It Starts with Love and Ends with Love

What an honor to interview fashion designer, YouTuber, makeup lover and reality TV personality Matt Sarafa this week. Matt describes his love of fashion that was sparked at age 7 watching Project Runway. During the interview he reports his “guilty pleasure” being reality television. Guess what? His passion for fashion and the path he paved for himself landed him on the Lifetime reality show Project Runway Junior! He described making friends with the other contestants that share his love for fashion as a gift that he will cherish lifelong. It gets even more exciting for Matt… Kelly Osborne rocked his ‘Hot Mess’ jacket on Instagram and again on a Cosmopolitan video during this exciting launch of his fashion career. His ‘Hot Mess’ clothing line will be out end of summer/early autumn 2016 just as he starts as a freshman at UCLA!

 

“Once I discovered fashion I became less anxious. I have always been an anxious person,” Matt described during his interview. He reports his anxiety vanishing once he was aligned with his pursuit of a career in fashion coupled with coming out as a gay male to his family. He reports spending many years,”caring about what other people thought of me.” “It really does not matter what other people think of you. It really does not matter,” Matt stated with conviction.

 

We talked about the importance of self -love and being your own best friend.

Matt was grateful to have such loving friends and family during his coming out process. “I wish I would have done it sooner. I have 100’s of teens reaching out to me on social media about their fears about coming out as gay, bisexual, or transgender.” His advice on coming out, “Do it when you are ready.” Matt discussed the strong influence of social media with his generation. His tips are: be kind, be authentic and be positive with this powerful medium.

 

Matt and I discussed his strong desire to continue to be a role model and to be of service, “I am addicted to giving back.” His mother was a social worker at Children’s Hospital Los Angeles before Matt was born and a yearly Sarafa family tradition is to adopt a family in need at the hospital during the holidays. Matt is setting the intention to carry the spirit of service throughout his life and has set hopes with the success of his fashion career that he can give to charities that support HIV research and to charities that raise awareness and support the LGBT community.

 

Professionally as a psychiatrist and personally as a trusted friend, I have had the privilege of being a listening ear when people are experiencing fear or anxiety about self-expression of sexuality or gender identity. While I was in residency at Emory University I was fortunate to be asked by my gay colleagues to be a co-therapist of a gay and lesbian group in which young adults were at different phases of self acceptance with their sexuality and their coming out process. I felt honored to have been chosen to have this experience and as a doctor I found it invaluable for my work as a mental health professional.

 

“Love is love,” was the biggest take home point I learned.

 

As a child psychiatrist I have had teens struggle with their sexual and gender identity and parents who feared for their children if it was true that they were gay. One Mom in my practice was labeled by her son as the “trophy Mom” as she had handled her son’s coming out process with flying colors. He did not know that she had sought out therapy with me and attended an LGBT parent group before he had formally told her. Being open, loving and accepting is crucial for the best support of yourself and your loved one.

Here are some tips that I have found helpful throughout the years:

-Do not force or rush your (or your loved one’s) self discovery of sexual preference or gender identity. It is a very personal process.

-Confiding in a trusted friend, or loved one is invaluable.

-Seek out therapy as you feel necessary as there are many feelings to sort out; having a neutral party can be extremely helpful.

-Remember there are LGBT support groups for teens, adults and parents to call upon in your community.

-Be patient with loved ones that have different beliefs about sexuality and gender preference. You cannot control their initial reactions whether they respond in a positive, neutral or negative way.

-Self love and being “your own best friend” is an essential ingredient for mental health and wellbeing.

 

Thank you Matt Sarafa for sharing your wisdom and your thrive story this week on my podcast. To listen: (Matt Sarafa Podcast on the Dr. Denise Show).

Dr. Denise

Pediatric Addiction

Are you ready for the latest on pediatric addiction? I was fortunate to attend the American Physician Institute 6^th Annual MasterPsych conference in Laguna, California. I was struck by the passion, enthusiasm and compelling data presented at a lecture on Substance Use Disorders in Children and Adolescents by Dr. Ximena Sanchez-Sampler, a Harvard addiction psychiatrist. She shared with us that someone she loved experienced a fatality that was substance use related. The room was silent, you could sense the compassion we all felt for her. With strong conviction she reminded us that, “Adolescents are not little Adults!” All adolescents, regardless of demographic, racial or ethnic factors, are at risk for substance use and associated problems.

