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Wednesday, December 31, 2014

The Globalization of Attention Deficit Disorder

From the Psychology Today Blog
"DSM-5 in Distress"

By Allen J. Frances, M.D.
December 22, 2014

Mental disorders have become a global commodity. A diagnostic fad heavily promoted first in the US now quickly spreads around the world.

Multinational corporations have perfected the profitable art of international marketing. The reach of pharma stretches everywhere in the world with a sales pitch easily translated into every language.

"Sell the Ill to Sell the Pill"

The basic strategy is to expand the market by convincing the healthy that they are sick-that their expectable distress and imperfections are a mental disorder caused by a brain chemical imbalance that requires correction with an overpriced pill.

The very best customers are those who weren't sick in the first place. Their sky high placebo response rate guarantees they will be very satisfied even with treatments that were not really necessary and may even be harmful. This explains how bleeding and purging were the go-to medical treatments for thousands of years, even though they did absolutely no good and instead caused lots of harm.

Once the adult market gets locked up, drug companies direct their marketing guile to recruiting ever younger kiddie customers and the old folks in nursing homes. And it isn't satisfied until it has captured every possible customer in every possible country.

The U.S. is by far the best market because it is big, rich, and the easiest to control and to monopolize. Only in the U.S. has pharma been able to bully and bribe politicians into allowing direct-to-consumer advertising and into disallowing price negotiation even with its biggest buyer (the government).

The results in the U.S. are massive over-diagnosis and massive over-treatment with medication. Sweet profits that make drug companies the most profitable of all industries, but bad for patients.

The pickings are less easy and less lucrative in the rest of the world- but still nothing to sneeze at.


I sought the perspective of Patrick Landman on the progressive globalization of ADHD. Dr Landman is a Parisian child psychiatrist who has just published the book "ADHD: The Invention of an illness." He will describe the international trend and why until recently the French have been more than successful than most in resisting it.

Patrick writes:

"We must face the fact that some mental disorders are sold just like industrial or commercial products. Once the US market had become saturated, Pharma concentrated its efforts on developing new international markets that held more promise of promoting possible rapid growth.

It is no longer just medication that is marketed - now drug companies also market diseases. Psychiatry is particularly well suited to this strategy because the criteria for distinguishing between normality and pathology are not scientifically defined and because mental pathologies are multifaceted and somewhat arbitrary social constructs.

Attention Deficit Hyperactivity Disorder is a prime example. The US ‘market’ already has 11% of children aged 7 to 17 diagnosed with ADHD and 6% on medication. Rates tripled in just 20 years and revenues increased 50 fold to almost $10 billion/yr. The US consumes almost 70% of the world’s anti-ADHD drugs. The growth of ADHD has been almost equally strong in Canada, Australia, and New Zealand but the rest of the world is there to be conquered.

Of course, the multinational pharmaceutical companies are not solely responsible for the expansion and globalization of ADHD. We must also include the ways in which information about ADHD can be spread worldwide thanks to internet access; the tests and checklists which enable self-diagnosis and the way self-diagnosis is marketed; the role of the service users and discussion forums; the change in thinking regarding what users demand; the pressure on children to succeed academically; and, lastly, the domination of DSM IV and later DSM 5, which widened the ADHD definition compared to the one in the International Classification Of Diseases.

Faced with this globalization, we are bound to be interested in any small islands of resistance, and specifically in the French example. Until 2005, the prevalence of ADHD in France had long remained very low- around 1-2% compared to the 11% in the United States and more than 5% in the United Kingdom, the Scandinavian countries, and Spain.

The reasons for this French particularity are multiple and interconnected. First, French child psychiatry has been strongly marked by psychoanalysis and the psychopathological tradition, and there has been an ideological resistance to prescribing medication to children.

Secondly, there is a specific French classification of mental diseases based on the European clinical tradition,which does not associate hyperactivity with attention disorder. Many French child psychiatrists therefore see ADHD as a social construct ‘made in USA,’ one that lacks validity and is based on a narrow biological reductionism.

Thirdly, for a long time the French education system was fairly tolerant of children’s behavioral problems.

Lastly, the power to prescribe psychostimulants to children was legally restricted to medical specialists and hospital psychiatrists.

Since the 2000s, many things have changed and the latest figures show that 3.5% of children have now been labeled with ADHD. France is definitely catching up. What are the factors behind this change?

First is the massive introduction of the DSM into psychiatric training and practice.

Second, media campaigns have discredited psychoanalysis and child psychiatry and favored neuropediatrics, whose neurodevelopmental hypotheses are supposedly more ‘up-to-date.’ The exclusively bio-medical model has made significant inroads.

Third, society’s demand on psychiatry has also changed, and the focus is now on making the behavioral problems of the disruptive child disappear as quickly as possible.

Fourth and most important, drug companies are working hard to sell ADHD.

Fifth, the pressure from certain users associations for the recognition of ADHD as a qualification for disability rights.

And finally, the French education system is undergoing a major crisis: the struggle to integrate children of migrant origins who are often caught up in multiple social, cultural, linguistic and educational problems.

More and more often, teachers have to deal with situations that seem to be out of their control; increasingly, they become the pre-diagnostic filters of 'ADHD' - brokers of medical prescription. The effect is to turn school and societal problems into medical disorders in the individual child.

French child psychiatry is currently moving away from the exclusively psycho-social model of ‘brainless’ psychiatry (which in some cases turned out to be too reductionist) and towards the (equally reductionist) biomedical model imported from the USA.

The social role of psychostimulants has changed as well: if for Marx religion was the opium of the people and a way of putting social conflict to sleep, psychostimulants have become the opium of our children, sedating familial, pedagogical, educational, psychical, and social conflicts.

