Headache among patients with HIV disease: Prevalence, characteristics, and associations – by Dr. Kale Kirkland: An Interview with Dr. Todd Smitherman
In this podcast, Dr Todd Smitherman of the Department of Psychology at the University of Mississippi discusses a recent study to characterize headache symptoms among patients with HIV/AIDS and to assess relations between headache and HIV/AIDS disease vables.
A University of Mississippi study of headaches among HIV patients is being hailed as a critical step to improving treatment and reducing unnecessary medical costs among sufferers.
The paper, “Headache among Patients with HIV Disease: Prevalence, Characteristics, and Associations,” is being published in a forthcoming issue of the journal Headache and is already available online.
The study, which is attracting broad interest in the medical and mental health communities, was conducted as part of a doctoral dissertation by UM psychology alumnus Kale Kirkland while working in the Headache Research and Treatment laboratory under Todd Smitherman, assistant professor of psychology. The study was conducted in conjunction with clinicians from the University of Alabama Health Center in Montgomery.“This research is of interest to clinicians and physicians for several reasons,” Smitherman said. “Recent research from the U.S. Centers for Disease Control and Prevention shows that, despite the availability of medications that effectively slow disease progression, most Americans with HIV do not have the disease under control. Our study shows that patients with poorly-controlled HIV/AIDS are most prone to suffer also from frequent, severe migraines at rates that far exceed those of the general population.”
Specifically, the results of the study show that headache affects one of every two HIV/AIDS patients, but these are not your typical, run-of-the-mill tension headaches.
Approximately 27.5 percent of the patients studied met criteria for “chronic migraine,” a rare headache condition in which a person has migraine symptoms – with or without other headaches – for 15 or more days per month. In comparison, only 2 percent of the general population is classified as having chronic migraines.
“This translates into a 13-fold increased risk of chronic migraine among patients with HIV disease,” Smitherman said. “The strongest predictor of headache was the severity of HIV disease, such that patients with more advanced disease had more frequent, more severe and more disabling migraines.”
This is the first study since the proliferation of highly active antiretroviral therapy, or HAART, medication to demonstrate that having HIV/AIDS portends a very high risk of headache, particularly migraines.
These data highlight how important it is for physicians to regularly monitor CD4 levels, an indicator of immune system functioning, among this population and to pay close attention to headache symptoms among patients with more advanced disease. They also emphasize the importance of adherence to medication regimens among HIV patients.
“The study used a structured diagnostic interview to assess headache symptoms consistent with diagnostic criteria from the International Classification of Headache Disorders among 200 clinic patients in Montgomery, Alabama with HIV or AIDS,” Smitherman said. “Patients also completed measures of headache-related disability, and their medical records were reviewed for information about prescribed medications, CD4 cell count, date of HIV diagnosis, possible secondary causes of headache and other relevant medical history.”
“We decided to conduct this study due to a lack of research in the area of headaches in the HIV population,” Kirkland said. “In general, prior to our study, there was no ‘typical’ HIV headache.
“With the results from our study, we hope that infectious disease physicians will now be able to discuss with HIV patients what to expect in terms of headaches. This should also help prevent unnecessary medical costs, lessening the need to have expensive procedures – such as MRIs and spinal taps – ordered to rule out opportunistic infections.”
HIV-related infections were determined not to be frequent causes of headache among patients in the study, but the authors caution that further studies that include neuroimaging procedures are needed to confirm these findings.
Because the study came from a psychological perspective, Smitherman and Kirkland said they hope to further educate mental health professionals on HIV, which should help improve treatment, given that HIV patients also have increased rates of depression and anxiety.
Teach your children the importance of physical activity, and exercise with them! The target duration for physical activity in adolescents is 60+ minutes daily.
How much better can exercise make you feel?
A new study suggests that the mood boost may be profound.
