Christine-Motokane

Christine Motokane is a self advocate on the Board of Autism Society of Los Angeles, an anti-bullying activist, author and sought after speaker who shares her story as a female living with autism and tips on coping with anxiety on a daily basis.


Christine Motokane is a self advocate serving on the Board of Autism Society of Los Angeles.  Recently graduating from Loyola Marymount University with a degree in Psychology, Christine wants to make an impact in improving the lives of people with autism.  She is currently working on an anti-bullying initiative at the middle and high school levels.  Another area that she would like to focus on is the vocational training and opportunities for young adults with autism.  Christine herself has sought a mentor to help her navigate through young adulthood and wants to develop good mentorship programs for other young adults.  Always mindful to integrate herself in society but at the same time remembering to embrace her autism.  Christine published an autobiography in 2014 titled “Working the Double Shift A Young Woman’s Journey with Autism”.  She has spoken about her experiences with various groups such as Manhattan Beach Unified School District, Southwest SELPA, the FRED conference, Loyola Marymount University, UCLA and the US Autism and Aspergers Association.

Dr. Jess P. Shatkin, MD, MPH who is a Child, Adolescent, and Adult Psychiatrist shares his work with NYU School of Medicine and how sleep can decrease depression & anxiety.


Dr. Jess P. Shatkin, MD, MPH is the Vice Chair for Education and Professor of Child & Adolescent Psychiatry and Pediatrics at the NYU School of Medicine. In addition to directing one of the largest training programs in the country in child and adolescent psychiatry at the NYU School of Medicine & Bellevue Hospital Center, he is also the founder and director of the nation’s largest undergraduate child development program, Child and Adolescent Mental Health Studies at NYU. A visionary in mental health education — his major clinical interests are mood and anxiety disorders, attention deficit-hyperactivity disorder, disruptive behavior disorders, and sleep.

Gary Goodridge is an MMA Fighter who lives with depression due to his head injuries.


Gary Goodridge (aka ‘Big Daddy’) is a nine-time world champion arm wrestler; a boxing champion; a lethal Ultimate Fighting Championship contender; and a renowned Mixed Martial Arts warrior. In Japan in the MMA world he was a celebrity compared to Michael Jordan. In early 2012, he was diagnosed with early onset of dementia and due to his many brain injuries, he also lives with depression.

 

 

Protect Your Brain

“Dr. Denise, you need to see the movie, Concussion, with Will Smith. It depicts exactly what I have experienced living with depression and dementia, ” encouraged Gary Goodridge, legendary MMA UFC and Pride fighter.  That is exactly what I did before interviewing him this week. I didn’t stop there. I read his book “Gatekeeper: The Fighting Life of Gary ‘Big Daddy” Goodridge”, researched the NFL’s as well as the MMA’s policies on dealing with head injury, and read countless articles on CTE (Chronic Traumatic Encephelopathy).  In 2012 Gary was diagnosed with early onset dementia and depression and his doctors said that he was exhibiting symptoms similar to other professional athletes that on autopsy were diagnosed with CTE.

What is CTE? Dr. Bennet Omalu and colleagues in the Department of Pathology at University of Pittsburgh together published in the journal Neurosurgery in 2005 an article called, “Chronic Traumatic Encephalopathy in a National Football League Player.”  Dr. Omalu’s autopsy of former Pittsburgh Steelers Mike Webster in 2002 revealed large accumulations of tau protein in Webster’s brain, affecting mood, emotions, and executive functions similar to the way clumps of beta-amyloid protein contributes to Alzheimer’s.

According to the Brain Injury Research Institute founded by Dr. Julian E. Bailes, M.D.,Dr. Bennet  Omalu M.D. and Robert P. Fitzsimmons in 2002 ( protectthebrain.org ):

“Since the 1920’s the term dementia pugilistica or “punch-drunk“ syndrome has been known as it has occurred in boxers. Dementia pugilistica is actually a variant of chronic traumatic encephalopathy (CTE), which is itself a serious type of brain damage resulting from repeated concussions and is found in many professional athletes and military personnel who have been subjected to multiple impacts to the head.

Severe concussions and mild traumatic brain injury are both capable of causing CTE, and the likelihood of developing this condition is increased with the number of impacts.”