 

Dr. Sanchez-Sampler discussed that until recently, brain development was thought to be complete by age 10. “Through brain imaging technology (fMRI) we have learned that maturation process of the human brain is not complete until age 24 or 25.”

 

Why is this important?

 

Adolescence is a time of critical brain development, especially in the parts of the brain needed for complex tasks, organization, planning and judgment.

 

Remember a teen brain and an adult brain respond differently to a few drinks. “Dr. McDermott, I am less shy and I am more fun when I have a few drinks at a kick-back.” Teens let loose, are socially disinhibited and this makes the experience rewarding enough to repeat. Adults usually just get tired and fall asleep!

 

Did you know that 47% of children who have their first drink before age 13 are at risk of an alcohol disorder in contrast to 9% who have their first drink after 21? (Arch Pediatr Adolesc Med. 2006;160:739-746)

 

Did you know that 17% of children who first use marijuana before age 13 are at risk of a marijuana disorder in contrast to 4% who have their first use after 21?(Substance Abuse and Mental Health Service Administration (2010))

 

Fact: Addiction is a pediatric disease. Early intervention, education and prevention are essential to change the statistics above.

 

Can research-based programs prevent drug addiction in youth? Yes! To access the data and the recommendations go to drugabuse.gov and type in NIDA’s Preventing Drug Use Among Children and Adolescents: A Research Based Guide for Parents, Educators and Community Leaders.

 

I find that kids do better when a discussion about substance use comes up organically. The headlines, sitcoms, movies, and advertisements give all of us plenty of opportunity to offer teaching points. It is always better to ask open-ended questions such as “What do you think about that?” Quality time with your child or teen leads to open communication. It is important to spend time doing fun activities with each other which will foster respectful relationships with one another.

 

Another Tip: Substance Abuse often travels with undiagnosed mental health issues.

 

Ready for a thrive story? I am! John’s (pseudonym) first use of marijuana at age 12 was followed by abuse of multiple substances. He was caught dealing drugs, expelled, and sent away to residential treatment. Today he is re-enrolled in school, is at home with his parents and is being treated for his Generalized Anxiety disorder, ADHD, and his Substance Dependence. I find that keeping it real and direct with the teens in my practice is appreciated. Recently, I pointed out to him how happy I was that he was alive. He looked at me stunned when I said this and then smiled and said: “I could have been dead at least 30 times!” We discussed in therapy how his “savvy skills” and need for what I call “healthy adrenaline rushes” need to be put to good use. He is going to ask his Dad if he can take a real estate class this summer while still in high school as he has an entrepreneur itch that he wants to satisfy. He started seeing me while he was in acute crisis and now he is heading towards his “thrive zone.”

 

In summary:

Adolescent brains are not the same as Adult brains.

Addiction is a pediatric disease.

Substance Abuse often travels with undiagnosed mental health issues.

 

Your child can thrive if they know the facts about addiction and have early intervention with any other behavioral issues.

 

Dr. Denise

 

Childhood/Adolescent Depression

Can a child or teen suffer from depression? Yes. A thorough clinical assessment needs to happen and every environmental, physical and emotional dimension needs to be taken into account. Kids can experience “feeling sad” or “irritable” for many reasons: for being bullied, for dealing with parents getting a divorce, for moving to a new home, for not being able to do their homework. The list goes on. If your child is having marked changes in mood I recommend a visit to the pediatrician to make sure there are not medical contributing factors (thyroid disorder, metabolic problems). The pediatrician is a great starting point to help guide you to the next step.

