Family Game Night Can Make You Smarter

By Scott Benson, M.D. 

My daughter brought two treats when she came home for college break.  A new game, Bananagrams, and a new book by Richard Restak, M.D. and puzzle master Scott Kim called The Playful Brain: the surprising science of how puzzles improve your mind. 

In this collaboration, Kim shares some of his favorite puzzle formats, and Dr. Restak explains the science behind the games.  Together they cover a wide variety of puzzles that have been shown to keep us alert, thinking, and youthful in mind and spirit.  fMRI data (which shows electrical activity in different parts of your brain) helps to tease out which areas of the brain are activated as people solve different types of puzzles.  

Scientists have not been able to prove a direct link between these forms of brain exercise and prevention of various forms of dementia.  But the puzzles, and games like Bananagrams, provide a focus for interpersonal interaction – playing with your family, talking with your neighbors – which does have a powerful effect on mood and our sense of well-being. 

Summer is the perfect time to bond with your kids in a board game challenge.  How do you get your family to put down their cell phones and turn off the TV to play a game?  Please share suggestions!

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Bipolar in kids? Probably not.

By Scott Benson, M.D.

The 5-year-old little girl had been referred to a therapist by her school because of her severe disruptive behavior. The almost daily tantrums had everyone concerned. She was uncooperative with the assessment and arrangements made for further evaluation. The therapist wrote a diagnosis of bipolar disorder.

The patient was certainly reactive to any limits and her tantrums seemed like they would never end. But she slept well at night; she rarely had behavior problems with her grandparents who provided afterschool care.

After a few parent training sessions with the little girl and her parents her behavior control improved. But continued treatment was threatened when her dad tried to get her on his new health insurance. The diagnosis of bipolar got the application bumped by the computer and it took a lot of calls and several letters to get her on the policy so that her treatment could continue.

At times it seems we are a little too quick to throw a label on a child’s behavior, and bipolar disorder seems to be the most popular current label.

But new research at the October meeting of the American Academy of Child and Adolescent Psychiatry found that children with some symptoms of mania probably do not have bipolar disorder.

Boris Birmaher, M.D., a child and adolescent psychiatrist at the University of Pittsburgh presented his group’s research. More than 2,000 children presenting to 10 different academic centers were included in the Longitudinal Assessment of Manic Symptoms (LAMS) study. 621 were found to have elevated symptoms of mania, but the full evaluation did not find sufficient symptoms for a diagnosis of bipolar disorder. Most had attention deficit hyperactivity disorder (ADHD), others had another disruptive behavior disorder. Children who did have bipolar disorder have poor function and are likely to require treatment in hospitals.

"Kids with manic symptoms don't necessarily have bipolar disorder," he told Reuters Health. On the other hand, "Many children with bipolar disorder are not being correctly diagnosed."

The LAMS study which will follow these children for five years should provide direction for the assessment and treatment of children with severe behavior problems. In the mean time parents should insist on an adequate evaluation for children with severe behaviors.

The Parents' Medication Guide for Bipolar Disorder in Children & Adolescents is a great source of information for understanding the evaluation process and treatment options. Or visit HealthyMinds.org for more information on bipolar disorder or mental health issues in children.

ADHD: Can My Kid Just Outgrow It?

By R. Scott Benson, MD


Won't he just outgrow it? This is the wish of every parent – that a little time, a little more love, or discipline, or happy thoughts will solve what might be a serious problem. And I hear this question often from parents of pre-schoolers who are having behavior problems in pre-K programs or daycare settings.

But we can’t wait. And now there is even more research to support the importance of a careful evaluation and treatment when indicated. This month’s Archives of General Psychiatry reports the results of a long term study of children who were diagnosed with ADHD between the ages of 4 and 6 years old. There was a control group of children without ADHD. As adolescents the children with the early diagnosis of ADHD had higher rates of depression and suicidal thoughts. Fortunately, there were no suicides in this study. Benjamin Lahey, Ph.D., the study director is a professor of health studies and psychiatry at the University of Chicago. He said the study “reinforces our belief that parents of young children with ADHD should pay close attention to their child’s behavior and its consequences and seek treatment to prevent possible long-term problems.”