For psychiatry, the future lies in refusing all of such extreme and reductionistic theories and treatments. We must use common sense in combining a humanistic tradition with scientific discovery. We can avoid the over diagnosis and over treatment of ADHD by taking a rounded view and resisting drug company manipulation."

Thanks so much, Patrick. It is crucial that parents everywhere become informed consumers in order to protect their kids from over diagnosis and unnecessary meds.

Check out this previous blog for specific tips.

.........................................................................

Allen Frances, M.D., was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

Tuesday, December 30, 2014

Editorial: Finally, the Anti-Vaccine Movement is Losing Steam

From The Los Angeles Times

By The Times Editorial Board
December 23, 2014

The percentage of fully vaccinated kindergartners
rose this year from 90.2% to 90.4%.

Maybe the public is learning more about just how unsound and unscientific the anti-vaccine rhetoric is.

For the first time in years, there has been a slight uptick in the number of kindergartners who started the school year with all their recommended vaccinations, the state reported Tuesday.

This is good news for California, where the anti-vaccine movement has thrived over the last decade, despite its basis in a thoroughly discredited study and public statements by a few celebrities who are neither scientists nor medical experts.

The increase is significant not because it is big, but because it happened at all. After five years of falling immunization rates, the percentage of fully vaccinated kindergartners rose this year from 90.2% to 90.4%, the state Department of Public Health reported.

Some of the increase may be the result of a law that took effect this year requiring most parents to receive information about vaccination from a health professional before they can exercise a “personal belief exemption,” which allows them to keep their children from being vaccinated simply because they don't like the inoculations.

The law is hardly tough on disbelievers: Parents are still free to exempt their children after they've become better informed, and they can avoid even receiving the information if they claim that their religious beliefs run counter to vaccination.

The number of personal-belief exemptions had been rising steadily until this year when it fell significantly, to 2.5% of parents from 3.2%. But it's not simply the new law at work. Kindergartners in both public and private schools were more likely to be vaccinated this fall, but the percentage increased more in private schools, where parents aren't subject to the law.

Perhaps as the topic gains attention, the public is learning more about just how unsound and unscientific the anti-vaccine rhetoric is. Or perhaps recent outbreaks of whooping cough and measles have grabbed some parents' attention. The measles outbreak earlier this year was the largest since 1996, and many of those who fell ill had intentionally not been vaccinated.

"This is a health issue where the welfare of the many should take precedence over the unfounded fears of the few."

That might be their own business if it weren't for the fact that the diseases can be spread to people who were vaccinated but did not receive full immunity and to those few who have valid medical reasons for not being vaccinated. Vaccinations are not 100% effective, and their success relies on having almost everyone participate. Vaccination rates in many schools are well below the levels needed for this so-called “herd immunity.”

The Department of Public Health should use the new data to craft policies that might turn this blip into a health trend. This is a health issue where the welfare of the many should take precedence over the unfounded fears of the few.

Mother's Depression When Kids Are Young Linked to Risky Teen Behaviors

From Reuters Health
via the HuffPost Parents Blog

By Shereen Lehman
December 22, 2014

Having a depressed mother during elementary or middle school raises the likelihood a child will engage in risky behaviors like drinking and smoking during the teen years, according to a new Canadian study.


Based on nearly 3,000 children followed since they were toddlers, the researchers also found that kids with depressed mothers in "middle childhood" were likely to start risky health behaviors earlier in their adolescence than other kids.

"Although there is a fairly good body of evidence suggesting that maternal depression is associated with depression in the child, there is a lot less about how maternal depression might influence adolescent behavior," Ian Colman, the study's senior author, told Reuters Health in an email.

"Given how prevalent maternal depression is, and that risky adolescent behaviors are associated with poor long-term outcomes in adulthood, we thought better evidence in this area could be really useful" said Colman, a researcher at the University of Ottowa in Ontario.

Previous studies have suggested a link between a mother's depression during pregnancy or right after a baby is born to the teenager's mental health (see Reuters Health article of October 10, 2013 here: http://reut.rs/1zWKAiz).

But not much is known about maternal depression and later adolescent behaviors, Colman's team writes in the journal Pediatrics.

The study team analyzed data from the National Longitudinal Survey of Children and Youth, a large Canadian population study that began when the kids were ages two to five in 1994, and ended in 2009 when they were teenagers.

Every two years, the participating mothers answered questions about their own physical and mental health, and about the health of their kids and spouses or partners, their available social support and family functioning.

Once the children reached the age of 10 or 11, they filled out their own questionnaires.

When they reached adolescence, the young participants were asked about their engagement in risky behaviors such as drug and alcohol use, carrying a weapon or running away from home. A total of 2,910 teens completed the study,

The researchers found that teens who had been exposed to maternal depressive symptoms during middle childhood were more likely to use alcohol, cigarettes or marijuana, and to engage in violent and nonviolent delinquent behavior.

In addition, they were more likely to engage in these behaviors earlier than teens whose mothers had low or no symptoms of depression.

The study team also found that teens exposed to recurrent maternal depression throughout their childhood engaged in more nonviolent risky behaviors compared to those whose mothers had low or no depression.

In contrast, kids whose mothers' depression symptoms started when the child was already in the early teens did not engage in more risky behaviors than kids without any maternal depression exposure.

The results don't prove that the mothers' symptoms when their children were young caused the children's behavior in adolescence.

But, the authors write, middle childhood is a period of increasing cognitive, social and emotional development. Kids in this age group begin school, refine their language skills and increasingly engage in social peer relationships. Being exposed to a mother's depressive symptoms and negative parenting behaviors may harm the child's own development during this sensitive time and lead to "lasting deficits," they speculate.