 

As a society we need to hold our mental health and wellness in the highest regard. It is essential in assessing a change in your child’s mood, irritability or sadness level to include a highly trained professional that has assessed childhood depression and knows how to address safety issues including suicidal thoughts and self harm. My professional opinion is that a child psychiatrist is the best choice to make this assessment. You would be surprised to know how often kids present with suicide or cutting behavior and I was the first one they shared this with. One complicating factor in providing adequate mental health services is that there is a shortage of child psychiatrists to provide the care that is needed. The solution is prevention, education and early screening as well as psychiatrists having collaborative relationships with pediatricians, psychologists, educators, other professionals and parents. This is a societal issue not just a medical issue. We need to build the infrastructure to support our children in a unified way.

 

The data shows that depression affects ~5% of all adolescents.

 

In clinical practice when assessing a child or teen for depression or any other presenting behavior a Child Psychiatrist follows the practice parameters of AACAP. A clinical interview with the child and the parents separately is standard of care. A review of report cards, standardized testing, behavioral rating scales, and gathering any other relevant information is part of the assessment. If a diagnosis is made then treatment is determined after weighing in on all of the factors for your child.

 

I believe that it is essential for psychoeducation to weigh in all the factors of treatment. Cognitive behavior therapy is an absolute part of the treatment of childhood depression whether medication is indicated or not. Coping strategies, family, and school environment are essential for the best long-term outcome. I am happy to say that I have many “thrive stories” of young adults that I see ~three times a year now that had appropriate treatment for depression as teens. They are attending top colleges, having children, and getting promotions at work.

 

Dr. Denise

Compassion In Action Coupled with Wellbeing

Last November I attended an event entitled Compassion In Action that Dr. Sonnee Weedn  organized with guest Humanitarian Buddhist Monk Lama Tenzin Choegyal. Words cannot express how peaceful and inspiring the morning retreat was in which he blessed our work and inspired all of us. Lama Tenzin Choegyal shared his spiritual path and adventure that started in 2000 when he traveled with his two brothers through the Upper Dolpo region of the Himalayan border between Nepal, India and Tibet. During his journey he rescued abandoned and neglected children and founded an orphanage called the Children’s Education Development (CED) Society (http://www.cedhouse.org).  At the present time there are over twenty children that are being educated and many are attending college.  You can watch Walk the Waking Journey, an 80-minute documentary that is a four part series on YouTube that describes Lama Tenzin Choegyal’s journey with the children of the CED house.  The children are being educated, loved, and are being raised to go back to their villages and/or be of service to the community at large.

The seed of attending this retreat was planted last July when I attended His Holiness, The 14^th Dalai Lama’s 80^th birthday party. I brought my husband one day and my sister and dear friends the next day.

Nobel Peace winners had all of us shouting “I have the power” as a reminder that we ALL can contribute with acts of love and compassion towards one another. 

The desire to make an impact on a more global level was in my mind and I felt as though I would be traveling to India at some point soon – it was a deep inner knowing.  When I met Lama Tenzin Choegyal and Dr. Sonnee Weedn in November of 2015 there was an unspoken shared alliance of being of service for OUR children.  Dr. Weedn and I exchanged emails about her work as a transformational psychologist throughout the year and ways we could collaborate.  I have humbly accepted her invitation to travel as her guest to Dharmsala, India to attend the 4^th International Conference of Men-Tsee-Khang (Tibetan Medical Society) this October in which the topic will be:  “Causes, Conditions and Remedies of Depression.” Dr. Weedn was invited to speak again by invitation from His Holiness, the 14^th Dalai Lama and Men-Tsee-Khang.   It is a great honor to have interviewed Dr. Weedn on my podcast this week in which we discussed many interesting topics with great emphasis on integrative wellness strategies.

Dr. Weedn discussed her presentation “8 Ways of Wellbeing” which is a compilation of the research Roger Walsh M.D., Ph.D. at U.C. Irvine that she presented at the 3^rd International Conference of Men-Tsee-Khang (Tibetan Medical Society) in 2015.

Here are the 8 essential ingredients to good mental health or TLCs (Therapeutic Lifestyle Changes):

1. Exercise – “Move it or lose it.”
2. Relationships- “Friends can be good medicine.”
3. Relaxation- “Examples are meditation and practicing mindfulness.”
4. Time in Nature- ”Just twenty minutes of fresh air can be therapeutic.”
5. Giving Back- “Acts of altruism.”
6. Nutrition- “Honoring your body with healthy food choices.”
7. Spiritual Practice- “Finding a community that emphasizes the practice of compassion and forgiveness.”
8. Recreation- “It is important to play!”