So the better question is “What treatment is recommended for pre-schoolers?” And we have good science to help answer that question. Carefully managed studies have shown that pre-school children and their families should have at least 12 weeks of behavior management training as a first level of care. And this is not just any behavior management. At a conference in Florida, Dr. Regina Bussing recommended that families should consider a number of behavior training programs – the Positive Parenting Program, The Incredible Years, and Parent Child Interaction Therapy. These are intense programs that are very different from a few words of advice from a well-meaning pediatrician or the do-it-yourself manuals that are so prevalent in the bookstores.

Let us know of other successful behavior training programs in your community, and we will post those links here.

Does the sandman still come to your house?

By R. Scott Benson, M.D.

Keeping children up at night?

Some worrisome stories were on the evening news last week; but the part of the news broadcast that caught my attention were six ads for medication to promote a peaceful night of sleep.

These ads are having their desired effect as I have more and more families expressing concern about their children’s sleep. They read the stories about shifting school start times to improve teens’ school performance, but the first question they ask me is usually about the latest new medications.

Research is clear: there are many things that should be done before we reflexively open the medicine cabinet.

1. Consider the impact of 24-hour access to electronic communication tools. Does your child keep a cell phone in their room overnight? To talk to whom? 
2. Remove televisions and computers from children’s bedrooms. There is strong evidence that easy access to these devices interferes with sleep.
3. Watch out for shifts in sleep schedules on the weekend. Most of us thought we could stay up late on weekend nights, make up for the sleep by staying in bed until noon on Saturday, and sleep in again on Sunday. But it only takes these two days to reset your biologic clock. No wonder that Monday finds a body at school but the mind is home in bed.
4. Plan evening routines so your child finishes activities (including homework) more than an hour before planned bedtime. It takes a while to settle after an hour of frustrating work on spelling words.

The first step in evaluating any concern about sleep is keeping a careful sleep diary. There are samples available at SleepEducation.com, the website of the American Academy of Sleep Medicine. The University of Michigan has a wealth of material on their website devoted to children’s sleep problems.

Sleep tight.

Caregiving and Youth

By R. Scott Benson, M.D.

I met a remarkable young woman last week. Sarah (not her real name) was only 15 years old so she couldn’t get a summer job, so she offered to help with her grandmother who had recently returned home from a brief hospital stay. Sarah was pretty excited about the opportunity since she always felt that she was her grandmother’s favorite.

After a few weeks Sarah had what she described as a pretty typical panic attack. Her parents weren’t particularly surprised since Sarah had had some problems with anxiety when she started middle school. Those problems resolved with brief therapy. They quickly arranged for a reevaluation aware that she was at risk for a recurrence of her anxiety problems.

Before she came for the visit she had experienced a couple more panics and was having trouble settling for sleep at night. She couldn’t identify any new stressors. She was positive about her family and peer relationships. She told me her time with her grandmother was going well and she enjoyed the responsibility. She did tell me that her grandmother needed someone with her and the family didn’t have any other easy options.

We reviewed the tools she learned in the sixth grade for control of her anxiety symptoms. Her schedule was a little cramped and she had dropped her regular exercise (she is a runner). We got that going again, talked about her sleep and agreed on a follow-up appointment.

That week Sarah continued having panic attacks and some crying spells. I asked her to tell me a little more about the time she spent with her grandmother. At first she was hesitant since she didn’t want to complain – “Sometimes it’s hard, but it’s okay.” I pressed for more, and she began to cry. It was turning out to be harder than she thought it would be. Her grandmother had gotten mean and complaintful. Nothing Sarah did was right.

She could tell her grandmother was getting forgetful, but she wasn’t prepared for the repeated accusations that it was Sarah who was misplacing, even hiding things from her. Sarah, ever dutiful, would retrace her steps, offer reassurances to her grandmother, only to hear the same accusing questions a few minutes later. The worst for Sarah was her grandmother’s angry name calling, accusing Sarah of stealing, questioning her behavior with her boyfriend, claiming sexual behaviors that never happened.