The nitty gritty of the study is that researchers at the University of Vermont report a 23 percent reduction in both suicidal thoughts and suicide attempts among bullied students who exercise four or more days a week. The analysis of national data from the Centers for Disease Control and Prevention showed that across the board, frequent exercise was associated with improved mood for adolescents, both bullied and not.
It’s important to note that the study shows an association only between exercise and improved mental health. Still, lead author Jeremy Sibold, an associate professor at the University of Vermont, and chairman of its Department of Rehabilitation and Movement Science, says this is an important first step. It…”shows a critical relationship between exercise and mental health in bullied adolescents,” he says. “These data do not prove that exercise will reduce sadness or suicidality, but certainly support more research in this area.”
The study, published online in the Journal of the American Academy of Child & Adolescent Psychiatry, concludes:
Physical activity is inversely related to sadness and suicidality in adolescents, highlighting the relationship between physical activity and mental health in children, and potentially implicating physical activity as a salient option in the response to bullying in schools.
An accompanying editorial, by Dr. Bradley D. Stein and Tamara Dubowitz of The Rand Corporation in Pittsburgh, says,
“…the evolving literature suggests that physical activity interventions appear to be potentially promising as preventive interventions for some children and adolescents at risk for developing mental health disorders and for augmenting more traditional interventions for children and adolescents being treated for depressive and anxiety disorders and attention deficit/hyperactivity disorder.
The “side effects” of such physical activity interventions are likely to be more positive for many children than those of many other therapeutic interventions and potentially less costly…”
I asked Sibold a few questions about the study. Here, via email, are his answers:
RZ: What’s the biggest surprise in the findings?
JS: We were not surprised really that exercise was associated with less sadness, etc., as exercise has been widely reported to have robust positive effects on a range of mental health markers.
However, our statistics were quite rigorous, and to see the positive associations extend to victims of bullying, including those who report suicidal behavior, was certainly a pleasant surprise and a first in the field we believe. It is also quite concerning that 25 percent of students overall report being bullied in the last year. This is a concern we cannot ignore in our schools.
What would you tell parents based on this study?
I would make sure that parents who read or hear about these results understand that this study is reporting associations between variables. In other words, this was not an interventional study. This is, however, an important first step in the research literature that shows a critical relationship between exercise and mental health in bullied adolescents. These data do not prove that exercise will reduce sadness or suicidality, but certainly support more research in this area.
We are continuing to explore exercise as one of several interventions in at-risk children as part of the evidence based treatment programming at the Vermont Center for Children, Youth and Families.
The other thing I would encourage parents to do is to educate themselves and their families on the benefits of exercise as part of an overall plan for child and family health. Too many children are falling into sedentary habits, and our paper certainly supports the consideration of including exercise and physical activity as part of the response to mental health concerns in our kids.
Of course, parents should speak to their children’s physician(s) about this and should not assume that exercise should replace any other treatment at this time.
Any other important points?
In a world where sedentary activity and its consequences are continuing to increase at alarming rates, and where bullying continues to burden children often resulting in dire consequences, this paper is the first to report on the well-established positive effects of exercise on mental health in bullying victims. Should these data prove to be true in subsequent research, exercise would represent a largely safe, economical and highly accessible potential treatment option as part of the public health response to bullying victimization.
Here’s more from the University of Vermont news release:
Across the U.S., nearly 20% of students report being bullied on school property. Bullying is associated with academic struggle, low self-esteem, anxiety, depression, substance abuse, and self-harm. Exercise has been widely reported to have robust positive effects on mental health including reduction in depression, anxiety, and substance abuse.
Using data from a nationally representative sample of youth who participated in the National Youth Risk Behavior Survey (CDC), a group of researchers…examined the relationship between exercise frequency, sadness, and suicidal ideation and attempt in 13,583 U.S. adolescents in grades 9-12. The authors hypothesized that exercise frequency would be inversely related to sadness and suicidality and that these benefits would extend to bullying victims.