To hear a more in depth evidence based research about the TLCs above, you can listen to my interview with Dr. Weedn here: https://www.drdenisemd.com/2016/07/dr-sonnee-weedn-ph-d-csat/

For more information on Roger Walsh M.D., Ph.D and his body of work check out: http://www.integralhealthresources.com/integral-health-2/therapeutic-lifestyle-changes/.

As a society we are living at a time when we are conditioned to getting “answers in real time” and with our advanced technology “instant gratification” is OUR new norm.  Many people can benefit from modern day medicine when it is of absolute necessity, yet too often the “quick fix” of a pill is desired and lifestyle habits are ignored. Medicine has its place yet a “pill is not a skill.” Dr. Weedn and I discussed the evidence based wellness strategies above and we both agreed that prevention strategies and maintenance habits are key for mental health and overall wellbeing.

I would love to see the key ingredients of Dr. Walsh’s Therapeutic Lifestyle Changes be implemented globally and introduced to elementary school aged children and perhaps be called “Therapeutic Lifestyle Behaviors.” In the Manhattan Beach elementary school system here in Southern California the children are benefiting from Goldie Hawn’s MindUp program, a research base program with 15 lessons based in neuroscience ( http://thehawnfoundation.org/mindup/). Students learn to self-regulate their behavior and mindfully engage in focused concentration required for academic success with an emphasis on kindness and compassion as well.

Can you imagine a comprehensive global integrative wellness program that would be part of our school systems that covers the material from the MindUP program coupled with the 8 Therapeutic Lifestyle Changes? If we introduce these lifestyle habits to our children at a young age we can focus on prevention and wellbeing and set them up for a lifetime of thriving and resiliency.

Dr. Weedn and I covered many more topics on the podcast this week including her neurocoaching practice, her integration of her spiritual knowledge and her heartfelt work as the author of  “Many Blessings A Tapestry of Accomplished African American Women”  (http://www.manyblessingsbook.com)! She described this book as her greatest accomplishment.

I would like to express my gratitude for Dr. Weedn’s acts of compassion,, wisdom and significant contributions to wellbeing.

Dr. Denise

 

Autism: Gender Differences In Girls

 

Autism advocate, author and recent Loyola Marymount University graduate, Christine Motokane, boldly states on my podcast this week, “I am breaking stereotypes.” Understatement.

Christine shares her triumphs and challenges as a female with autism who was diagnosed at age four. As a teen she read many books about autism that she described were “very clinical” as they had been written by doctors, educators, professionals and parents. They were factually useful, yet she was craving information from others who were living with autism. She admires and respects, Temple Grandin (templegrandin.com), American professor, author and world-renowned autism spokesperson who has written many of the books that she has found the most helpful. Christine’s book about her personal experience, “Working the Doubleshift. A Young Woman’s Journey with Autism” was written to inspire, educate and raise awareness about autism and gives insights as to what it is like to be a female living with autism at a time when there are more readily available services. She states, “We all will be touched by someone who has autism at some point in our lifetime.”

In March of 2014 the CDC estimated the prevalence of autism as 1 in 68 children (1 in 42 boys and 1 in 189 girls). Did you know that boys are diagnosed with autism at a much younger age than girls that have Autism Spectrum Disorder (ASD)?