“Big Daddy”, Gary Goodridge has a true samurai spirit both in and outside of the ring.  He reports his medication is helping with aggression and depression. He has been given cognitive strategies to help him keep sharp with his recent cognitive decline: keeping a day planner to help with short-term memory and maintaining structure to his day.  Walking his dogs, and spending time with his daughters and family give him the most joy.  “The gym really helps me~my own workouts as well as teaching children keeps me inspired.” He spoke about this on the interview.  He also spoke about the need for rest in between fights and other tips he thinks could have helped him to minimize repeated head trauma.  “I would have had second thoughts about fighting if I knew then what I would be experiencing now,” he mentioned during another discussion. He and I spoke about his desire to provide for his family as well as his natural ability as a fighter keeping him engaged in the sport. Gary’s love of his daughters and his desire to be a role model and advocate for mental health awareness is giving him the hope and inspiration to fight on while living with depression and dementia.

In Discover’s July/August 2016 article by Jeff Wheelwright, “Ahead of the Hit,” it was pointed out that the science is still gray on CTE and predicting the effects of impacts.  Dr. Ann McKee and her group at Boston University continue to define and help with the consensus of the definition of the neurodegenerative disorder CTE.

In my professional opinion as a Mother and as a Doctor my consensus opinion is “Protect your brain and your child’s brain.” That is it.  It is common sense.

  • Avoid or minimize head trauma.
  • Avoid or minimize substance use.
  • Seek out treatment for mental health and focus on lifestyle habits that promote well-being.
  • If you or your child play a contact sport and are having any changes in behavior or changes in cognition contact your physician at early onset to prevent any long-term neurodegenerative consequences.

Routine physicals are mandatory for optimal health.

Our children need us to be advocates for their health and well being. If we can encourage participation in sports and extracurricular activities that minimize head trauma and concussions we are doing our job to protect our children.

Thank you, Gary Goodridge for sharing your story, you have taught me a lot and have inspired me in many ways.

Dr. Denise

Cute child feeding his pet dog

Keeping The Family Peace

What does Family Peace even mean? Are you thinking that sounds a bit too “Kumbayah”?

I do not think every minute of family time is going to go smoothly. I am talking about “mostly kind, mostly peaceful”. Trust me. I am a Mother as well as a Doctor. We have teens and a kindergartner. So, with this context let’s go for it!

I want to make sure that you know that parents need to be on the same page in raising your child a “majority” of the time. I also believe that if you are a single parent reading this you need an amazing support system (family, friends, coaches) to support you in raising your child. We all need support and the right kind of help.

I believe the core ingredients to family peace are: respecting each other, having fun together, setting clear expectations, setting clear boundaries and being consistent in your parenting style. This includes letting any relatives, childcare, coaches, and teachers know of your child’s “style” of relating to the world in the best way possible.

If you want your child to respect you, you need to spend time with them having fun too.

I mean it. If your kids are laughing with you combined with obeying family expectations you are “nailing it”.

 

Most kids respond amazing to praise.

If you like a behavior and want to see more of it you can praise the process of the action they are taking. “I like the way you fed the dog without me asking. Strong Initiative!” “You were really focused when you were doing your homework”. “Thank you for listening to me today. Your behavior was amazing”.

When I was in training as a Child Psychiatry Fellow at UCLA, we all praised and praised and praised the good behavior. I roll pretty positive yet even for me it felt like an “over the top” Hallmark card greeting of joy. Guess what? It works. This method of praise combined with “ignore” described below have been the gold standard recommended of parent training techniques.

 

Ignore the behavior you don’t want to see.

Do not make eye contact, look away, face another direction. If they keep doing it you can redirect them with: “I really liked the behavior you were having earlier today. I want you to continue to earn your allowance (your screen time, your gaming time); let’s turn it around”.

 

In Summary:

 

Step 1: Sort Quality of Behavior

Behavior you like = Praise It

Examples: Feeding the dog. Doing Homework. Saying thank you. Sharing a toy.

Behavior you dislike= Ignore It.

Examples: Whining. Stalling on chores. Fighting with sister. Rolling their eyes at you.

Behavior you find Unacceptable. Set firm consequences.

Examples: Hitting a sibling. Leaving house without permission.

 

Step 2: Praise Effectively=Better Behavior

Tips on Praising:

Praise the behavior not the child.

Praise immediately.

Make eye contact.

Get on the same level as your child.

Hug or give a pat on the back.