Overall, 30% of students studied reported sadness for 2 or more weeks in the previous year; 22.2% and 8.2% reported suicidal ideation and suicidal attempt in the same time period. Bullied students were twice as likely to report sadness, and three times as likely to report suicidal ideation or attempt when compared to peers who were not bullied. Exercise on 4 or more days per week was associated with significant reductions in sadness, suicidal ideation, and suicidal attempt in all students. In particular, the data showed a startling 23% reduction in both suicidal ideation and suicidal attempt in bullied students who exercised 4 or more days per week.
Getting an accurate, reliable diagnosis is essential for treating your mental health. Don't let the fear of change be a leash, preventing you from seeking a new path and finding yourself. If this article sounds familiar, it's time to make adjustments.
1. It’s freaking out at the idea of getting anything less than a stellar score on a test, but not having the energy to study.
2. It’s having to stay in bed because you don’t have the will to move, but unraveling at the thought of what will happen if you miss school or work.
3. It’s feeling more tired the less you move, but your heart racing at the thought of taking the first step.
4. It’s getting more tightly wound the more mess piles up, but only staring at it and thinking, I’ll clean tomorrow.
5. It’s making six million to-do lists just to untangle your thoughts, but knowing you’ll never actually cross anything off.
6. It’s believing that every canceled plan will end your friendships, but not having it in you to follow through.
7. It’s feeling hopelessly low that you’re still goddamn single, but canceling every first date because the thought of going through with it gives you heart palpitations.
8. It’s fearing every day that your partner will get fed up and leave, but your anxiety whispering in your ear that they deserve better and should.
9. It’s ignoring texts and turning down invitations, and it’s aching when the texts and invitations stop.
10. It’s the constant fear of winding up alone, but accidentally isolating yourself because you sometimes just need to hide from it all.
11. It’s wanting nothing more than to crawl home and sleep at 2 p.m., but your skittering, panicked pulse keeping you awake at 2 a.m.
12. It’s alternating between feeling paralyzed in the present and scared shitless about the future.
13. It’s not enjoying the good days because you’re too gripped by the anxiety that the next low is around the corner.
14. It’s sleeping too much or not at all.
15. It’s needing a break from your racing thoughts, but not being able to climb out of the pit of yourself.
16. It’s needing to do everything, but wanting to do nothing at all.
17. It’s coping mechanisms and escapism, because when you’re not trying to hide from one part of your brain, you’re hiding from the other.
18. It’s wondering if the things that are making your heart feel heavy are things your anxious mind just made up.
19. It’s sitting awake at 3 a.m. worrying about a future you’re not even sure you want to have.
20. It’s feeling too much and nothing at all at the same time, which means feeling like you can never win.
But you can. And you will. You’re not alone.
"Scientists studied a group of Australian teenagers who had various problems, among them: Acting out, bullying, agitation, hyperactivity, trouble concentrating, ADD/ADHD, depression and/or anxiety. The teenagers who had reduced levels of mag had the most behavior concerns and they performed the worst. When they increased their magnesium intake, then the behaviors improved … a lot."
A teacher emailed me and said she couldn’t wait for her classroom to be dismissed because of the inattention, disrespect and general hyperactive behavior with a student. Her student threw all his books on the floor, after ripping two pages out and then mumbled something incomprehensible as he ran out. He’s only seven. She said he is not the only one, it is fairly routine. The days of “Leave It to Beaver” behavior are long gone.
Sometimes behavior problems escalate and are far more problematic than this. Chronic problems with ADD or ADHD can coincide with temper tantrums, bullying, defiance and vandalism. How many adults in your life behave like this. Is it just personality, or do you think it is due to the scrambled up brain waves from playing on devices and looking at screens all day? How much contribution comes from your gene SNPS, discipline methods and nutritional status?
Because my focus is on health and medicine, I’ll tell you that inadequate magnesium could be a missing piece. It’s something you can evaluate with an RBC blood test, and thus control. People need magnesium to curb depression, to keep their heart beating in rhythm and relieve anxiety.