 

Maia Szalavitz’s article in the 3/1/2016 Scientific American Mind entitled, “Autism-It’s Different in Girls” is cutting edge and cites behavioral and preliminary neuroimaging findings that suggest autism in girls manifests closer to typically developing males in their social abilities than typical girls or boys with autism. The estimate of 1 in 68 children in the U.S. having autism is speculated to be higher due to the undiagnosed girls on the autistic spectrum. The article spoke about girls with autism being harder to diagnose for several reasons, including criteria developed specifically around males and overlapping diagnoses such as obsessive-compulsive disorder or anorexia. Kevin Pelphrey, a leading autism researcher at Yale University’s world renowned Child Study Center spoke about how even he did not recognize the condition in his daughter Frances, who was diagnosed at age five. They went from doctor to doctor, “They kept saying, ‘Oh, you have a girl. It’s not autism.” The criteria for diagnosing autism spectrum disorder (ASD)-a developmental condition that is marked by social and communication difficulties and repetitive , inflexible patterns of behavior-are based on data derived almost entirely from studies of boys. Pelphrey is now leading a collaboration with researchers at Harvard, UCLA, and University of Washington to conduct a major study of girls and women with autism, which will follow participants from childhood to adulthood. I believe this research will be groundbreaking and eye opening to many of the gender differences in behavior that we see not only in autism but in children’s mental health issues in general.

 

Christine addressed the many gender differences and biases she experienced first hand in her book, and during my podcast this week she shared: “Girls are better at masking their behavior.” Christine spoke about being initially diagnosed with attention deficit hyperactivity disorder, before getting her diagnosis of autism. Her speech delays, social interactions, sensory issues, and hyperactivity coupled with an astute observation from a relative led to an assessment at the regional center when she was four years old which started her path of intervention for autism. In her late preschool years she attended an invaluable six-week program at UCLA in which she made a lot of progress and the doctor told her Mom, “that I was going to be high functioning and that academics wouldn’t be a problem. However, I would struggle socially.” Christine has gratitude for “her village of support” which throughout the years has included her parents, relatives, behavioral therapists, doctor, aids, mentors, educators and other professionals. She writes about her village, and her experience on her blog~ redefiningnormalayoungwomansjourney.blogspot.com/.

Christine eloquently describes how dealing with a day at school can be exhausting from an emotional and a sensory perspective. “I think I have always had anxiety.” To cope with stress she takes walks once or even twice in a day, she also finds jumping relaxing; her “moving meditations.” She has cognitive strategies that she has learned from her behavioral therapy that are part of her daily thrive plan. She is passionate about raising awareness for the need to have a better support system for individuals with ASD when transitioning out of high school and into adult and college life. She and I discussed the need for a mentoring system. This would be much like a buddy system with other individuals that have autism that can mentor a younger person that is newly navigating the social challenges of having ASD. Christine has a lot of information and insight and is a self advocate on the Board of Autism Society for Los Angeles; you can follow her on Facebook by going to Working the Double Shift: a Young Woman’s Journey with Autism.

Here are some tips if your child is having social delays or behavioral issues:

-If your child is having social delays or restrictive interests, early assessment is key for your child to thrive. Ask your pediatrician for referrals to behavioral health professionals in your area.

-Pediatricians, educators, occupational therapists, and speech pathologists are often the first people to recognize social or behavioral issues with your child. Be open and receptive to observations, referrals and assessments. Knowledge is power.

– I highly recommend: New York Times Best Seller “NeuroTribes” by Steve Silberman as well as the “Thinking Person’s Guide to Autism: What you really need to know from autistic people, professionals and parents” by Emily Willingham, Jennifer Byde Myers, and Liz Ditz . Parents and teens in my practice have found these books very helpful!

I have exponential gratitude and inspiration for Christine Motokane for sharing her experience and wisdom with “US” this week. Thank you Christine!

Dr. Denise

 

 

 

Mental Health & The Importance of Sleep

“Psychiatrists and psychologists were like our version of superheroes,” a comment Ilana Glazer, actress, comedian, and previous student at NYU made about her experience with the CAMS (Child and Adolescent Mental Health Studies) program.  As Vice Chair for Education and Professor of Child & Adolescent Psychiatry and Pediatrics at the NYU School of Medicine, Dr. Jess P. Shatkin has contributed significantly to child psychiatry and is a true visionary in mental health education. As Founder and director of the nation’s largest undergraduate child development program, CAMS, he is leading the way in integrating tangible, engaging curriculum for our college students.  During the podcast this week he discusses the wide variety of classes that students can take at NYU while enrolled in the CAMS program on topics such as sleep, divorce, positive psychology and more! This is an example of an integrative mental health education curriculum that can have a life long ripple effect of tips and tools for wellbeing and hopefully attract some bright minds into working with children as educators, psychologists, psychiatrists or other mental health providers.

