think music reveals a lot about a person and can be a window to one’s soul. It can help quieter teenagers to express themselves, and it can express emotions that tempestuous adolescents may not be able to voice.

It is difficult for parents to hear songs about drugs, nirvana, suicide, gangs, racism, sexism, and sex. It is scary to think that your child is taking those lyrics to heart. Teenagers experiment with different types of music, and often much of it is just a phase. Remember, the songs that you listened to in high school that your parents thought were suggestive? Most likely your parents weren’t happy when you were listening and singing those lyrics either.

As with many other trends, the music phase will pass without any lasting damage. Music only becomes a concern when your teenager is manifesting other emotional difficulties and is using music-listening to get away from problems, to substitute for real-life activities, or to accompany a depressive withdrawal. In these cases, the music is giving your teenager a message about depression, severe social problems, drug use, and even suicide plans and parents must intervene. Parents should not turn off the music. Instead, learn about the music. Today you can find the lyrics to almost any song on the Internet, so GOOGLE the artist and the song. That is the best way to assess the lyrics. Then have a discussion about it with your son or daughter. You will get a glimpse of what is bothering your teenager and then, if necessary, you can seek required help. Click here for recommendations from Common Sense Media to help you talk with your teenager about the music they are choosing to listen to.

WHY MEDICATION?

March 24th, 2015

I do not believe that every child with a mental disorder needs medication, but I do feel strongly that some do. To withhold these important therapeutic agents can be harmful and, in some cases, tragic. However, I fully understand why parents are often anxious, hesitant, and concerned about their children’s welfare. All too often, such feelings arise from the biased, misleading, and even fabricated stories that are conveyed through the media and on the Internet.

I have experience prescribing almost all of the current psychotropic drugs and have treated children and teenagers with all the varied disorders listed in the diagnostic manuals. I have seen the therapeutic effects of medication when administered properly, the harmful effects when they are abused or prescribed incorrectly, and have observed the side effects that very rarely occur.

In my book, When Kids Need Meds, I try to alleviate some of the misconceptions and the fears. I discuss the mental disorders, explain the process of psychiatric evaluation, answer the many questions, and talk about stimulants, antidepressants, antipsychotics, mood stabilizers, sleep medications, and anti-anxiety drugs. I focus on the importance of non-medication therapies, too. I also provide references for readers to obtain more information.

Friendly and easy to use and read, this guide covers almost every aspect of an extremely important and very prevalent topic to educate, comfort and provide support. I believe parents will find it invaluable.

Now through the month of April I am offering free copies of my book. If you are interested in a copy please email me at drpaul@henrypaulmd.com.

Here is a link to an excerpt from the book.