lederr

Archive for December, 2012|Monthly archive page

2013

In Uncategorized on Monday, 31 December 2012 at 14:12

“For last year’s words belong to last year’s language
And next year’s words await another voice.
And to make an end is to make a beginning.”
~T.S. Eliot

2013

Advertisements

FAPE and class size…

In Education, Education advocacy, School reform, Special Education on Thursday, 27 December 2012 at 09:26

wow, 6-8 kids in a resource class sounds like a great idea and it is the law, but…what to do when the law and politics don’t mesh???  so the law says we must offer smaller classes, and i agree that some kids really, really need this type of individualized instruction only able to be taught in much smaller classes.  there are general education and team-taught classes with upwards of 40 kids in a class and that does not allow for the type of instruction some of our kids need.  so, glad to see the courts upheld smaller class sizes to adhere to FAPE, but i have to wonder exactly how that is going to happen when all i see in my district is cut, cut, cut.  cutting programs, closing schools, firing teachers…so i have to wonder how school districts are going to follow FAPE without teachers to teach the classes and, in some cases, rooms to hold them in.  guess we shall see.  maybe this, along with other recent events, will send the message that we need to be throwing money at education and early intervention services.  or, maybe there will need to be law suits to get the districts to realize where their money needs to go.  all i know now is that teachers are completely over-worked and under-paid (my district’s employees-that would include me-have not had a raise or any increase in SIX years) and programs and schools in my district are closing.  not sure how they are going to provide FAPE with a cap of 6-8 kids.  not unless we have a paradigm shift and decide education in the u.s. needs a complete overhaul and it does NOT start with the teachers.  we need to reorganize our priorities and make EDUCATION primary…not testing, numbers, pay-for-performance.  true education by any means necessary, i.e. NOT making up new standards every few years, NOT rating everything as it relates to test scores, and NOT blaming teachers.  i think after newtown we all saw where teachers’ hearts lie…with their students.  

Special Ed: FAPE Required a Smaller General Education Setting (6-8 Students)

NOVEMBER 27, 2012

BY: LUCILE LYNCH

Nov. 26 (2012): The United States Supreme Court recently denied the Petition for Writ of Certiorari filed by the Solana Beach School District in the case of KA.D. v. NEST (Case Nos. 10-56320, 10-56373). This case is significant because it effectively upheld the lower courts’ decisions that FAPE required an offer of a smaller general education class.

A summary of the underlying facts is that the student, diagnosed with autism, was placed by her parents at Hanna Fenichel (a small private preschool for typically developing peers), because the district failed to offer a small group setting with typical peers at a public school. The district’s offer consisted of a bifurcated placement, which divided the student’s school day between a special day class and a general education class. The parents’ position was that their daughter had difficulties in larger educational settings, but that their daughter was able to participate in a general educational setting with a 1:1 aide as long as the setting had a small student teacher ratio. There was no dispute that the student benefitted from her instruction at Hanna Fenichel. Parents sought reimbursement for the private placement.

At Hanna Fenichel, the classes consisted of 6 – 8 students. The District’s offer of placement would have required for the student to interact with about 42 children. The Ninth Circuit Court of Appeals upheld the trial court’s decision that the district’s offer of placement failed to provide FAPE. The district then filed a Petition in an effort to have the U.S. Supreme Court overturn the decision of the Ninth Circuit Court of Appeals. Although the actual opinion is not published,* parents should be aware of the reasoning of the lower courts in case they have similar claims or concerns with respect to their child.

For more information:

Ninth Circuit Opinion

U.S. District Court, S.D. California

Attorney for parents: Michael T. Kirkpatrick, Public Citizen Litigation Group, 1600 20th Street, N.W., Washington, D.C. 20009, 202-588-1000.

*Opinons that are not “published” do not serve as precedent and do not have the same binding effect as cases that are published. However, the reasoning of the courts may be beneficial to parties asserting similar claims and may be cited under certain circumstances.

Retrieved from: http://www.examiner.com/article/special-ed-fape-required-a-smaller-general-education-setting-6-8-students

autism night before christmas…

In Autism Spectrum Disorders, Inspiration on Tuesday, 25 December 2012 at 11:54

Autism Night Before Christmas
by Cindy Waeltermann

“Twas the Night Before Christmas
And all through the house
The creatures were stirring
Yes, even the mouse

We tried melatonin
And gave a hot bath
But the holiday jitters
They always distract

The children were finally
All nestled in bed
When nightmares of terror
Ran through my OWN head

Did I get the right gift
The right color
And style
Would there be a tantrum
Or even, maybe, a smile?

Our relatives come
But they don’t understand
The pleasure he gets
Just from flapping his hands.