Colman said that asking for help can be hard, but even just talking about how she is feeling can sometimes be a really helpful start on the road to recovery for a mother experiencing depression.

Colman thinks it's great that there seems to be a growing focus on maternal health, but added, "let's not forget that what is good for mothers is often good for their kids as well."

Monday, December 29, 2014

How CTE (Chronic Traumatic Encephalopathy) is Impacting Sports

From Ohio University

December 28, 2014

Based upon the response to several recent posts here on the serious and sometimes lasting or even irreversible consequences of concussions, we thought you might be interested in this very informative new infographic created by Ohio University.

A new study from the Radiological Society of North America concluded that even for young football players who didn't experience a concussion, football and other contact sports have caused brain abnormalities that mimic mild traumatic brain injuries, which could over time lead to the frightening neuro-degenerative disease called CTE.

This clearly points to the need for closer scrutiny of youth sports, and further research into concussions and CTE.

About CTE

CTE, or Chronic Traumatic Encephalopathy, is a disease caused by repetitive concussions or head injuries, and is quickly becoming a popular topic in relation to sports.

Recent studies have brought to light the reality and relevance of this disease in sports due to the increasing frequency of diagnoses in athletes.

Cases of CTE have been confirmed in all major sports including but not limited to:
  • Football
  • Boxing
  • Hockey
  • Wrestling
  • Baseball
  • Rugby
  • Soccer

CTE has also been confirmed in individuals who have not participated in contact sports, but had suffered other head injuries.

While CTE can only be confirmed by studying the brain post-mortem, some of the reported symptoms include:
  • Confusion
  • Depressio
  • Impaired judgment
  • Suicide
  • Dementia

Due to the difficulty of diagnosing CTE, the most effective tools to combat this disease are awareness and prevention through making sports safer.

Many sports leagues have amended the rules of their sports in a specific attempt to minimize the frequency of CTE-inducing injuries.

How To Help Children Control Their Emotions, Reduce Anxiety and Boost Attention

From PsyBlog

By Dr. Jeremy Dean
December 27, 2014

Children who study the piano or violin might also find it easier to control their emotions, focus attention and reduce their anxiety.


Along with parents, teachers and friends, learning a musical instrument has a vital role to play in children’s psychological health, the largest study of its kind to date argues.

Researchers at the Vermont Center for Children made musical training available to 232 youths between the ages of 6- and 18-years-old.

Their brains were also scanned to see how the cortex changed in size, over up to six years.

The thickness of the cortex — the brain’s outer layer — in different regions has already been linked to various psychological problems, such as lack of attention, high levels of aggression or depression.


The results, published in the Journal of the American Academy of Child & Adolescent Psychiatry, showed changes in the motor areas as expected, but also more wide-ranging benefits of musical training:

“Playing a musical instrument was associated with more rapid cortical thickness maturation within areas implicated in motor planning and coordination, visuospatial ability, and emotion and impulse regulation.” (Hudziak et al., 2014)

Particularly important changes in the cortex suggested improved…

  • “…executive functioning, including working memory, attentional control, as well as organization and planning for the future.”

While the standard approach to psychological problems is often to medicate, the study’s first author, Professor James Hudziak, thinks there is a better way: “We treat things that result from negative things, but we never try to use positive things as treatment.”

Given the findings of these and other similar studies, it’s all the more surprising that three-quarters of all high school students in the US rarely or never take music or art lessons.

The study’s authors write:

“Such statistics, when taken in the context of our present neuro-imaging results underscore the vital importance of finding new and innovative ways to make music training more widely available to youths, beginning in childhood.”

Related Articles

About the Author

Dr. Jeremy Dean is a psychologist and the author of PsyBlog. His latest book is "Making Habits, Breaking Habits: How to Make Changes That Stick". You can follow PsyBlog by email, by RSS feed, on Twitter and Google+.

How Teachers Help Students Who've Survived Trauma

From The Atlantic

By Jessica Lahey
December 2, 2014

One out of every four children sitting in American classrooms has experienced significant personal or emotional distress.

When I was teaching at an independent middle school, the term “professional development” meant shoring up my skills in English and Latin, strengthening my cultural literacy base, and learning about new teaching techniques and innovations.

But now that I am teaching English and writing in the adolescent wing of a residential drug and alcohol rehabilitation facility, “professional development” has taken on an entirely new meaning.

I’ve had to switch up my priorities and expectations, not to mention my acronyms. Today, I’m less concerned with boosting my students’ A.P. (Advanced Placement) scores than I am with mitigating the consequences of their high ACE (Adverse Childhood Experiences) scores.




ACE scores emerged out of the Adverse Child Experiences Study, a collaborative effort of the Centers for Disease Control and Kaiser Permanente’s Health Appraisal Clinic in San Diego. Kaiser surveyed more than 17,000 participants between 1995 and 1998 about their exposure to childhood maltreatment and family dysfunctions and are still being tracked for health outcomes.


The findings of the ACE Study suggest that adverse childhood experiences such as neglect, abuse, household violence and substance abuse “are major risk factors for the leading causes of illness and death as well as poor quality of life in the U.S.”

Furthermore, these negative outcomes are dose-dependent, meaning that the more adverse experiences a child experiences, the higher their subsequent risk for negative outcomes.

According to one review of the study’s data by Co-Principal Investigator Dr. Robert Anda, “One of the strongest relationships seen was between the ACE score and alcohol use and abuse,” and my students are certainly proof of that statistical correlation.


