Harold S. Koplewicz, M.D., is one of the nation’s leading child and adolescent psychiatrists. Dr. Koplewicz is the founder and director of the Child Mind Institute (CMI)—a non-profit, started in 2010, dedicated to improving the mental health of children. Dr. Koplewicz is a member of the Autism Science Foundation’s Scientific Advisory Board. ASF intern Max Rolison interviewed Dr. Koplewicz about the Child Mind Institute and psychiatric components of autism.
What is the goal of the Child Mind Institute?
Simply put, the goal of the Child Mind Institute is to transform mental health care for the world’s children. We are building the only independent non-profit exclusively dedicated to improving the mental health of children everywhere, and collaboration is the key to our success. We provide the latest evidence-based treatment at our offices in New York and around the country and the world via travel and telemental health; pursue and enable cutting-edge basic science and clinical inquiry both by our own researchers and in our network of partners; and educate the public about children’s mental health and the need to address it through our website, our partners, and through national public education campaigns.
What is the Child Mind Institute currently focusing on?
Our core missions: we’re expanding the reach of our clinical practice with technology but also with scholarships so that children who might not otherwise have gotten care get treatment. We’re building up our research arm so we can launch studies at the end of the year. And we’re moving towards our next education event, a symposium in the fall featuring top scientists that we hope will encourage a younger generation of researchers called On the Shoulders of Giants.
What services are available at the Child Mind Institute for individuals with ASDs?
Diagnostic services like the ADOS; medication management for disruptive symptoms and comorbid conditions; and neuropsychological testing and educational assessment to help parents get their children into the classes that can benefit them and the accommodations they deserve.
What advice would you give to parents first receiving an autism diagnosis?
- Stay calm and think about yourself and your relationship with your spouse or partner—a strong, loving family means better outcomes for your child.
- Find a very good professional whom you can trust to be the “captain” of your team. You will need a team of skilled folks to work with you and you need them to work together to help you. The “captain” of the team can coordinate activities, but also serves as someone to whom you can turn to ask tough questions while also creating a team you trust.
- Build networks
- Within your family – talk to your family (nuclear and extended) about autism, how it affects your child (and how it does not). Tell them that you will need their help
- Within your community – you can use the “A” word in public. It is not a mark of shame. Talk about the challenges you face as a parent and ask for help
- Within the Autism Community – you are not alone and need not learn everything new. Others have come before you. Ask for their help; learn from their experience.
- But, be careful as not everyone approaches the problems in ways that are scientific or rational (In other words, sadly, there are some predators);
- Remember: Your common sense did not disappear with the diagnosis of autism. You are still a good parent who has good instincts and judgment. You just have a new set of challenges to face.
How does autism relate to other psychiatric disorders?
What we don’t know, but would like to know and hope to know soon, is how the underlying biology and structure of the brain of a child with autism relates to a typically developing brain and also to other disordered brains; we’d also like to know how the gene-environment interactions compare.
What we do know is that many other psychiatric and neurological disorders are comorbid with autism, including anxiety, OCD, seizure, Tourette’s. Like many psychiatric disorders, autism is a syndrome that is a reflection of brain function. The brain is a large, complex organ that is finely tuned to meet all the demands of complex human life. While we don’t know exactly how the brain is changed to create autism, we do know that it affects those circuits in the brain that are responsible for supporting reciprocal social interactions.
And truthfully, though all disorders can be seriously impairing, autism is one that permeates all aspects of life in a particularly forceful way, i.e. closer to bipolar or schizophrenia than panic disorder or dysthymia.
How is medication used to treat children with autism? How, do you think, this can be improved?
There are no medications to specifically treat autism. However, there are medicines that are very effective in treating some of the symptoms of autism, particularly those that interfere with other learning and social interactions (such as irritability, restrictive and repetitive behavior, poor attention and problems with emotional regulation). Most medications are used in conjunction with excellent behavior management, social skills training and educational programs – indeed, good medication therapy is designed to optimize the use of the other therapies.
We also have treatments for all of those co-occurring conditions I just mentioned, so medication can definitely help kids who have autism even if it doesn’t help with the central difficulties.
The medications we have today are pretty effective. However, until we know a cause, designing specific medication treatments will not be possible. But, as with most other areas of medicine, even when we don’t know the cause, we can design and use medications to safely and effectively reduce the symptoms of a disorder. We can do this with autism just like we do with diabetes and other chronic medical disorders.
What do you think could be improved in autism clinical care?
We need better educated clinicians in all disciplines. We need better educated public officials making policy. We need to reduce the stigma and the blaming of parents. We need to make services available to everyone who needs them
We know that certain behavioral therapies are effective, but much more so when the intervention is early, so screening and parent and pediatrician education leading to early diagnosis will have a direct impact on clinical effectiveness. And we need to make sure that all kids who are identified can get treatment, which means getting the government, the states, and the insurance companies to recognize and fund these interventions. The fact is that they are costly, but this is a complex and very difficult disorder even for “high-functioning” people.
Do you find that children with autism face the same type of stigma that children with other psychiatric disorders face? How is this stigma being addressed?
Yes and no. Every kid with a disorder can often feel ashamed and outcast, and get bullied. But kids with autism can have the added burden of a) in all honesty, some really odd behaviors, and b) limited social knowledge and understanding. This can really put them at sea. And of course parents of kids with autism have had to weather a litany of awful opinion, from “refrigerator moms” to today, when people wonder why they can’t just control their kids. The only way to combat this stigma is through knowledge, education, and the advancement of the science that will reveal the causes and course of mental health disorders, particularly autism.
To learn more about the Child Mind Institute, please visit their website www.childmind.org.
Child Mind Institute
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New York, NY 10022