Have a smile on your face.

Use a loving tone of voice.

Create meaningful praise to your child.

 

Step 3: Ignore Effectively.

Tips on Ignoring:

Ignore IMMEDIATELY!

Make no eye contact.

Turn away from your child.

Focus on something else (counting to 10, breathing).

Have a neutral, blank face.

Give no verbal or nonverbal message.

Stay calm and emotionally detached.

 

Praise when the behavior stops or one you like starts.

If your child is wearing you down and there is another parent around (or adult figure) I recommend tapping or whispering “tag team” to your support and to take a break from your child if you are semi “losing it” (aka about to drop the f-bomb or yell at the top of your lungs). Quickly transition with “Your Father is going to talk with you now and I will check in with you in a little while”.

I am a firm believer in “date nights” or “alone time” away from your children so you can be a more effective parent.

Do not spend the entire date talking or thinking about your child. You need to play/relax too.

Be consistent. Be loving. Be concise. Set developmentally appropriate rewards.

I have to “walk the walk” at my house just like you. I find mindfulness and twenty minutes of meditation my “secret peace weapons”. Really. I actually tell myself: “Be kind. Be loving”, all throughout the day.

 

You can do this!

 

Dr. Denise

Medication and Child Psychiatry

I am personally grateful that I went to medical school and became an Adult and Child Psychiatrist. Why? Because mental health is the most important part of a person’s well-being. Happy individuals with healthy thoughts create a society in which we can all thrive. We need to think of our children and our future. We need to get rid of the stigma of mental health and focus on mental wellness.

Did you know there is a shortage of Child Psychiatrists in the U.S.A.?

According to the American Academy of Adult and Child Psychiatry, there are approximately 8,300 practicing child and adolescent psychiatrists in the United States — and over 15 million youths in need of one.

I just attended an amazing MasterPsych conference presented by the American Physician Institute in Laguna, California last October. Guess what discussion I engaged my “kindred spirit” child psychiatry colleagues in during our lunch breaks?

Integrative mental wellness and collaborative care.

Using the least amount of medications.

Spending time with our patients.

We talked about the importance of tools such as solution oriented therapy, cognitive behavioral therapy (CBT), nutrition, exercise, yoga, meditation, parent training, and psychoeducation.   As doctors, we know how and when to prescribe medication and value all of the clinical trials that have been done to support the treatment when needed.

I believe that a Child Psychiatrist is the best person to decide if a child would benefit from being placed on a medication for behavioral issues. The dilemma we have is that there are not enough of us. We need to solve the problem of shortage of well-trained child psychiatrists and be a part of the solution for our children getting the proper treatment.

WE NEED A PARADIGM SHIFT. NOW.

Step one is getting rid of the stigma of mental health in our society. Doctors of all specialties and subspecialties need to respect and hold mental health in high regard. In medical school I excelled in many rotations as a third year medical student, even surgery. When I declared psychiatry as my residency choice there was a definite stigma from my colleagues. I moved forward with passion and strong conviction that psychiatry was the right fit for me. I believe that mental health is the foundation of all health and wellness. It should be integrated into all health care.

As Child Psychiatrists we need to be open to being part of the solution of attracting more medical students into our profession. We need to be thought leaders in supervising pediatricians on mental health diagnosis’. If we have a proper system in place then I believe the children will get the right treatment and be put on the least amount of medication.

Dr. Denise

 

The Dr. Denise Way

My approach is to meet my clients where they are at – to understand their world view and their perspective on medicine and wellness. I want people to embrace their mental health. Your strengths can be your weaknesses. My golden rule is to be loving and be kind and be the best version of yourself. What does your best look like for you to thrive, not just exist? Create your own golden rule – something that keeps you grounded and mindful throughout the day.

Depression

If you’re not having the true joy each day that you are familiar with in the past, there could be a good chance that you’re suffering from low grade depression. Most people who come to see me have just had a traumatic event and they are pre-disposed to having a larger depression and now they are having hopelessness and the inability to get out of bed. You don’t have to wait until a traumatic event happens and you start feeling hopeless and not be able to get out of bed. Go see someone before your low grade depression turns into a major depression. You can have a lot more joy in your life. If you don’t have enough energy or enough joy, even if you are successful you might want to get assessed or let your doctor know you are feeling this way. You can experience a much more joyful life.