Child Mind Institute Summit: A Conversation with Dr. Harold Koplewicz and Secretary Hillary Rodham Clinton

Since 1980, NYC-Parents in Action’s mission – to help parents keep children safe from drug and alcohol addiction and guide them toward sound choices – has been our goal. Over time, natural allies in this cause (especially at the intersection where mental health issues and addiction risk meet) have become invaluable expert partners, bolstering PIA’s efforts. Two such organizations, to whom PIA is very grateful, are the Jed Foundation (JED, founded in 2000) and the Child Mind Institute (2009).

For over 30 years, PIA has heard and learned – from the experts, our schools, the culture at large and our own parent discussions – that mental health can affect a child’s freedom from, or susceptibility to, substance abuse and harmful choices. Successfully countering the latter means sensitively monitoring, nurturing and guarding the former. We hope to bring to our parents the most current thinking on how best to accomplish this.

Our Fall Seminar in cooperation with JED probed these issues with an expert panel. In November, I attended the Child Mind Institute’s Summit on The State of Child and Adolescent Mental Health, a conversation between Harold Koplewicz, MD (President, Child Mind Institute) and Hillary Rodham Clinton (67th Secretary of State; author, It Takes a Village), moderated by Willow Bay (Dean, USC Annenberg School for Communication and Journalism).

The Summit opened with an articulate and wrenching testimonial from a young NYC independent school student, Alex, who in Middle School became severely depressed when she was bullied; scorned for being friendless; and targeted by peers, who proclaimed a “Hate Alex Day.” Alex spoke frankly and feelingly of the isolating experience of depression, yet showed in her confident cheerful delivery that recovery is possible. After consultation with CMI, Alex and her family found the support and treatment needed for her to get well.

The moderator, Willow Bay, then turned to Secretary Clinton and Dr. Koplewicz for their thoughts on teen mental health and the related factors that may have significant impact.

Secretary Clinton noted a societal need to “do more to give communities tools to support people’s struggles with mental health.” Dr. Koplewicz agreed, and pointed out that research is poised to help fulfill that need. He noted that the “science of the brain has expanded over the past two decades,” bringing a better understanding of how growing brains change; he further noted how that understanding has helped clinicians develop “evidence-based treatments that work” – very important during the teen years, when brain changes occur at a rapid pace.

Brain change is “especially dramatic in adolescence,” he said. A process known as pruning begins at age 13 and continues to age 24 -25. This process “makes it easier to learn,” but also makes it easier to acquire bad habits; “plasticity” eases the road not only to learning but also to addiction. In CMI’s 2017 Children’s Mental Health Report, Dr. Koplewicz writes, “Adolescence is a time of unprecedented cognitive . . . growth and vivid experiences of new ideas, feelings, and ambitions. It’s a period of intense learning and development, but it is also a high-risk period for impulsive behavior, and for the onset of mental health and substance use disorders.”

By age 24-25, a young adult may use “more caution,” but such protection is thin from age 13 – 21. He offered some challenging mental health statistics: 50% of disorders (as varied as depression, anxiety, addiction, and suicide ideation) begin before age 14, and 78% before 18. For girls aged 15 – 19, suicide is the leading cause of death, with the incidence rate rising around the time school starts.

Secretary Clinton observed it is key to “ensure information is readily available to parents and their kids” to help them navigate the shoals of pre-adolescence and adolescence. “We dump so much on the schools to do,” she said, expressing hope that received knowledge would match our confidence in the schools’ ability to help. She advocated for both better in-school programs and greater parental access to solid, usable information.

Dr. Koplewicz agreed, and likened current school mental health education to the AIDS prevention curriculum that developed in schools over time: during the height of the AIDS crisis, parents wanted schools to teach the children about the virus, and programs were developed in response. Now, he said, while health education has improved overall, “a mental health curriculum should be standard” in schools.

Asked about a link between drug use and mental health, Dr. Koplewicz noted that marijuana use negatively affects the teen brain: it is associated with a heightened risk for addictions, up to three times the normal risk for later drug dependence, if use begins before age 18. Further, the link between persistent marijuana use and declines in IQ (irreversible even if use is stopped) “is exaggerated in adolescents who begin chronic use of marijuana before age 18.”

The rapid pace of brain changes in teens also leaves them vulnerable to depression and anxiety, researchers believe. According to CMI’s 2017 Children’s Mental Health Report, “anxiety disorders are the most common mental health disorders of childhood and adolescence.” Dr. Koplewicz said a third of teens suffer from some form of anxiety disorder, and while it is normal to be anxious at appropriate times (e.g., in response to an alarming circumstance) a child who habitually responds to environmental triggers with high alarm and anxiety, may have an anxiety disorder. He added that 35% of vulnerability to anxiety disorder is genetic. “Genes load the pistol,” he said, “and the environment [provides] the triggers.”