“He needs discipline,” they say
“Just a well-needed smack,
You must learn to parent…”
And on goes the attack

We smile and nod
Because we know deep inside
The argument is moot
Let them all take a side

We know what it’s like
To live with the spectrum
The struggles and triumphs
Achievements, regressions…

But what they don’t know
And what they don’t see
Is the joy that we feel
Over simplicity

He said “hello”
He ate something green!
He told his first lie!
He did not cause a scene!

He peed on the potty
Who cares if he’s ten,
He stopped saying the same thing
Again and again!

Others don’t realize
Just how we can cope
How we bravely hang on
At the end of our rope

But what they don’t see
Is the joy we can’t hide
When our children with autism
Make the tiniest stride

We may look at others
Without the problems we face
With jealousy, hatred
Or even distaste,

But what they don’t know
Nor sometimes do we
Is that children with autism
Bring simplicity.

We don’t get excited
Over expensive things
We jump for joy
With the progress work brings

Children with autism
Try hard every day
That they make us proud
More than words can say.

They work even harder
Than you or I
To achieve something small
To reach a star in the sky

So to those who don’t get it
Or can’t get a clue
Take a walk in my shoes
And I’ll assure you

That even 10 minutes
Into the walk
You’ll look at me
With respect, even shock.

You will realize
What it is I go through
And the next time you judge
I can assure you

That you won’t say a thing
You’ll be quiet and learn,
Like the years that I did
When the tables were turned…….”

HAPPY HOLIDAYS!!!

In Uncategorized on Tuesday, 25 December 2012 at 11:29

holiday card 2012 2

time to stop the blame and criticism…education reform needs reform

In Education, Education advocacy, School reform, School violence on Tuesday, 18 December 2012 at 13:47

Remembering the Fallen Sandy Hook Educators

By Anthony Rebora on December 17, 2012 2:41 PM

Here are the names of the faculty members who were killed Friday in the shooting at Sandy Hook Elementary School in Newtown, Conn.

Rachel Davino, behavioral therapist, 29

Dawn Hochsprung, principal, 47

Anne Marie Murphy, special education teacher, 52

Lauren Rousseau, teacher, 30

Mary Sherlach, school psychologist, 56

Victoria Soto, teacher, 27

Reports of the courage, selflessness, and sheer quick-wittedness of the educators at the school have proliferated over the weekend. In his speech at the prayer vigil in Newtown last night, President Obama highlighted the faculty members’ heroism as a source of inspiration for the country:

As these difficult days have unfolded, you’ve also inspired us with stories of strength and resolve and sacrifice. We know that when danger arrived in the halls of Sandy Hook Elementary, the school’s staff did not flinch. They did not hesitate.

… [T]hey responded as we all hope we might respond in such terrifying circumstances, with courage and with love, giving their lives to protect the children in their care.

We know that there were other teachers who barricaded themselves inside classrooms and kept steady through it all and reassured their students by saying, “Wait for the good guys, they are coming. Show me your smile.”

A number of educator-bloggers have also drawn inspiration and a sense of professional strength from the Sandy Hook teachers’ actions. Some highlights:

Angela Maiers:

You have just been reminded of why we are indispensable and why no one can simply walk in off the street and do our work. You are in this position of privilege to do one thing like no other person on earth can do.

Vicki Davis:

You are a teacher. You are noble. Why does it take a dumb tragedy for people to realize how dedicated most of you are to your students? You make sacrifices every day and I know that many of you out there would do the same thing for your babies in your classroom.

Anthony Cody:

On this day we are reminded that classroom teachers, staff and administrators are on the front lines with our children every day. They are witnesses to the children’s growth and growing pains. They see the blossoming and the blight. … They take the chance that violence may come into their lives. They take the chance that they will encounter children with damage beyond their ability to reach. They take the chance that the trauma that inhabits the lives of so many of our children will find its way into their lives as well.

John Wilson:

Today will be a time for community and political leaders to thank teachers for their unheralded bravery. A visit to the school to show support would be appropriate. Providing special treats for the teachers’ lounge with a note of appreciation would be welcomed. The stress that teachers have been under all year is compounded when students and their colleagues are harmed. It is a time to re-examine how teachers in this country have been minimized for the contributions they make, and it is a time to re-commit to honor and respect and reward America’s teachers.

Let us know how you and your colleagues are responding.

Retrived from: http://blogs.edweek.org/teachers/teaching_now/2012/12/here_are_the_names_of.html#Newtown

you don’t have to bypass treats…tips for holiday eating

In Fitness/Health, Mindfulness on Tuesday, 18 December 2012 at 06:52

Holiday Eating: 17 Things To Consider When You’re Obsessing About Food And Weight

The Huffington Post  |  By Margaret Wheeler Johnson Posted: 12/17/2012 12:55 pm EST  |  Updated: 12/17/2012 5:02 pm EST

Every year I tell myself it will be fine, and every year it is not fine.

After over a decade of dealing with my eating issues, I’ve come to think of my relationship with food as my mind’s other track — the ticker tape of thoughts and anxieties that streams constantly at the edge of my life.