Sarah had kept all this to herself even questioning if some of these hurtful accusations could be true, thinking her parents would disbelieve that her grandmother would say such things, worried what would happen to her grandmother if Sarah didn’t “tough it out” and help the family keep her grandmother in the family home.

Sarah was relieved to get these problems out in the open. She agreed that we should share these problems with her mother. Her mother was concerned that Sarah was having such a struggle with the grandmother; she knew there were some memory problems but had not seen these behaviors. Both were relieved to hear that these were not unusual behaviors in elderly persons with early dementia.

Sarah’s mother agreed to talk with their family physician about an evaluation for her mother. I talked with Sarah and her mother a little about strategies they could use to help Sarah with some of the stress of this caretaking responsibility. I suggested they look at the information available through the Alzheimer’s Association and the AARP site on caregiving.

Families will be challenged by increased demands for caregiving as the baby boom generation ages. A lot of this caretaking will fall on mature children and adolescents. Currently, there are estimated to be 1 to 1.3 million teens who have caretaking responsibilities. A lot is written about the demands on adults put in a caregiving role realizing that they are subject to depression, anxiety, and burnout. Teens in caregiving roles face the same risks and we need to be prepared to provide the support they need. Some communities have recognized this problem and started programs to provide these young people with the support they need. One program, the American Association of Caregiving Youth in Boca Raton, FL, is bringing national attention.

There is also information about Alzheimer's and the mental health of seniors at HealthyMinds.org.
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But not my kid!

By R. Scott Benson, M.D.

A recent study by the Jed Foundation and the American Psychiatric Foundation showed that most parents of college age children understand that there is a high rate of depression, suicide, and substance abuse problems in college.

“But not my kid!” Nearly two-thirds thought these problems would not affect their children.

Surveys of college students show that most experience important mental health issues in themselves or a friend. And other studies have shown that emotional problems are a leading impediment to college success.

Now that the excitement of senior trips and graduation has settled families are putting the finishing touches on a transition plan as their teenager moves to the excitement of higher education. Most families have discussed the obvious needs – a place to live, what courses to take, how to pay for all of it. But families should take time to discuss the possibility of problems and how to get help.

Since this new territory is fraught with emotional pitfalls the American Psychiatric Foundation has teamed with the Jed Foundation to develop a website of information that will provide a framework for this important discussion. Transition Year has material to help parents and teens learn the warning signs of problems. And systematically collect contact information preparing for the situation where help is needed. The site has collected links to reliable sources of information about psychiatric conditions that are often seen in college age youth.

The site would be useful to families who are still considering their child’s college options. An entire section on “Choosing a school” provides guidance on important issues to explore in order to find a best fit.

Of course in some communities the choice is simple. Go, Gators!

Won’t they do other drugs?

By R. Scott Benson, M.D.

This is a question I get every time I talk with a family about medication treatment for their child with attention deficit hyperactivity disorder (ADHD). And the best answer has been “some will, some won’t”.

But at the APA meeting in New Orleans there was a report from the research group at the Mass General in Boston. They have been able to suggest answers to a lot of question about the outcome of children with ADHD. There is a higher rate of substance use problems in adolescents and adults who have a diagnosis of ADHD. But in this 10 year follow-up of children they asked “What are the predictors?”

Their data confirmed that a diagnosis of ADHD was associated with an increased incidence of drug and alcohol problems. But the finding of severe conduct problems in these children was even more highly associated with future substance use problems.

The take home message for me is that medication alone will not be sufficient to address the severe problems that many children with ADHD present. Parent training, especially for those with severely disruptive behaviors, is a necessary, integral part of their treatment.

Talking about Mental Health

By R. Scott Benson, M.D.

In May a few years ago I was asked to give a talk to the seniors who exercised at the mall in the early morning hours. The timing was right for a mental health talk, since May is Mental Health Month.

The focus of my talk was new understanding of the brain and changing thoughts on the cause and treatment of mental illness. The audience was attentive but asked few questions. But after the talk an elderly man approached to clarify some comments I had made about schizophrenia. He called his wife over and they shared the painful story of their adult son’s deterioration as he developed unmistakable signs of this tragic disease.