In order to understand the implications of violence and other childhood traumas on my students’ addiction, cognitive development and capacity to learn, I recently attended a professional development session with Neena McConnico, Director of Boston Medical Center’s Child Witness to Violence Project.

According to McConnico, one in every four students currently sitting in American classrooms have experienced a traumatic event, and the number is even greater for those living in impoverished communities. Young children exposed to more than five adverse experiences in the first three years of live face a 75 percent likelihood of having one or more delays in language, emotional, or brain development.

McConnico further explained that children who witness violence often have trouble in the classroom because their post-traumatic stress can manifest itself as inattention, sleep dysfunction, distractibility, hyperactivity, aggression, and angry outbursts.


Alternately, these children may withdraw and appear to be unfazed by their trauma. “These children,” McConnico added, “are the children I worry about the most, the ones who sneak under the radar and don’t get the help they need.”

Teachers who suspect their students may be dealing with violence or other traumatic situations at home can be an essential source of stability and support.

McConnico outlined a few ways educators can help students cope, learn, and heal from the effects of a traumatic childhood.

Prioritize Relationships


Because these children may not have experienced many other positive relationships with adults, the student-teacher bond can be the most important gift educators have to offer. Teachers who are reliable, honest, and dependable can offer the stability these students so desperately need.

Listen

Teachers don’t need to solve children’s problems in order to help. Listening to students when they want to talk can make all the difference to a child struggling with a chaotic home life. “It’s really that simple,” McConnico said. “Listen, reflect back to them that they have been heard, validate the child’s feelings without judgment, and thank the child for sharing with you” advised McConnico.

Create Opportunities to Be Successful

In the day to day work of teaching, it can be far too easy to focus on the negatives, but it’s important to give kids moments of success. “Catch students being good and create opportunities for them to do the right thing.” Positive experiences beget positive experiences and those moments make kids feel valued and valuable.

Routines

Clear routines and expectations are important to all children, but particularly for those who live in chaotic environments where they are often out of control. Students feel safe when limits are understood, when teachers express clear timelines, expectations, and consequences.

Incorporate Downtime

Everyone can benefit from opportunities for mental rest, daydreaming, and opportunities to process new information, but traumatized children in particular need downtime in order to regroup, relax, and get a break from both the cognitive exertion of the academic day and the emotional stress of a chaotic home life.

For the 25 percent of American children who experience trauma at home, school may be their only harbor from that tempest, and teachers represent so much more than purveyors of facts and figures. To these kids, teachers offer reassurance that not all adults are harmful, that even if they are not made to feel worthy at home, there are people in the world who will value, support, and love them.


Teachers may not be able to protect their students from the evils of this world, but we can serve as allies, mentors, and role models through our relationships with them as they grow, recover, and begin to heal.

Sunday, December 28, 2014

NYC Sends $30M a Year to School with History of Giving Kids Electric Shocks

From ProPublica
via AlterNet

By Heather Vogell, Annie Waldman
December 23, 2014

Students keep getting sent there despite repeated evidence of abuse.

The Judge Rotenberg Center, a Boston-area school for kids with severe developmental disabilities and behavior disorders, has earned national notoriety for a long record of brutal techniques to keep children in line.

Electric shocks. Restraints. Hunger.

Federal and state authorities have repeatedly scrutinized the school. Even the United Nations’ Special Rapporteur on torture has chimed in.

But New York City kids are still being sent there. Indeed, nearly 90 percent of the school’s students — 121 of 137 kids — are from New York City, including 29 who enrolled this year. New York’s taxpayers send the Center $30 million a year.

The flow has continued despite records obtained by ProPublica showing the Center has repeatedly violated New York state rules, including by tying children down with leg and waist straps to punish them. The Center has received a string of warning letters from New York State and has been subject to two state inquiries over the past five years — neither of them previously disclosed to the public.

City education officials insist they never recommend the school and fight requests by parents to place children there. Families simply enroll their kids and then take the city to court to force it to pay tuition, officials say.

But Judge Rotenberg officials told ProPublica that Mayor Bill de Blasio’s administration has made it easier for New York City kids to go to school at the Center.

“I’ve seen a change since Mayor de Blasio came on board,” says Glenda Crookes, the Center’s executive director. City lawyers appear to be settling a lot of the cases, she said, adding, “It doesn’t seem like the parents have to go to hearings anymore.”

A de Blasio spokesman confirmed the Center is benefiting from a new policy in which the city doesn’t fight cases involving special needs kids in which it “is unlikely to prevail.” The change was part of an effort the city unveiled earlier this year streamlining the process for the city to cover the cost of private school or services for special needs children. Such cases have been fraught with conflict and litigation in recent years.

“The city still reserves the right to oppose families’ claims for schools that are not appropriate for the child’s need,” spokesman Wiley Norvell says.

Councilman Vincent Gentile, a longtime critic of the Rotenberg Center, says the issue goes beyond de Blasio. “I’ve said long ago that State Ed and New York City Department of Education have to take a stand on this,” Gentile says, “and up to now, they’ve been unwilling.”

“The city’s department of education is not putting up a big fight to keep kids out,” Gentile says.

Once kids are at Judge Rotenberg Center — with or without the city paying — it becomes almost impossible for the city to remove a child if the family doesn’t agree.

Many of the students Rotenberg accepts have tried to hurt themselves or others. In caring for them, the Center eschews psychotropic drugs and, for decades, has relied instead on so-called “aversive” therapy, using pain or other negative stimuli to change behavior. Its signature approach is to apply a two-second electric shock to students’ skin.