Did I eat too much? Too little? Am I hungry? How hungry? Should I eat now? Will I regret it if I don’t, or if I do? What if I gain weight endlessly? What if I’m just not equipped to feed myself? What kind of person can’t feed herself? If I were smarter/better/healthier/saner, I would be better at this…

Some days I can nearly tune it out, like news of unrest in a far-off country whose name and capital I used to know but now can barely recall. Sometimes I can almost pretend it doesn’t concern me. I can choose not to see it. I can go about my day.

Except now. From Thanksgiving through New Year’s, I’m forced to tune in. Festive brownies and cookies and bark and nog are everywhere. There are enormous meals with relatives who leave me questioning all of my food and life choices. There is way too much booze. There are little black dresses and glittery miniskirts that do not look like I hoped they would, and there are multiple opportunities, also known as holiday parties, to feel sized up by everyone in the room. Oh, and it’ll all be on Instagram very, very soon.

This year, I haven’t pretended that it’s fine. Mainly because I had this piece to write, I decided to feel it and think about it and recognize the ways in which this still really sucks. At the same time, I mulled over the things I’ve learned in the years since I made it through the initial throes of an eating disorder, the ones I’ve spent physically healthy but still trying to figure out how to feel okay about eating. And I thought about the maddening divide between all that hard-won knowledge and actually putting it into practice.

This is not a list of things I know because I’ve figured this eating thing out — far from it. It’s a list of the things I know because of some rare moments of clarity that I remember because they felt different from everything else on the ticker tape.

17 Things To Think About When You’re Obsessing About Food And Weight

BEFORE YOU EAT

1. You aren’t what you eat. 
Physically and long-term, you are. But experts have also noted that overeating once — even really, really overeating — won’t make you gain weight instantly.

More important, how much you eat at a single meal has absolutely nothing to do with whether or not you’re a good friend, daughter, mother, sister, aunt, thinker, worker, citizen or overall human. Nothing you consume will diminish how valuable you are in those areas that count so much more.

2. You’re not wrong to want what you want. 
It was an amazing moment when I realized that most healthy people like to eat and don’t feel bad about that. People who aren’t overweight and never will be like to eat. They want cupcakes just like overweight people want cupcakes. Goodness and wanting an enormous piece of chocolate cake aren’t mutually exclusive — despite thehundreds of millions of dollars spent annually to convince us that food and the people who eat it are virtuous or evil, clean or dirty, indulgent or guilt-free.

You’re not wrong or bad to want the cake. Who in their right mind wouldn’t?

3. Why you tend to eat more than your body wants.
And what puts you into overeating mode. Stressful conversation? A food that represents escape for you? Eating while you watch TV or read? Certain restaurants?

There are two reasons to think about this. For one, identifying your triggers can help you recognize when you’re vulnerable and protect yourself (more on that later). And the other reason is that thinking about what sets you off can tell you a lot about what you really want.

Geneen Roth, the author whose insights into emotional eating I find to be spot-on every time, wrote, “There is a whole universe to discover between ‘I’m feeling empty’ and turning to food to make it go away.”

Although I resist creating food rules for myself because they remind me of the deprivation of anorexia, when I’m having an especially hard time, I throw out anything that doesn’t have to be cooked before it’s consumed. If I have to cook it, I have to think about it and why I want it and what desire I might be trying to displace because fulfilling that other hunger or even acknowledging it feels too difficult or inconvenient or painful.

WHILE YOU’RE EATING

4. How amazing the food tastes. 
I am somehow stunned every Thanksgiving and Christmas by how good it all is. It makes sense — I’ve had a whole year to forget — but that means the flavors and textures amaze me every time. How good is cranberry sauce? It’s like jam, but earthier, drier and less sweet. And can we talk about mashed potatoes, which really are god’s gift, and stuffing — lord, I love stuffing — and the taste of real butter in food? What’s a life where you don’t let yourself taste real butter? Not any life I’m interested in.

5. When you stop tasting it. 
If you’re no longer into the flavor of what you’re eating, why are you still eating it? Waste isn’t ideal, but you may need to put off worrying about that until eating becomes less stressful. I’ve learned that if I’m not allowing myself to say no to what’s on my plate, that’s probably an expression of other things in my life I don’t feel like I can say no to. Saying no to food I don’t want right at that moment can help me begin to say no to the bigger things I need to refuse or contain.

6. It’s just food. 
Sure, holiday food is special, particularly if your family has its own recipes and traditions of preparing certain dishes together. And for anyone who struggles with food and weight issues, food is never — and may never be — “just food.” That said, remember that the traditional nature of holiday food means you’ve had it before and will have the opportunity to have it again. It’s much, much more important for you to feel good now, in the moment, and later in the day than it is for you to have a second or third helping you don’t really want. Remember that you’re more powerful than the food on your plate, and you matter more. Hear that? You are more powerful than the food on your plate. It’s just food.