This couple had been told by the treatment team that their parenting had caused their son’s condition and they needed to leave him alone so that he could recover. And they had carried a burden of guilt for years, viewing themselves as somehow toxic. I was able to answer a few of their questions and then I was encouraged them to join other families involved with our local chapters of Mental Health America and the National Alliance on Mental Illness.

The positive impact of these brave families sharing their stories was reinforced in a new survey from the American Psychiatric Association. And the results of this survey are a cause for celebration telling us how far we have come. More than a third said that stigma has declined, and openness about personal experiences by friends, family and public figures was influential.

The internet has become a valued source of information and was cited by 75% of those surveyed as at least moderately influential in reducing stigma associated with mental illness.

In addition to HealthyMinds, what are the reliable sources of information that have been useful to you? Where have you heard patient and family stories that have reduced stigma in your community?

On learning to worry

By R. Scott Benson, M.D.

Mardi Gras is a big celebration in my town and after the parades and the parties everyone picks up the idea of Lent and sacrifice. The best one I heard was a friend who decided to give up worrying for Lent. A good choice.

Psychiatrists have long recognized the toxic effects of excessive worry but too often pick up the mantra – “don’t worry”. Good advice, but usually it’s not enough. Research in cognitive behavioral therapy (CBT) for obsessive compulsive disorder sent me in a different direction. Engage your worries! Give them the attention they demand! With a little discipline.



I instruct my patients –

1. Make a list of your worries. Watch for duplicates. Worries are like that. They change a little to try and sneak back into your thinking.

2. Set aside time twice a day to get out your “worry list” and read through it. Try for once in the morning, and again in the late afternoon. Think English tea time. Give each worry the time it deserves. Pay special attention to any that you can do something about today.

3. If a new worry comes up you can add it to the list. This is especially useful for those late night worries that make it hard to fall asleep.

4. If worries try to get on your mind outside of your “worry time” gently remind that worry that you already have worried about it, and it will have to wait until the next worry time.

Worriers believe that they worry about everything, all of the time. Putting order to their worries helps them reframe the problem and put it in a correct perspective.

Helping children with transitions

By R. Scott Benson, M.D.

Before the New Year I shared the story of the family who was having trouble getting going in the morning. I touched on a couple of general principles for improving behavior. Structure, not punishment. Measuring the problem, and measuring the results.  Let me give another example.

Many children have trouble with transitions – moving from one planned activity to the next. The underlying problem is likely anger at being deprived of the fun of this activity and a little bit of anxiety about the unknown of the next activity. They might know in their thinking brain that the next activity will be fun, but the impulsive emotion for many children is fear. They have to “get a grip” on this fear in order to move to the next activity.

A mother asked for help with managing the meltdowns her four year old had when it was time to leave grandmother’s to go home. And it was frustrating because there had been a similar meltdown when they first left home to go to the grandmother. And he was having a great time while he was there.

Our plan – engage her child in a discussion. And these discussions are much later, even another day, or a Saturday morning. “I have noticed that when we are at grandmother’s and I say ‘It’s time to go home.’ Ka-boom. A meltdown. (You need to find a name for the behavior you want to eliminate. That way you have a code word for what you are measuring). Well, is there another way I could say it so that you didn’t get into your meltdown and waste 15 or 20 minutes.”

Your child might have a suggestion or no clue. Offer something silly like – “The lettuce is wilting.” This absurd statement when it is time to go will get him in his thinking brain trying to figure out what you are talking about. Use this as a starting point to script him for the transition. “I will say, ‘The lettuce is wilting.’ And you will say, ‘Does that mean it is time to go?’ And I will say, ‘Yes.’”

Practice this script two or three times until everybody has their words right. Then take it for a field test at grandmother’s. If there is success keep track with punch cards that can be traded for something reflecting the “time saved”. Maybe a movie.

If unsuccessful, re-work the script and practice, practice, practice.

Are there other behaviors that are a challenge at your house? Have you found strategies for success?