The Center cites case studies to defend the effectiveness of the shocks, but many mental health specialists don’t support their use. Dr. Gregory Fritz, the President-Elect of the American Academy of Child and Adolescent Psychiatry, says electric shocks and restraint holds can lead to lasting trauma and provide no more than a temporary fix for behavior problems.

“The problem with most of those aversive things is that you can never stop it,” Fritz says. “As soon as the aversive system is removed or tapered, they could go back to the problematic behavior.”

After a 2006 investigation found a variety of abuses including kids being shocked for minor infractions, such as swearing, yelling, and refusing to follow directions, New York State enacted rules against aversive therapy and the Center agreed to scale back their use. The school said it would only use shocks when a court approved them for a specific child. (Two New York students currently have such court orders.) The rules also require court approval of restraints, except for emergencies.

But three years later, New York officials found that the Center was still using so-called “mechanical” restraints — which can include devices that use straps or cuffs — on children it shouldn’t have. Officials briefly ordered the Center to stop accepting New York students. After the Center fought the prohibition, the state settled and allowed admissions to begin again.

Then, in 2011, Edward Placke, a former Assistant Commissioner of New York’s Education Department, was shaken by an encounter with a New York City teenager during a visit to the school. The girl was anxious, but she spoke deliberately, even though a Rotenberg staff member watched over their meeting. Get me out, she said. Take me home.

“She said she was shackled to a chair,” recalls Placke, now superintendent of a cluster of New York special needs high schools. “She said she was incredibly hungry and she was being provided the very minimum.”

Placke’s complaint triggered a probe by New York investigators. They pulled the files of 10 students, reviewed hours of video, and discovered “significant and serious” violations. Kids were still being bound as a way to punish them, the records show.

One child who wasn’t supposed to be restrained was left in waist and leg straps for nearly 10 hours.


Some students currently have court approval to be mechanically
restrained in chairs for health reasons. A 2011 New York State
investigation revealed that students were often restrained
as a way to punish them. 
Photo: Annie Waldman/ProPublica

Staff members had also altered reports about restraints or failed to record them altogether. Investigators also concluded that Rotenberg was not providing adequate schooling to students who were suspended, and that the school was suspending kids too often.

This time, state officials didn’t suspend the school. The state is keeping a close watch through occasional site visits, say officials.

“We understand the issues with the school. But we have to catch them at serious misconduct. We have to be able to uphold a decision to revoke,” says Richard Trautwein, counsel to the New York State Education Department.

In a written statement, the Rotenberg Center said it “did not agree with the findings of the NYSED in the report, but responded by adjusting policies and procedures in order to make it clearer to NYSED that it was in compliance.” It promised in a 2012 letter to state officials not to use restraint as punishment.

The Center has long fought states’ efforts to regulate it. It has won nearly every major court case and has spent substantial amounts on lobbying.

State and federal filings show the Center has employed Bracewell & Giuliani, former Mayor Rudolph Guiliani’s firm, as well as Albany powerhouse Malkin & Ross. Since 2010, the nonprofit school has spent about $770,000 lobbying officials in Washington D.C., Massachusetts and New York, including an effort to counter further restrictions on the use of aversive therapy by New York’s education department.

To recruit students, the Center runs radio ads and has a toll-free number, reaching parents who are desperate for help. “We get a lot of cold calls from parents,” Crookes, the executive director says. About 90 percent of the school’s kids are minorities.

The Rotenberg Center has also worked with an advocacy agency, Joan A. Harrington & Associates, that is listed on a city website as a resource for parents of special needs children.

The advocates are supposed to be independent experts, tasked with helping parents navigate government bureaucracy to find the best services for their child, yet Harrington acknowledged to ProPublica that she has previously been paid by the Rotenberg Center.

In an interview at her Brooklyn office, Harrington said she couldn’t remember how much she was paid or for what specific work. “I imagine it was for referrals and things, like everybody else is,” Harrington said. She said her last case involving the Judge Rotenberg Center was before she became ill in 2013.

Harrington also shares an office and administrative staff with attorney Anton Papakhin, who is paid by the Rotenberg Center to represent parents embroiled in court battles to send their children to the school, keep them there or get behavioral interventions approved by courts. He has received an average of $470,000 a year from the Rotenberg Center over the last five years, according to tax filings.

In a case this year involving a Rotenberg placement, New York City lawyers argued that Papakhin’s relationship with the Center posed a conflict of interest, potentially influencing him and another lawyer to recommend placements at the Center that weren’t appropriate. The judge on the case said there was no evidence that had occurred.

Papakhin represented the parents of most of the 29 New York City students who were enrolled at Rotenberg in 2014, the Center said. Papakhin says he also works with other schools and that there is no conflict.

“I represent the parents and only the parents,” Papakhin told ProPublica. “At any point of time, they change their mind and they decided to place their child in any other school, I can do that for them.”


Students with court approval for shock therapy carry the electronic
shocking device in a backpack or fanny pack,which is
remote-controlled by staff members.
Photo Credit: Annie Waldman/ProPublica

Papakhin and Harrington work together “from time to time,” as Papakhin puts it.

Harrington says, "It wouldn’t be unusual for me to walk out the door and say, ‘I have this case and look at what they’re doing,’ or for him to come in and say, he has a case, ‘do you know where I could put this child?’”

Other educational advocates recommended by the city say they don’t refer parents to the Judge Rotenberg Center. We “don’t recommend [the school] as a matter of course,” says Kim Sweet, executive director of Advocates for Children, one of the largest advocacy organizations in the city.

New York City’s Department of Education did not respond to our questions about why a city list directs parents to an office shared by a lawyer who works with the Rotenberg Center.