7. If you’ve hit any of your triggers and how you can change the situation. 
Now that you know what your triggers are, consciously watch for them. When you hit one, do whatever it takes to keep it from leading to behavior that you know will make you feel terrible. I’ve found that focusing on one action helps. “All you have to do is leave the table,” I tell myself. Or, “All you have to do is throw it away.” I don’t think about how I might feel after I do it. I shut off the list of potential consequences (“What if I’m hungry later? What if the host is insulted? What if people wonder why I left or where I went?”).

Get up. Go to the bathroom. Make a phone call. Invent a work emergency. Do whatever it takes to get away from the food for at least a little while to remind yourself that you’re in control, that it’s just food and that you can take or, literally, leave it.

8. Whether you’re into the people you’re eating with.
If not, think about how you feel about the people you’re eating with. In a 2011Glamour essay on not drinking during the holidays, Sarah Hepola observed, “When you’re sober, you see with utter clarity which friends you feel comfortable around and which make you itch for an open bar.” Apply the same test to the role food plays in your friendships. If you have any friends you wouldn’t hang out with if food weren’t involved, they could be part of the problem.
AFTER YOU EAT

9. Shame doesn’t motivate.
You’ve already started doing the thing. You know what I’m talking about. You think you ate too much, so you spend the next 12 to 36 hours berating yourself for the undisciplined, disgusting, worthless, fat (etc. etc.) waste of genetic material you think you are. You begin to plan how you’ll make up for your “sins” — you’ll exercise for three hours every day, you’ll restrict your calories for the rest of the week, you’ll go on a cleanse.

When I spoke to Geneen Roth about this last year, she emphasized, “Shame, guilt, punishment, fear has never led anyone to change,” and yet people remain convinced that it will. In her books, Roth has always advised that the day after you overeat is the time when it is most important to be kind to yourself. “Recognize the inner critic or the judge … for what it is,” she urged. “It’s not your friend.”

10. Bingeing isn’t “for ladies.”
One of the mantras that hindered my recovery from the worst of my eating disorder was a tagline I came across in (I think) a yogurt ad. The page demanded of the female consumer, “Why are you still eating like a frat boy?” That would never be me, I vowed, and I put the same question to myself every time I reached for “frat boy” foods. Smart, sophisticated, ambitious, successful women didn’t eat pizza or onion rings, I told myself — it didn’t even occur to them to want those things. I extended this made-on-Madison-Avenue logic to cookies and cake, then bread, then carbs of any kind. Then I was careful not to “need” carrots or anything with fat in it, then breakfast, then lunch, then ever finishing a serving of anything.

Here’s the confusing thing: As much as women are encouraged to subsist on yogurt and aspartame, romantic comedies regularly show women sobbing into pints of ice cream. Ads encourage ladies to binge, too.

No wonder women have an especially f-ed up relationship with food (and there aresigns that men are catching up). But there’s another reason women are prone to emotional eating, which Caitlin Moran summarized brilliantly in her book “How to Be a Woman,” excerpted in the Wall Street Journal in June 2012:

by choosing food as your drug — sugar highs, or the deep, soporific calm of carbs — you can still make the packed lunches, do the school run, look after the baby, stop in on your parents and then stay up all night with an ill 5-year-old…

Overeating is the addiction of choice of “carers,” … It’s a way of screwing yourself up while still remaining fully functional, because you have to… slowly self-destructing in a way that doesn’t inconvenience anyone. And that is why it’s so often a woman’s addiction of choice.

So the next time you overeat or have a full-on binge, think about the following:

A) It wasn’t heroin.
B) There’s stuff in your life you’re having trouble coping with. That stuff probably deserves your attention. You, in the meantime, deserve compassion.
C) There is actually no rule condemning women to starve or binge, just lots of unhelpful suggestions that we should. Work toward being a woman who doesn’t obey the insanity.

11. How big you are. 
Bear with me. “Big” is an adjective most of us learn early on is something you never, ever want to be called. It’s the opposite of being contained and in control. And in a culture that only puts very, very thin women on screens and in ads, big equals un-special, unworthy of attention, unseen.

After a lot of years of thinking about how much being “big” scared me, I realized the thing I feared the most wasn’t my own physical size, it was the huge, seeping, unnamed emptiness that no one sees. That was the mass I was really trying to shrink or fill through various eating behaviors. I think of it as a black hole located somewhere in my stomach/chest region, the center of my body. It’s freezing, ugly, abandoned, condemned, and for a long time I believed that emptiness would always be my starting point, where I was from.

But then on an ordinary afternoon when I was wondering for the nth time how I’ve let that emptiness motivate so much of my behavior throughout my life, a different explanation occurred to me. What if the cavity inside could be a place, not an emptiness? What if it was light and inhabitable? What if all along the space I’d been trying to fill and not feel was somewhere I wanted to live? And what if that space inside made me bigger than this war I’ve waged against myself as long as I remember, with food always my weapon of choice?