Magnesium works as natural sedative and helps the brain calm down from stress and stimulation. It’s a natural ‘chill pill.’ Specifically, it binds onto glutamate, an excitatory neurotransmitter and a receptor site called “NMDA” in the brain. When there is too much glutamate in the brain, then the brain functions in “excitatory” mode. Think of an angry swarm of bees in a disturbed clover field. Agitation, irritability, poor self control, reduced attention span, hyperactivity, and a hair-trigger temper occur with low ‘mag.’
Can supplements change an individual’s disposition? Well, it won’t take someone from moody to happy-go-lucky, but because it functions in 300 plus metabolic pathways, it’s utilized in trillions of cells. Magnesium is needed to neutralize homocysteine and carry it through the GSS gene, making your antioxidant glutathione. Magnesium is a cofactor for your COMT gene, which prevents the build up of norepinephrine, which would otherwise leave you feeling stressed out.
Scientists studied a group of Australian teenagers who had various problems, among them: Acting out, bullying, agitation, hyperactivity, trouble concentrating, ADD/ADHD, depression and/or anxiety. The teenagers who had reduced levels of mag had the most behavior concerns and they performed the worst. When they increased their magnesium intake, then the behaviors improved … a lot." - Suzy Cohen, Registered Pharmacist
The Standard American Diet (so SAD) lacks brain-loving minerals and so does all that Halloween candy! Even table salt is stripped of minerals. School lunches don’t typically offer salad bars. If you drink coffee, the chlorogenic acid will reduce systemic magnesium. Chronic Lyme or other pathogens can reduce magnesium too. With nearly four out of five individuals lacking in magnesium, it is no wonder why there are so many people struggling with focus, energy, mood, and behavioral concerns.
The best sources of magnesium include organic nonGMO fruits and veggies especially dark green leafy vegetables and spinach. Oatmeal, chocolate and pumpkin seeds are high. Supplementation is OK too, just avoid the “oxide” or “citrate” forms as they have a higher propensity to cause diarrhea.
An established ADHD diagnosis should lead to qualification for accommodations in all academic settings, including both public and private schools, and all standardized tests. Extra time on the ACT can be the difference between being accepted to certain colleges or even earning scholarships. Know your rights and defend them.
The process of securing academic accommodations for your child with attention deficit disorder (ADHD) can be confusing -- and intimidating. Follow these eight steps to take the hassle out of establishing an IEP or 504 Plan...
1. Get an Accurate EvaluationWrite a letter requesting an evaluation to see if your ADHD child might benefit from academic accommodations.
Address it to the chairperson of the Committee on Special Education Services - aka the Director of Special Education Services. (It's often a waste of time to send the letter to the child's teachers, guidance counselor, or principal.)
Should the school decline your request, or if you're dissatisfied with the evaluation's findings, arrange for a private ADHD evaluation. (In some circumstances, the school may have to pay for the outside assessment.)
TIP: Send your letter by certified mail or hand-deliver it and keep a dated proof of receipt for your records.
2. Meet With the Evaluation TeamA school-sponsored evaluation is conducted by a multidisciplinary team -- including special-education teachers, the school psychologist, and other professionals. As part of the process, they'll want to meet with you to learn more about how your ADHD child functions in school.
Team members will review your child's academic records, conduct a behavioral assessment, and observe her in the classroom. Following the assessment, you will discuss the results with the evaluation team and together you will decide whether your child needs special-education services to address how ADHD impacts her ability to learn.
TIP: Bring copies of your child’s report cards, standardized test results, and medical records, as well as a log of your communications with the school and other professionals to the meeting. (See our checklist of academic records that every parent should keep!)
3. Decide Which Laws Are ApplicableTwo federal laws provide for free, public special education services: the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Federal Rehabilitation Act.