Cheryl McCollins, a Brooklyn mother whose son is a former Rotenberg student, views the city as partially to blame for her son’s treatment. “They are the ones that referred me to this asylum,” she says. The city recommended the Massachusetts facility in 2001 after her son had been through numerous residential centers that weren’t right for him, she says.

A year later, her son was strapped spread-eagled to a restraint board and shocked multiple times while screaming for staff to stop, surveillance videos showed. The shocks were her son’s punishment for not taking his coat off in class. McCollins pulled her son, then 18 years old, out of the Center soon after and eventually sued the school, settling for an undisclosed sum.

Over the years, McCollins has repeatedly contacted the city to ask why the school was still an option for New York students. “Why are you giving them money to torture disabled children who can’t fend for themselves?” she recalled asking one city official.

While families of former students have filed several lawsuits against the Center alleging mistreatment, other parents continue to be the school’s most outspoken supporters.

“If it wasn’t for Judge Rotenberg Center, my daughter would be dead,” says Marcia Shear, whose daughter Samantha, 21, has been at the school for nearly a decade. When Samantha came to the school, her parents saw it as a last resort. Samantha had just been kicked out of yet another treatment center for children with behavioral issues after she hit her own head so many times she dislocated both of her retinas, leaving her almost blind.

The Center was the only school that would take her. Within a few months, the school introduced the electronic skin shock device into Samantha’s treatment plan — with Shear’s support.

“You see the kid is killing themselves, you have nothing to lose,” Shear says. “Until you have lived in our shoes and seen your kid practically blind themselves, you can’t judge.”

Read more about restraints and seclusions in public schools across the country who’s fighting federal limits on the practices, and whether your state law says it’s ok to pin down kids in school.


...................................................................

Heather Vogell is a reporter at ProPublica. Previously, she was a reporter at The Atlanta Journal-Constitution, where her work on test cheating in the public school system resulted in the indictments of the superintendent and 34 others.

Saturday, December 27, 2014

ADHD Drugs Increasingly Prescribed to Treat Hyperactivity in Pre-Schoolers

From The Guardian (U.K.)

By Sally Weale
December 21, 2014

A fifth of educational psychologists say they know of children being given medication despite guidelines advising against it.

An “alarming” number of pre-school children are being prescribed drugs to treat hyperactivity – contrary to medical guidelines that say they should not be used on children under six – because overstretched health workers go straight to medication rather than offering psychological interventions.

More than a fifth of educational psychologists say they know of preschool children who are being given medication such as Ritalin even though the National Institute for Health and Clinical Excellence (NICE) recommends psychological interventions should be tried first.

The report found that medication was seen as the main solution
in the treatment of ADHD. Photograph: Phototake Inc./Alamy

The survey, which aimed to investigate the medicalisation of childhood behaviour, also found there was an “intolerance of difference”, so children not conforming to the norm were increasingly being seen as having something wrong with them.

One educational psychologist who took part in the study, which was carried out by the University College London Institute of Education (IoE) and the British Psychological Society, wrote: “Our biggest difficulty is that children’s and adolescent mental health services and paediatric teams are so short-staffed they go straight to medication and completely ignore Nice guidance.”

Ritalin, which is the most commonly used trade name for methylphenidate, is a central nervous system stimulant used to treat attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD).

The NICE guidelines, which were amended in 2013, state: “Parent-training/ education programmes are the first-line treatment for parents or carers of pre-school children … Drug treatment is not recommended for pre-school children with ADHD.”

The findings are part of a survey of 136 educational psychologists from 70 local authorities across the UK, seeking their views on the assessment, diagnosis and treatment of ADHD.

The report found that medication was seen as the main solution in the treatment of ADHD. “Medication was felt to be the predominant form of treatment for ADHD despite Nice guidelines that psychological interventions should be implemented first,” the report said.

“Multiple systemic factors” were creating a “pressure for increasing rates of diagnosis and medication”.

The survey, which will be formally published next year, said there was an “urgent need to examine local policies regarding the effective prevention and intervention in cases of pre-school behavioural, emotional and social difficulties”.

Vivian Hill, director of professional educational psychology training at the IoE, who conducted the research with Horatio Turner of UCL, said: “It is very alarming to discover that terribly young children who often have not had access to alternative treatments are being put on medication.

It is almost certainly to do with the fact that the whole of children’s mental health services is incredibly underfunded. It’s quick and easy – one off the waiting list, one intervention in place.

“To work with a child or a young person and their family over time is much more costly, but much safer and likely to have much better results. Medication has a short-term impact. It will not make the difference long-term.”

Educational psychologists who took part in the survey said “intolerance of difference” affected the way adults viewed children’s learning and behaviour. One wrote: “There is an increasingly prevalent view in society that people who do not fit a particular environment must have something wrong with them.”

The report said “within-child” factors were emphasised too often, rather than environmental factors, “due to families and schools wishing to abdicate responsibility for children’s behaviour and systemic failings in current diagnostic procedures”.

One participant said: “It’s an easy explanation, which is convenient and comforting and absolves everyone of blame by locating the problem within the child.”

Educational psychologists said they were frustrated by factors that limited their ability to care effectively for children with ADHD. “Usually when [we] get involved the die is cast and is predominantly problem-focused, so much so that the only perceivable solution is medication,” one wrote.

The report concluded that educational psychologists should be involved in developing a broader understanding of contextual perspectives of ADHD among families and recommended establishing a multi-agency approach for its assessment and treatment.

One EP said: “My local authority has a behaviour pathway that includes ADHD.” Following its introduction one of the survey participants said that behavioural observation by an educational psychologist led to a significant fall in the diagnosis and medication of ADHD.