The moment didn’t last. Of course it didn’t. The impulse to fill that place, to cancel it out, returned. But now I know that it isn’t vacant and doesn’t need to be fixed, and I’m curious about what else is there. And that is huge.

12. The small space. 
If you don’t like thinking about any part of yourself as even metaphorically big, here’s something small you can explore. I’m not a fan of appropriating another faith’s scripture for secular Western self-coddling, but a Catholic nun originally pointed me to this quote from the Hindu Upanishads, so that boundary’s already been crossed. Here it is:

In the centre of … our own body, there is a small shrine …, and within can be found a small space. We should find who dwells there, and we should want to know him.

No matter how much you ate, the small space remains, undamaged, and so does the person inside. She is — you are — still there, and we should want to know her.

THE REST OF THE TIME (WHEN YOU DON’T HAVE FOOD IN FRONT OF YOU AND AREN’T STARVING OR STUFFED)

13. How you would feel if no one, including you, could see your body.
Here’s one of the simplest, most illuminating exercises I know: One weekend day, don’t wear makeup or do anything to your hair. Wear the most comfortable clothes you own, which may involve some very ratty sweats. Go through a whole day like that and notice that how you look in no way inhibits your ability to operate in the world. I do this a couple of times a month and feel better about everything listed above every time I do.

14. The fact that you do have a body and how amazing that is. 
For long periods of my life, I didn’t want a body. I remember wishing in my teens that I could just live as a brain floating around. I resented the maintenance a female body required. I didn’t mind so much the plucking and shaving and blow-drying and makeup — some of that was fun. I resented not being able to eat what I wanted — the women I grew up around dieted constantly, so I thought it was required of adult female humans. I resented that my body wasn’t good enough as it was. I resented that, through no fault of my own, my postpubescent body required serious management.

Years later, I’ve finally started thinking about my body in terms of what it can do. I learned, for instance, that exercise can be not about a countdown on the elliptical machine but about health and technique and spending more time outside. To my great astonishment, the body I punished for years can run five miles. If a calorie counter were involved, I’m not sure I ever would have discovered that.

15. If you want to lose weight, why.
Is it because you’re not a healthy weight (per your doctor)? Or is it because you look in the mirror and think, “I’m disgusting,” because you fantasize about slicing off parts of your body (which has never done anything to you except bear witness to your actions). If the latter, you don’t need to lose weight, you need to get angry at whatever made you feel like you deserve to be treated that way. No one does. And per #9, talking to yourself like that isn’t going to change your eating.

16. Pretending your issues aren’t your issues won’t make them go away. 
At some point in an episode of obsessing about how much I’ve eaten and how much I’m going to eat and worrying that food will always, always control my life, that I will never escape the ticker tape, I get so fed up that I swing to the opposite extreme. “I’ll just shut it off,” I tell myself. “Why don’t I just wing it? Everyone else manages to feed themselves,” I think, then add, in near-demented contradiction of all eating experiences in my life up to this point, “How hard can it be?”

Let me save us all a lot of trouble by reporting that much like shame, this has not ever, once, resolved anything for me.

17. This is hard. 
Eating sanely — I can’t say normally because emotional and intellectualized eating seem to be the norm in American culture — is an incredibly ambitious proposition. Eat when you’re hungry, stop when you’re full: so much easier said than done.

How sanely you eat is relative, but when I’m berating myself for the fact that I’m still struggling to do that, I try to think about how far I’ve come. One reason eating in December is especially hard for me has nothing to do with sparkly miniskirts and everything to do with the fact that 12 years ago at this time of year I weighed 30 pounds fewer than I do now. I was 18 and looked 11, I was freezing all the time because I had so little body fat and sometimes I brushed my teeth multiple times a day because toothpaste almost felt like food. I remember one night sitting curled up, gaunt and silent, against my mother at my university’s holiday service — she had come to take me home and put me in a hospital — and recognizing that the way I was living wouldn’t sustain me but being unable to imagine any other way of being. I remember the point when, surrounded by the music and warmth, I thought very clearly that it would be so much easier if that moment were my last.

The truth is that it would have been easier — for me, though not my family. If I’ve learned anything in the aftermath of an eating disorder, it’s that the day-to-day business of feeding and inhabiting an adult female body is harder than starving it ever was.

Twelve years later, there are still times when I eat until I’m ill in order not to feel, and there are times when I look in the mirror and think, “Look what you’ve let yourself become.” So far the best thing I know to do about all of that is remind myself that I stuck around for the hard part, that I would have missed so much if I hadn’t and that I’m doing the best I can.