Dr. Koplewicz would like to see mental health and learning disorders tackled in earnest; he noted that this country has “tackled polio, AIDS, seat belt use, DUI, peanut allergy and asthma. We also need to tackle depression, anxiety, ADHD.” He added that research shows that when a combination of cognitive behavioral therapy (CBT) and medication is used, the results have been good: “When kids stick to the combined treatment for 10-12 weeks, it is very effective.”

Secretary Clinton noted that college administrators are “deeply worried about the increase in anxiety and depression,” they face on campus, and that they’re trying to put in place the tools to cope. The fastest rising budget piece at Harvard, she said, is funding mental health offices.

Dr. Koplewicz warned the audience of a link between increased anxiety, and increased use of smartphones and social media. According to CMI’s 2017 report, teenagers and young adults ages 16-24 are the most intense users of social media, with nearly 90% using the internet for their social networking. However, despite some benefits of social media (high connectivity with friends, ability to maintain a broad social circle) there is also “evidence that overuse has a negative impact on self-esteem.” Further, no matter how rewarding social media use may be for your child, it doesn’t necessarily make her happier: heavy usage leads to an increase in reported unhappiness. Eighth graders who spend 10 or more hours a week on social media are 56% more likely to report being unhappy than those who spend a lesser amount.

Secretary Clinton cautioned, too, that internet content can trigger not only disorder in a child, but disorder on a societal level. Both speakers agreed there is “toxic material” on the internet. Secretary Clinton sounded a note of caution on radicalization via the internet. Dr. Koplewicz noted the “contagious quality” of “wanting to belong” that is so strong in teens; the internet can play a role in enticing kids with group belonging. Secretary Clinton wondered if the internet could be used to distribute helpful messages to teens, and Dr. Koplewicz cited movements like “It Gets Better,” and other organizations with web presences designed to help troubled teens. Both speakers noted there is a positive role to be played by social media and internet, but that this is a good time for serious conversation on the subject: “The soul-searching over technology that is going on right now, is a conversation we need,” said Secretary Clinton.

There is a physical price to pay too, with high usage of social media and the internet; it is associated with lack of sleep. According to the CMI report, teens who spend three or more hours a day on electronic devices are more likely to get fewer than seven hours of sleep. “Students need sleep!” Dr. Koplewicz stated. “Less than seven hours increases the risk of vulnerability” and of the likelihood of anxiety levels that can lead to a disorder. It can be a vicious circle – teens who don’t get enough sleep may become more anxious and depressed, and then, depression can make it harder to sleep. And, without treatment, the temptation to relieve bad feelings by self-medicating with drugs and alcohol, may become overwhelming.

Both Clinton and Koplewicz stressed that communication between parent and child is crucial. Start conversations early, continue in middle school, and don’t let up in high school, they advised. Build in regular, “non-screen” time to talk. Talk to your kids, directly, about their day. KEEP THE CONVERSATIONS GOING, they both urged.

Parents may not realize it, but they are still, no matter what, the most influential presence in a pre-teen and teen’s life, noted Dr. Koplewicz. Establish early a habit of putting your outsize level of influence to good use. Your opinion matters; make it count.

Dr. Koplewicz recommended that parents borrow the cognitive behavioral tactic of harnessing the power of positive reinforcement – a “grab the good, ignore the bad” approach:

1) GRAB onto good behavior – when you see it offer PRAISE.
2) IGNORE mildly bad behavior – DO NOT reinforce it with attention.
3) INTERVENE for really bad behavior – halt it quickly.

“Adolescence always pushes the envelope,” he said. But parents can counter the most unhealthful outcomes of that instinct by keeping lines of communication open, by staying involved and setting aside non-screen time to be present with their child, to talk with him, to stay close. Start early, he said. Establish communication and keep it going.

For parents who know our mantra – Be Informed, Be Involved, Be Connected – this is familiar ground. While we cannot control every step as our children’s brains and independence expand, we can and should keep lines of communication open so we are poised to see the signals we need to see, before they lead to emotional pain, risky behavior or dangerous situations.

For a window into the teen perspective, come to our annual Teen Scene, on February 12th and hear NYC independent high school students “tell it like it is.” It’s an opportunity to hear, straight from the “envelope-pushing” source, how it really feels to live the highs, lows, stresses and rewards of adolescence in New York City. Register now!

Melanie Wells, Editor