Profiles in Special Education:
Dr. Harold Koplewicz:
Impassioned Pioneer, Educator, Innovator
Even his writing overflows with passion, confidence and good cheer. He is “THRILLED,” the announcement reads, that NYU’s Child Study Center has just “matched” nine of the “best” future child and adolescent psychiatrists in the country to continue their studies at NYU. In person, Dr. Harold S. Koplewicz’s ebullience is even more pronounced. Arguably one of the nation’s most animated advocates for improving mental health research and treatment for children and adolescents, he readily sprinkles data references with humorous and telling anecdotes, as he articulates progress made and research and clinical treatment to come, all the while giving generous credit to colleagues. His young clients and their parents, teachers, classmates, neighbors, friends, relatives—indeed, children all over the world—could not ask for a more informed and enthusiastic campaigner. His credentials include being The Arnold and Debbie Simon Professor of Child and Adolescent Psychiatry, Chairman of the newly established Department of Child and Adolescent Psychiatry at NYU (only the second such department in the nation), founder and director of the NYU Child Study Center, Professor of Pediatrics at NYU’s School of Medicine, and director of the Division of Child and Adolescent Psychiatry at Bellevue Hospital Center. He was also appointed last year by Governor George Pataki to be director of the Nathan S. Kline Institute for Psychiatric Research, one of two internationally known New York State-funded institutions doing pioneering research on dementia, schizophrenia, health delivery services and child psychiatric disorders.
Continually included in annual lists of best doctors, Dr. Koplewicz uses his reputation to advance the cause by way of media appearances and constant advocacy, anywhere. In the 9 years he has been at the helm of the Child Study Center (its location “once, a gas station, now, the leading such facility in the country”), he has dramatically increased funding and staff.
He is particularly determined to educate educators and the general public about mental health disorders in children—“more science, more education”. “There is no time to lose…we are in a public health crisis” and face a “critical shortage” of child and adolescent psychiatrists. We build access ramps for the physically handicapped, he points out, so why not also provide ramps for those with psychiatric disorders? Accommodations in testing are a start, but much more can be done in academic environments to level the field and enhance the learning process for these children. Even awareness and education is lacking; schools should include new scientific findings about brain abnormalities in middle school science curricula—their detection, diagnosis and treatment, in order to eliminate myths and misconceptions early. Why not have every medical school follow NYU’s lead in offering a minor to undergraduates that could lead them to consider becoming child and adolescent psychiatrists?
Of 6,300 child and adolescent psychiatrists in the United States, most are concentrated in a few big cities, leaving vast areas, in New York State alone, without needed professionals. Why don’t more medical school graduates enter the field? Preparation time, for one, says Dr. Koplewicz. Child and adolescent psychiatrists must not only complete their internships but also then go on for 2-3 years of general psychiatry, followed by 2 more in the specialty. Then there is the matter of relatively low prestige (psychiatrists get paid for the time they put in with a child, but not for the extra hours they may spend with parents, teachers, social workers, et al.). Moreover, adults recommend themselves for care and may be diagnosed within one or two sessions, while children, for the most part, do not want to attend sessions and may come from families who cannot afford extensive treatment. Dr. Koplewicz takes heart, however, from the recent enactment in New York State of Timothy’s Law, which provides insurance coverage parity for mental health, and locally he points to Parent Corps, a head-start-like pre-school program already in 30 schools in the city that aims to prevent behavior problems working with at-risk children prone to violence by teaching effective parenting and encouraging parent/school partnership (Education Update will explore this program in a future issue).
But myths and stigmas remain. Despite extensive research that shows that “genes load the gun, though environment pulls the trigger,” mommy bashing is still prevalent, along with parental denial (“he’ll grow out of it”). Too many families rely on drugs, as if pills, alone, could help children organize their world (medication may work but only for short periods of time during which children get more attention but not more treatment). Many parents may not know that untreated mental disorders in childhood inevitably lead to severe mental illness in adolescents, with dire consequences for the children, their schools, their communities, the country. What are the leading causes of teenage deaths? Accidents, homicides, and suicides. “They are related,” says Dr. Koplewicz, by way of anxiety and depression. An estimated 12 million children and adolescents, perhaps 1 in 8, suffer from some kind of mental problem which remains undiagnosed, untreated or under-treated—either by behavior therapy, medication or combined treatment. Attention Deficit / Hyperactivity Disorder (ADHD), the most common psychiatric disorder affecting children, if not early and effectively addressed, tends to result in even more severe learning disorders, depression, school drop out and violence. (New data, based on functional MRI modeling, suggests that ADHD brains look and may pulse differently.)
Although Columbine, 9/11 and media attention to autism have all contributed to make Americans more aware of mental disorders in youngsters, most adults remain ignorant of basic findings, such as the fact that 75 percent of adult mental illness starts in childhood or adolescence. Talk about putting the money where it’s needed—specifically from age 3 on, with major focus on the middle school years, a time of tremendous “turmoil” and neurobiological change. We must attract scientifically trained teachers to these grades and administrators who follow the latest brain research, says Dr. Koplewicz. “We’ve shown we can respond to AIDS education in the classroom, why not to learning disabilities and mental disorders? Tipper Gore may have done the nation good service in acknowledging her bouts with depression, but in not wanting to discuss her treatment, she missed a great opportunity to talk truth to power.
This interview wraps up late in the evening. Dr. Koplewicz has reports to go over before he darts home in order to have dinner with his “beautiful, patient, and supportive wife”, Linda Sirow, an art educator at the Dalton school.#