Retrived from: http://www.huffingtonpost.com/2012/12/17/holiday-eating-what-to-think-when-you-obsess_n_2315545.html?ir=women&utm_campaign=121712&utm_medium=email&utm_source=Alert-women&utm_content=Photo

Breakthrough in biosensing: New virus detection method under development

In Fitness/Health, Medication, Medicine on Sunday, 16 December 2012 at 16:05

Breakthrough in biosensing: New virus detection method under development.

the anarchist soccer mom…

In Education, School violence on Sunday, 16 December 2012 at 15:10

http://anarchistsoccermom.blogspot.com/2012/12/thinking-unthinkable.html

Harrowing, Detailed Account of What Happened on 12/14

In Education, School Psychology, School violence on Sunday, 16 December 2012 at 14:40

well-put, ms. ravitch!  we need to realign our priorities!

Harrowing, Detailed Account of What Happened on 12/14.

know the statistics…

In Education, General Psychology, Humane Education, Personality Disorders, Pets, School Psychology, School violence on Sunday, 16 December 2012 at 12:47

http://www.incasa.org/PDF/2011/animal_human_violence.pdf

woulda, shoulda, coulda…

In Education, Education advocacy, School Psychology, School violence on Sunday, 16 December 2012 at 09:54

School Psychologists Feel the Squeeze

As school budgets shrink, school-based mental-health services are losing resources and support.

By Kirsten Weir

September 2012, Vol 43, No. 8

 

The Philadelphia school district came under fire last February when it announced a plan to eliminate half of its 110 school psychologist positions to help close a budget shortfall. After the public outcry, district administrators decided against the cuts.

But not all schools have been so lucky. The economic downturn has forced schools nationwide to tighten their belts — and many school psychologists are feeling the squeeze. Cash-strapped schools have already eliminated what they dub as “nonessential” school personnel and programs, such as art and physical education programs, says Ronald Palomares, PhD, assistant executive director of the APA’s Practice Directorate. And even after making these cuts, schools lack funding.

“Now that there’s less money with the same focus on academics, [schools] are looking at a broader definition of nonessential personnel,” he says. “And unfortunately, that is often where school psychology has fallen.”

That nonessential designation is, of course, all a matter of perspective. Federal special education law requires public school districts to employ school psychologists to evaluate students for special-education services. Fulfilling that role is the primary responsibility of the nation’s estimated 32,300 school psychologists (School Psychology International, 2009). About 6.5 million public school students — about 13 percent — received special-ed services in the 2009–10 school year, according to the National Center for Education Statistics.

In their remaining time, school psychologists tend to students’ mental health needs by consulting with teachers and families of children who have social, behavioral and emotional problems. Some also lead psychosocial groups, such as grief groups for students who have suffered a loss, or pregnancy prevention programs for at-risk girls. They also assist children and schools during times of crisis, such as following a student suicide.

“It’s a combination specialty,” says Frank C. Worrell, PhD, director of the school psychology program at the University of California, Berkeley. “The solution to a psychology problem may be an academic intervention, and the solution to an academic problem may be a psychological intervention. Recognizing the connection between these worlds is important.”

Not enough hours in the day

Despite the need for school psychologists, they are in short supply. The National Association of School Psychologists (NASP) recommends that districts employ one school psychologist for every 500 to 700 students. But that’s not happening, says Philip Lazarus, PhD, director of the school psychology program at Florida International University and 2011–12 NASP president.

“In many states, that ratio is more in the neighborhood of one to 2,000, though in some states it goes as high as one to 3,500,” Lazarus says. “We certainly don’t have the number of personnel we feel is necessary.”

With too few personnel to go around, many school psychologists don’t have the time to perform the full range of services they are trained to provide. Though most school psychologists serve two or three schools, it’s not unusual for a single professional to be responsible for visiting five or even seven different schools, says Worrell.

As money becomes tighter, school psychologists may find they’re stretched even thinner. Most school districts haven’t cut school psychologist positions outright, but many have opted not to fill vacant positions, or have shortened annual contracts by a month or two, says Lazarus. “That’s a subtle way students are losing services,” he says.

Rachel Barrón Stroud, PhD, a school psychologist at Hays Consolidated Independent School District outside Austin, Texas, has seen that trend firsthand. “Our district continues to grow, but there’s no talk of adding additional personnel. The needs of students are being met, but the staff continues to get busier,” she says.

Meanwhile, the district has lost technology specialists and academic interventionists, hurting students and staff alike. Without those technology specialists, for instance, school psychologists may have to spend more time trouble-shooting for special-education students who use assistive technology to communicate.

“The job is getting more difficult in terms of time management,” says Barrón Stroud, who still makes time to provide counseling and teacher consultations and to lead two social-skills groups each week. She says she manages to fit in the extra tasks because she regularly takes work home at night. But she adds, “I think, in general, school psychologists feel like they don’t have time to do all the things they’d like to do.”

Changing the conversation

Budget shortfalls are also undermining psychologists’ prevention efforts at schools — even though research suggests schools are often the best places to reach kids (Cognitive and Behavioral Practice, 2008).