IDEA covers kids with very specific conditions, including mental retardation, emotional disturbances, hearing impairments, and speech and language difficulties. Kids may qualify for coverage if they frequently have one of these problems in addition to attention deficit. Some qualify under another IDEA category: Other Health Impairments. If your child’s ADHD is so severe that he’s unable to learn in a regular classroom, he may qualify.
12 Steps to Smarter School Accommodations
Section 504 covers ADHD kids who don’t qualify for special-ed services under IDEA, but who need extra help in the classroom. The law prohibits schools from discriminating against students because of physical and mental impairments. Just as the school must provide ramps for kids in wheelchairs, it must make modifications (such as preferential seating, extra time on tests, or help with note taking) for kids with brain-based learning barriers.
FYI: If the team decides your child doesn’t need special ed, you’re entitled to appeal your case in a "due-process" hearing - a legal proceeding that often requires legal representation for the family, testimony from independent experts, and a review of meeting transcripts, test scores, and other documents.
4. Develop a PlanIf your child qualifies under IDEA, you should meet with the team to develop an Individualized Education Program (IEP), which specifies your child’s educational goals and how those goals will be met in the 'least restrictive environment' – which generally refers to a regular classroom.
Parents must be assertive. Make sure the IEP spells out exactly how the school will help your child meet his goals, which should be specific, measurable, and achievable.
Include time limits: “By month three, James will reduce his interruptions from 10 per day to 2 per day.” The IEP should explain exactly how James will be taught to stop interrupting. Unless the strategies are specified, there’s no way to enforce them.
If your child qualifies under Section 504, a school representative will help you and your child's teacher compile a 504 Plan, or a written list of accommodations that must be followed at all times. Unlike an IEP, there are no legal requirements about what should be included in a 504 Plan, and the school isn't required to involve the child's parents in the process (although many schools do).
TIP: Learn more about writing and implementing an IEP – including required provisions and the evaluation-team composition – on the federal Education Department’s web site.
5. Insist on a Customized PlanThe school may try to tailor your child's IEP around its existing programs, even though IDEA requires schools to customize the plan based on the child's needs.
If you're not satisfied with the IEP, don't agree to it.
The school may offer something more, or you can request a due-process hearing. If you prevail, the school district may have to pay for your child's education in another school that offers the needed services - even if it's a private school.
TIP: For specific accommodation ideas, check ADDitude's free Printable: Classroom Accommodations for School Children with ADHD.
6. Monitor Your Child’s ProgressBy law, the educational team must meet annually to review your child's IEP. Many school districts schedule the annual meeting in the spring, so that team members can review current strategies and your child’s progress, and set goals for the coming year.
You can request a meeting whenever you think one is needed – like the beginning of each school year. Your child’s progress during the summer, or the demands of the new grade, may necessitate plan changes.
If your child receives special services under a Section 504 Plan, the school is not required to hold an annual review or to involve parents in meetings. However, you may still request a meeting at any time, and many schools invite parents to participate in the process.
7. Create a Paper TrailAs you secure services for your child, put all requests, concerns, and thank-you's in writing -- and keep copies on file. A note asking the teacher for your child's test scores can be valuable if you later have to document that the request went unmet.
After each IEP meeting and conference with school staff, summarize the main points in a letter to participants. This establishes a written record of what was said.
How Do IEPs and 504 Plans Work, Anyway?
A recent U.S. Supreme Court decision underscored the importance of good record-keeping. The Court ruled that, in a due-process hearing, the legal burden of proving that a plan fails to meet a child's needs falls on the parents. It's more important than ever to document your child's difficulties, to be assertive about receiving progress reports, and to push for changes to the IEP as the need arises.
8. Seek SupportIf at any point you reach an impasse with school authorities - or if you just want an expert to accompany you to meetings - contact an educational advocate or attorney. Many offer free or low-cost consultation.