A Department of Health spokesman said: “Prescribing decisions are for doctors to make, but there are clear independent guidelines for the treatment of ADHD, which only recommend the use of drugs in severe cases and as part of a comprehensive treatment plan.

“Children’s mental health is a key priority, which is why we’ve formed a taskforce to look at how we can provide the best possible care and have invested £54m in improving access to psychological treatments.”

Friday, December 26, 2014

Fine Particulate Air Pollution Linked with Increased Autism Risk

From the Harvard School of Public Health
via ScienceDaily

December 18, 2014

Summary: Women exposed to high levels of fine particulate matter specifically during pregnancy -- particularly during the third trimester -- may face up to twice the risk of having a child with autism than mothers living in areas with low particulate matter, according to a study. The greater the exposure, the greater the risk, researchers found. It was the first US-wide study exploring the link between airborne particulate matter and autism.



Women exposed to high levels of fine particulate matter specifically during pregnancy--particularly during the third trimester--may face up to twice the risk of having a child with autism than mothers living in areas with low particulate matter, according to a new study from Harvard School of Public Health (HSPH). The greater the exposure, the greater the risk, researchers found. It was the first U.S.-wide study exploring the link between airborne particulate matter and autism.


"Our data add additional important support to the hypothesis that maternal exposure to air pollution contributes to the risk of autism spectrum disorders," said Marc Weisskopf, associate professor of environmental and occupational epidemiology and senior author of the study.

"The specificity of our findings for the pregnancy period, and third trimester in particular, rules out many other possible explanations for these findings."

The study appears online December 18, 2014 in Environmental Health Perspectives.

Prior studies have suggested that, in addition to genetics, exposure to airborne environmental contaminants, particularly during pregnancy and early life, may affect risk of autism. This study focused specifically on the pregnancy period.

The study population included offspring of participants living in all 50 states in Nurses' Health Study II, a cohort of more than 116,000 female U.S. nurses begun in 1989. The researchers collected data on where participants lived during their pregnancies as well as data from the U.S. Environmental Protection Agency and other sources on levels of fine particulate matter air pollution (PM2.5)--particles 2.5 microns in diameter or smaller--in locations across the U.S. The researchers identified 245 children who were diagnosed with autism spectrum disorder (ASD) and a control group of 1,522 children without ASD during the time period studied.

The researchers explored the association between autism and exposure to PM2.5 before, during, and after pregnancy. They also calculated exposure to PM2.5 during each pregnancy trimester.

Exposure to PM2.5 was significantly associated with autism during pregnancy, but not before or after, the study found. And during the pregnancy, the third trimester specifically was significantly associated with an increased risk. Little association was found between air pollution from larger-sized particles (PM10-2.5) and autism.

"The evidence base for a role for maternal exposure to air pollution increasing the risk of autism spectrum disorders is becoming quite strong," said Weisskopf. "This not only gives us important insight as we continue to pursue the origins of autism spectrum disorders, but as a modifiable exposure, opens the door to thinking about possible preventative measures."

Journal Reference

Marc Weisskopf et al. Autism Spectrum Disorder and Particulate Matter Air Pollution before, during, and after Pregnancy: A Nested Case–Control Analysis within the Nurses’ Health Study II Cohort. Environmental Health Perspectives, December, 2014 DOI: 10.1289/ehp.1408133

Wednesday, December 24, 2014

An Alternative To Suspension And Expulsion: 'Circle Up!'

From NPR's Blog "nprED"
via Morning Edition

By  Eric Westervelt
December 17, 2014

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Listen to Part I (4:13)
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A restorative justice circle at Edna Brewer Middle
School in Oakland, California. Credit: Sam Pasarow

One by one, in a room just off the gym floor at Edna Brewer Middle School in Oakland, California, seventh-graders go on the interview hot seat. Some 80 students have applied to be "peer leaders" in the school's new, alternative discipline program called "restorative justice."

Kyle McClerkins, the program's director, grills them on aspects of adolescent life: "What is the biggest challenge for middle school girls? What has changed about you from sixth grade to now?"

This school and the Oakland Unified School District are at the forefront of a new approach to school misconduct and discipline. Instead of suspending or expelling students who get into fights or act out, restorative justice seeks to resolve conflicts and build school community through talking and group dialogue.

Its proponents say it could be an answer to the cycle of disruption and suspension, especially in minority communities where expulsion rates are higher than in predominantly white schools.

Oakland Unified, one of California's largest districts, has been a national leader in expanding restorative justice. The district is one-third African-American and more than 70 percent low-income. The program was expanded after a federal civil rights agreement in 2012 to reduce school discipline inequity for African-American students.

At Edna Brewer Middle School, the fact that students are taking the lead — that so many want to be part of this effort — shows that it's starting to take root.

"Instead of throwing a punch, they're asking for a circle, they're backing off and asking to mediate it peacefully with words," says Ta-Biti Gibson, the school's restorative justice co-director. "And that's a great thing."

Last school year — the program's first year — Gibson says, kids weren't ready to talk things out. "Last year there was a lot of different conflicts, a lot of fights."

This year, he says, they're more willing to "circle up."

The circle sessions are designed to resolve conflicts
and build school community. Credit: Sam Pasarow

The school tried this alternative discipline approach a few years ago. But problems with teacher buy-in, training and turnover killed it before it got off the ground. And it's still a big work in progress, says Principal Sam Pasarow. "I believe our staff is struggling with restorative justice because they might feel at times a consequence didn't come down on a student when it should have."