“Children spend the majority of their day in schools,” says Tammy Hughes, PhD, a professor of counseling, psychology and special education at Duquesne University. “Further, because school psychologists work with parents and teachers, they are uniquely situated to help children across multiple settings.”

But too often, when budget cuts loom, prevention and early intervention are the first to go. “The trimming happens at the prevention end — at the time we have the most ability to influence positive social and emotional development and address symptoms very early,” says Hughes.

School psychologists aren’t the only mental health positions affected. School counselors, social workers and academic interventionists can all be considered nonessential when there’s not enough money to go around. Cutting these positions puts extra stress on teachers, who have fewer resources to help them manage students with behavioral and emotional problems.

“Teachers are getting overwhelmed with responsibilities,” Palomares says. “How much can they do at such a high level of expectation and still be successful?”

Inadvertently adding to the burden is the No Child Left Behind Act of 2001, which places an emphasis on student testing and school performance. Unfortunately, policymakers have failed to acknowledge the close link between mental health and academic achievement, says Lazarus.

“Students who can’t focus, or are dealing with difficult family problems, won’t succeed in schools no matter how many reforms are put in place by governors or presidents,” he says.

He and others point out that education reform has focused on increasing academic test scores without considering students’ emotional well-being. “And there’s a direct correlation between emotional health and academic success,” Lazarus says.

Bright spots

In spite of the grim economy, school psychologists’ efforts are making significant headway. One positive sign is a new national focus on bullying, says Susan Swearer, PhD, a professor of school psychology at the University of Nebraska–Lincoln, who participated in the White House Bullying Prevention Conference earlier this year. That focus has helped to bring student mental health to the forefront, she says.

“Issues like bullying really point to the importance of school psychologists being at the leading edge of mental health service delivery for youth. It’s a perfect issue to address the fact that we can’t shortchange mental health services in schools,” she says. “But in this era of dwindling budgets, the [school] leadership has to really prioritize mental health treatment.”

And indeed, some districts are already boosting their focus on students’ mental health. Among them is the Baltimore City Public School System, which employs 128 full-time school psychologists to serve 84,000 students — a ratio of about 1:656. Many of those students come from families of low socioeconomic status and often experience social and emotional difficulties, and school personnel are extremely committed to helping students overcome those difficulties, says Rivka Olley, PhD, who supervises psychological services in the system.

“Unlike a lot of districts, we are known for the fact that our school psychologists are providing mental health services,” she says.

Baltimore’s school psychologists and social workers proactively work with teachers and establish student support teams to help students at the first signs of trouble. They also meet with families in their homes or churches, at coffee shops or local restaurants. “We want to make that connection because that’s what the research shows makes a difference for these kids. It’s really reaching out to the families and bringing them into the loop,” Olley says.

Ultimately, it’s hard to argue against making student mental health a priority. And school psychologists can take a leadership role in making that argument, Hughes says, by reaching out to both administrators and legislators to underscore the importance of investing in students’ mental well-being.

“The potential for impact is enormous,” she adds, “if we can get everyone working in the same direction.”


Kirsten Weir is a writer in Minneapolis.

Retrieved from: http://www.apa.org/monitor/2012/09/squeeze.aspx

musings on the madness…con’t.

In Education, School Psychology, School reform, School violence on Sunday, 16 December 2012 at 09:49

i truly believe that there were warning signs (especially in childhood, so more evidence that the schools are one of the BEST resources for this information). when someone does something like this, there is always hindsight about things that were “off” or not right. rarely, if ever, does someone do something this horrific in the absence of even some “signs” that something just isn’t right or this person is at risk. it’s just many people do not realize these correlations (and that would be the first step…education for all). but, with confidentiality and an extremely litigious society looking to blame, blame, blame…what can we (as school employees) do??? if we reported these incidents, could you not see the parents who would threaten to sue because of “confidentiality,” “predetermination of disability,” or some such nonsense?

not to mention how short-staffed and over-worked we are. i used to have regular “lunch bunches” with my kids. i can’t even recall the last time i took time out to eat lunch by myself, let alone ate with kids. i work straight through just trying to keep up with the paperwork, legal issues, meetings, and assessment (i won’t discuss how much time it took me on friday to fill out the needed information for my “brand new” evaluation process…), and trying to fulfill all my “duties and responsibilities.” i am not putting the blame directly on administration or “downtown” as what can they do when funds are cut and cut again, programs are eradicated, and we are doing the job of two or three people?

it’s a trickle down effect from the “reformers” and a society that would rather pay athletes than those who teach and work with their children. that said, this “education reform” has all the wrong priorities. instead of blaming the teachers, the unions, etc., cutting salaries and programs, inventing new curricula, money needs to be pouring into education and NOT for reform and new tests and ways to evaluate data.