You sleep all night, only to wake up in the morning feeling fuzzy and groggy. What will help wake up your brain so that you can enjoy life every day? Two main ingredients: blood and information flow. Whip these elements into a frothy morning experience and you’ll be able to face the day feeling energized and capable.
When you wake after sleeping in a prone position your brain is the largest it will be all day. According to a new study published in Neuroimage, throughout the day your brain shrinks, becoming its smallest size at night. Then you sleep and, miraculously, wake up in the morning with a bigger brain. One theory that researchers suggest to explain this phenomenon is that your sponge-like brain rehydrates while you sleep; lying down redistributes body fluid to the brain, from where it has collected in the outer extremities during the day. This hydration suggests that your brain is primed to work for you in the morning (water is a key ingredient in your brain’s ability to function). The more blood and information you immediately feed your brain, the more awake and functional you will feel.
Speed up the wake-up-your-brain process with these five daily practices:
may bring you a migraine instead.
What wonders in front of your eyes should appear, should an uncle or aunt ruin Christmas … or New Year's.
Dr. Kale Kirkland of the Kirkland and King Clinical and Forensic Psychologists Clinic in Montgomery, AL, says there are more constructive ways to handle the stress of our family - God love them - than fussing, fighting and hitting the spirits.
The American Psychological Association also has weighed in multiple times on the topic, most recently saying that those who are nostalgic about the holidays seem to weather the holidays slightly better than the rest of us.
When their cheeks are all rosy and their noses like cherries, it means too much egg nog's to blame for their merry.
Some of the biggest irritants at the holidays are the very things that are supposed to bring us joy: Gifts and kids.
"I think my dad is Scrooge," Julie Richard said. "He acts worse than a baby. You cannot get him anything that he is happy with. Even if he tells you exactly what to get and you get it, he is still not happy. I will keep a smile on my face because I feel Christmas is [about] seeing the smiles on the children's faces, not the grandparents."
Now, Andrew! Now, Timmy! Now, Becky and Kristen! Where is your mother, and why won't you listen?
"How about [when someone] falls asleep while their kids are awake and running around the house," Matthew Greenlee said. "Ask me to watch your kids. Don't assume we all want the responsibility."
Some people have relatives that can cause such a clatter. But others have ways to deal with the matter.
Kirkland recommends people focus on their own behavior when dealing with an annoying family member.
"You don't have control over what other family members are going to do, be able to acknowledge that and accept that for what it is," Kirkland said.
Also, when there were differences or conflicts going on, leave it until after the celebration.
"The whole family is getting together trying to have a good time," Kirkland said. "It is worth it to go ahead and set aside those differences. If you need to work something out, wait until the appropriate time and try to enjoy the holidays with your other family members.
Many people's idea of "making it through" the holidays is to dive into the liquor cabinet early and often. But Kirkland recommends keeping alcohol out of an already combustible equation.
"I think the excessive drinking, overeating and a lot of unnecessary family conflict are pretty common problems this time of year," he said.
Sometimes the source of stress is the season itself: The dullness of winter days, the gray skies and too much time indoors.
Kirkland said at this time of year, it is common for people to develop seasonal depression, known as Seasonal Affective Disorder. Even those who typically do not suffer from it can be vulnerable for one reason or another.
The treatment of choice has been to spend more time outdoors in the sunlight, stay active and be social.
In addition to the financial stresses that could come in preparation of the holidays, he said some stress could arise from the changes that take place within families as time passes. New traditions have to be put into place and people must find new ways to enjoy time with one another.
"I think typically people have a lot of expectations about what the holidays are supposed to be for them, particularly when you're dealing with families," Kirkland said. "You have traditions that might have been in place for many years. As families grow and change over time, those traditions start to change and have to change. I think that adjustment is hard for people."
The cousins can come and cause chaos, so careless. Yet ‘tis always better to have some self awareness.
"Some members of my family drive me crazy all year round," Becky Benton said. "But I'm sure I drive them crazy, also."