Why is it so important to encourage our youth to be aware of the importance of mental health and hopefully recruit them into the field?

We are experiencing a crisis in the ability to provide the mental healthcare for our children and there is a shortage of child psychiatrists in the USA. According to the American Academy of Adult and Child Psychiatry, there are approximately 8300 practicing child and adolescent psychiatrists in the United States- and over 15 million youths in need of one.  I have worked  > 40,000 patient hours since finishing my child psychiatry fellowship at UCLA in 2001, and I can let you know firsthand that being at the front line of mental health care is eye-opening.

Did you know that 70-80% of lifelong mental health issues begin in childhood?

I believe that all of the current practicing child psychiatrists need to “step up” to inspire, contribute, and collaborate on the mental health crisis that we are facing at this time in history. It is vital that we as a society embrace, integrate and encourage our children to strive for inner peace, happiness and wellbeing starting as early as possible.  Why? Being educated and empowered about your mental health is vital for happiness.

When individuals thrive, we all thrive.

Dr. Shatkin has started a “Mental Health Revolution” at the undergraduate level and he will be leading a consortium this fall in which other universities will model their programs after the NYU CAMS program.

Are you ready for an example of a CAMS course?

Dr. Shatkin teaches a sleep course at NYU entitled “While you were sleeping” where students learn about the science of sleep, hygiene, evolution and dreams and how getting better sleep can help reduce depression and anxiety. How cool is that class? It is practical, real & engaging.  Cynthia Haddad, who took the course in the summer of 2013 told the HuffPost, “I learned basically everything about sleep. We learned how it affects our bodies. We learned about how sleep affects us in our waking hours- the brain, body, emotionally. I learned the following and try to keep to these rules: Do not use devices up to an hour before bed; no caffeine past noon; and use the bed only for sleep and sex-so that when you get into bed, your body knows it wants to sleep.”

Data is key in making recommendations of what works and does not work when modifying behavior.  In 2014, Dr. Shatkin and his colleagues compared sleep quantity and quality between NYU students taking his course and those not. Students in Dr. Shatkin’s class slept 22 minutes longer on average per night after two months into the course and fell asleep 9 minutes faster! Dr. Shatkin presented his data at the annual AACAP meeting (American Academy of Child and Adolescent Psychiatry) and discussed how his study also showed that better sleep hygiene is associated with fewer depressive symptoms and less anxiety!

A great way to understand your (or your child’s) sleep pattern is to keep a sleep log to share with your doctor, which you can download at: http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf

The American Academy of Sleep Medicine recommends 7 or more hours of sleep for an adult.

As of June 13, 2016 The American Academy of Pediatrics (AAP) has issued a Statement of Endorsement supporting the American Academy of Sleep Medicine (AASM) guidelines outlining recommended sleep duration for children from infants to teens. The consensus group recommends the following sleep hours:

• Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health.
• Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health.

Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health.

Prevention, wellness and early intervention are crucial for mental health for our children.  We spend 1/3 of our life sleeping. Can you imagine if all of our pediatricians, parents and educators were educated and encouraged children to focus on sleep hygiene at a very young age?

Adequate sleep, nutrition, exercise and meditation can prevent many trips to the doctors office.

I tell my patients that my goal is for you to spend the least amount of time in a doctor’s office and on no medication or the least amount needed.

Here are some “Sleep Tips”:

• Regulate your sleep rhythm with a regular wake up and bed time.
• Eliminate or do not have caffeine after noon each day.
• Avoid or minimize alcohol use.
• Do not use electronic devices one hour before bed.
• Try to exercise no later than four to five hours before going to bed as it raises your body temperature which can make it difficult falling asleep (if you are exercising before bed and are having no difficulty falling asleep-keep exercising!)
• Use your bed for sleep or sex only.

Thank you Dr. Jess Shatkin, you are truly an inspiration to all of “US”! Your superhero cape is on its way to NYU.

Now – let’s start sleeping better!

Dr. Denise