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District-wide, Oakland says the approach is working. The district says new, as-yet unpublished research shows the percentage of students suspended at schools that have fully adopted the program has dropped by half, from 34 percent in 2011-12 to just 14 percent in the following two years.

They say the data show chronic absence is down dramatically and graduation rates are up at restorative-justice schools, and that at two sites last year the disproportionate discipline of African-American students was eliminated.

Several other urban districts are trying some version of the approach, among them: Chicago; Minneapolis; Palm Beach County, Fla.; and Denver.

But there is no real agreement, yet, on how best to implement these kinds of programs, says Trevor Fronius, who's researching the trend with WestEd, a national nonprofit education research and development agency.


Objects that represent concepts and ideas are placed on
a mat in the middle of the circle. Credit: Sam Pasarow

"Most programs involve dialogue and some form of talking circle," he says. "But there are a wide variety of types, and there's no consensus yet on best practices."

Fronius adds that it's not clear that anyone is tracking just how many U.S. school districts are doing restorative justice "in a serious way."

Teacher Concerns

At Edna Brewer, Principal Pasarow says he's trying to work with the handful of remaining teachers who have yet to embrace the approach: those who think it's not their job to lead talking circles when kids misbehave.

Some teachers, he says, have told him, "I don't know how to teach circle, and I don't know how to have deep conversations about my feelings and emotions with students." Pasarow says he understands the concern and thinks it's a valid one, but he points out that the program "is not group therapy; it's community-building."

But some critics say it is pretty close to group therapy, and they worry that some kids might think they can rig the system and get away with behaving badly if they talk about their feelings.

Teachers "have to be comfortable with being uncomfortable" to make it work, McClerkins says.

Students here say the "harm circle" talks do come with consequences — that's the restorative part — including school community service, apologies, public acknowledgement of their bad behavior and more.

At lunchtime, I asked some students if they'd seen any difference this year in terms of school culture, discipline and community.

"They're not as judgmental," 13-year-old Kweko Power says of her classmates.

Her friend Eva Jones, 12, agrees. She says there have been fewer hurtful rumors and fights, and there has been less gossip. "It seems easier now to, like, make friends with people, because people are less angry and defensive. It's just way easier," she says.

Last year, "there was, like, a lot of fights — like, every other week there was a fight. And now there's, like, a fight once per year. "

Well ... not quite.

About a half-hour later, I hear some yelling. In the gym, pushing and verbal sparring has descended into a full-blown fistfight between a seventh-grade boy and an eighth-grade girl.

The program's director, McClerkins, has pinned the boy to the gym floor.
Students congregate outside at Edna
Brewer Middle School. The hope of restorative
justice is that dialogue builds trust and
community and reduces the need for
suspensions and expulsions.
Courtesy of Terri Phelan.
After the students are pulled apart and people calm down, the restorative justice process kicks in.

Encouraging Dialogue

After a weekend "cooling off" time, the school schedules what they call a "harm circle." Both of the students — the eighth-grader, Briona, and the seventh-grader, Rodney — must attend. The school has asked us not to use their full names.

At first blush, the circle session looks a little California flaky: teachers, parents and the students sit in a circle of desks. On a small stand in the middle sit a rock, feather, candle and water jar — representing earth, air, fire and water.

Rodney's mom, Tozma, sets the tone early on.

"I be worried about Rodney," she tells the group. "He's tall for his age, and a lot of stuff happens to black boys. And I try to get that across to him."

Tozma is raising her son on her own, and tells the circle that she's deeply worried about where he's headed. He has an anger problem, she says, and she's tried to get him counseling.

"Talk to Rodney like he your own son," she says. "I'm not the kind of parent who's gonna argue with you about chastising my son, because I want him to be here. I don't want him to be in jail."

Then Briona's mom, Marshae, looks at Rodney and, with a mix of gentle reprimand and warning, talks about her own son.

"He used to go to counseling and they'd say, 'Oh, he's angry.' But he knew you don't hit a female." Her son was an athlete in track and football, but now, "he's in jail," she says. "He just turned 18 in jail. You don't want to go there," Marshae says.

This kind of communication is central to alternative discipline. Here are two mothers sharing fear and worry about raising kids through hard times in a tough neighborhood.

It's not a he said/she said breakdown of a fight. The hope is that dialogue builds trust and community and reduces the need for suspensions and expulsions.

McClerkins tells the students, who are both African-American, "you already have a lot against you and it has nothing to do with what you've done good or bad. There is wisdom in this circle that can help you navigate this. Stay close to it as you get older, and listen. Really listen."

Eventually, the circle does get around to the fight on Friday and who did what.

Rodney shows some remorse with a whispered apology. But his mom is not satisfied and wants to know what's going to change.

"What do you plan on doing to make sure these kinds of incidents don't happen again?" she asks.

Rodney pauses. He thinks for a moment and answers in a quiet voice. "Like, I don't play with people and stuff, I won't horseplay and stuff like that."

Then Briona admits she helped instigate by yanking his backpack and teasing.

The school's restorative justice co-director, Ta-Biti Gibson, reminds Briona, who runs track, how much she has improved this year in sports and in class. "I think about your future," he says, "I talk with you about college."

Her mother tells her to "really learn from this" and "pick your battles."

It's agreed as a group that the two students will have to write and post anti-bullying posters and do after-school service. And they'll have to do joint morning announcements offering tips on how students can get along better.

Rodney's mom ends the meeting by thanking the group. "He really don't have a man voice at home," she says, "so I appreciate everybody. And just keep working with my child."

Rodney responds, too. "I appreciate my mom for not giving up on me."

As the circle breaks up, Briona's father, Al, tells Rodney: "I can tell your mom will never give up on you."