So, remember your manners and to treat them all right, for you may come to miss them when they're all out of sight.
"My family lives out of state so I don't have to deal with those shenanigans anymore, but now that I don't, I almost miss it," Britt Adas said. "We only got together for Christmas, Thanksgiving, Easter, etc. So even though there was drama, it was kind of entertaining for the time being."
Psychologists' children see firsthand both the trials and triumphs of the profession — whether it's 4 a.m. emergency calls, department politics or the satisfaction of helping people overcome traumas or harmful habits.
And sometimes those experiences make an impact: Many psychologists' offspring follow in their parents' footsteps. Informal outreach yielded dozens of these relationships (see Family Ties), and there are many more.
Here, the Monitor highlights five. While each of these relationships is unique, they also have many commonalities. For one, these psychologist parents unanimously said they never pushed their children to become psychologists, and their children agreed. For another, these relationships are marked by strong mutual respect. Parents were quick to say how much they learned from their psychologist children, professionally and personally, and their children said they felt the same way.
Having a common profession also appeared to deepen their parent-child bonds as well as help the young people handle the stresses of graduate school.
"To have a parent who understood exactly what I was going through and who could talk with me at an academic level was really wonderful," says Kristen Kirkland, PhD, daughter of Montgomery, Ala., practitioner Karl Kirkland, PhD. Her brother Kale is also a psychologist.
Karl Kirkland adds that for him, at least, it is gratifying to have his children not only choose a similar field but trump his accomplishments — something he sees in both Kristen and Kale, who attended top-tier graduate schools and are launched on successful careers in industrial-organizational and forensic psychology, respectively.
"All parents want their children to have a better batting average than they have chalked up," he says. "Mine hit home runs without breaking a sweat."
While seeing their psychologist parents in action likely plays a role in youngsters' career decisions, Karl Kirkland adds it's important to acknowledge the allure of the field itself. "That Kristen and Kale chose psychology says a lot about the field—that it is rich in terms of diversity and opportunity, that it is still alive and well," he says.
Support centralGrowing up in a lively household with three other siblings, Kristen Kirkland, PhD, and Kale Kirkland, PhD, were never starved for attention from their father, Karl Kirkland, PhD, a clinical and forensic psychologist in Montgomery, Ala.
Karl attended all his children's high school basketball games and cheered their academic successes, while his wife, Lauren, coached their cross-country team. Karl also shared his work with them, chatting with them about cases, taking them with him to court and bringing them to his office to help file paperwork.
That support only intensified when Kristen and Kale decided on psychology careers. To help her get into graduate school, Karl encouraged Kristen to publish as an undergraduate, and the two co-wrote an article on child-custody complaints that landed in Professional Psychology: Research and Practice. When it came time for Kale to do his dissertation, Karl helped him gather the data, resulting in a groundbreaking article in the journal Headache on headaches in HIV-positive and AIDS patients that was widely covered in the media.
"He has always been incredibly supportive of anything any of us have ever pursued," says Kristen. "He was so helpful about anything we did in school, almost to the point where if we let him, he would have written our papers for us."
Karl's guidance paid off handsomely. After earning her doctorate from the City University of New York Graduate Center's industrial-organizational psychology program, Kristen spent several years training and developing leaders, teams and employees at Wall Street firms. That work gave her the skills to take on challenges closer to her heart, consulting with nonprofit agencies like the Southern Poverty Law Center and Every Mother Counts, a campaign to end maternal mortality worldwide.
Meanwhile, Kale joined his father's clinical and forensic psychology firm, Kirkland & King, PC, after graduating from the University of Mississippi in 2011. There, he tackles forensic cases, treats troubled teens and enjoys a high level of camaraderie with his coworkers, his father most of all.
"Some people have said, ‘Oh, I don't know if I'd ever be able to work with my dad,'" says Kale. "That's not the case with me at all."