instead of being able to give my email or number to a kid who may be in distress and alone and in need of a professional to speak to, I WOULD BE FIRED! we are not allowed. while we pour money into “celebrity” we take money away from the very place that turns these kids into celebrities, doctors, teachers, athletes, scientists, etc….the schools. the place children spend 8+ hours a day, 180 days a year. the place where we can identify and intervene in things before they become school shootings.

and we can. and we do. it is just to a much lesser extent because of time, money, and, of course, CYA. what if the shooter did have a trusted adult to call? i am not saying he would have or things would have been different, but i can tell you about times i have intervened (even going to the hospital with a suicidal child after school) and things changed. but, as i said, this is NOT allowed anymore. and, while i DO understand the reasons this is not allowed, i wonder if we were not trying so hard to CYA and keep things on a less personal level, would this have happened. if we weren’t afraid of “making waves” or the massive amounts of paperwork, new curricula every few years, or having so much to do that it stops us from connecting with the very kids we work with, would this have happened. we don’t need more criterion-referenced tests, we don’t need personal evaluation instruments that take 50 hours or more, we don’t need to blame the unions and the teachers…we need to take a hard look at our priorities AS A NATION and realize that something needs to change and it’s not the curriculum. instead of piling money into failing banks and auto companies, we need to save our schools and our kids. because, ultimately, the information you can get from those that spend hours every day with your kids…THAT is more important than ANY test score. we are reacting when we need to be intervening. hindsight is always 20/20, but i truly believe there were signs that went unnoticed or worse…unspoken.

musings on the madness…

In Education, Musings, School Psychology, School violence on Saturday, 15 December 2012 at 13:00

the real madness.  not the madness of the occurrences in newtown.  education madness.  how this MIGHT have been avoided.  or at least how i feel i could have done something…were we not focusing on the wrong things.

1.  he has “some” kind of mental illness…

there are only a handful of “mental illnesses” with a higher than average propensity toward violence or carrying out violence. and, even fewer to do something of this magnitude. i have my suspicions as to what, if any, diagnosis, this person has (and, let me give you a clue, it’s not an autism spectrum disorder (asd), a learning disability, or obsessive compulsive disorder (ocd). at any rate, while NO unstable person should have access to a gun, i don’t want people thinking that this boils down to some mental illness and that being an excuse.  unless you are saying “someone MUST have seen the signs” as they have been known and written about for YEARS.

2. we already know the “signs.”  research.  read the literature.  BE INFORMED!

to me, what this shows so very clearly (more than the talk of second amendment rights OR gun control)

3.  i am not advocating that we shouldn’t talk of such things, just not now.

is the need for EARLY INTERVENTION via better early mental health screenings and resources, more education regarding mental health, resources for help…i could go on and on. ironic (but in an horrifically tragic way) that the SCHOOL PSYCHOLOGIST was among those killed.  SHE would have been one of the most qualified to screen, support, and follow children such as these (and, we DO have them). as a school psychologist in the age of education funding cuts and one person doing the work of what was once divided by two or three positions, WE CAN’T DO IT ALL.

4.  you know, i keep asking for the to be one of my super powers, but no luck yet.  maybe i can make it one of my evaluative goals for next year…

unfortunately, things like just taking time to get to know the kids, spending time doing things like reaching out, mentoring, being a real part of a school (as opposed to your FOUR schools) are difficult to come by.  i am confident we (i am speaking as a school psychologist, but counselors, teachers, administrators, etc. can tell you A LOT about your kid/s) can be instrumental in screening and providing resources and intervention if we could just go back to doing all the other things we are good at

5. and, yes, we are good clinicians and do like our assessment, but we are not merely “testers” as much as we have been relegated to the role, we are not taking it gladly

i say this talk needs to be about stopping this crazy education-reform-value-added-data-driven madness and make education and mental health services (especially early INTERVENTION programs, NOT after the fact!) a priority in this country.  

6.  look i love sports and entertainment as much as the next, but there’s something off about a country that cares more about “reality” tv than the reality their kids face every day…the place they spend the majority of their time every week

PEOPLE! many times we are with your children more than you are! we mold YOUR most precious asset.

7.  it really should be.  if not, check yourself

why in the world would you want to CUT funding to education? why would you want LESS resources allotted? i don’t get it.  we pour money into entertainment, sports, alcohol…education should come first. these are kids. YOUR kids.

i just think we are focusing on the wrong things.  in the end, children and adults lost their lives.  other children will be haunted by this for days, weeks, months, and years to come.  how many kids need to be killed?  we can stop this now.

NOW is the time…

In Education, School Psychology, School violence on Saturday, 15 December 2012 at 09:14

Now Is the Time to Talk Guns, Mental Illness

By: Roland Martin

 

Editor’s note: Roland Martin is a syndicated columnist and author of “The First: President Barack Obama’s Road to the White House.” He is a commentator for the TV One cable network and host/managing editor of its Sunday morning news show, “Washington Watch with Roland Martin.”

(CNN) — Enough!

Enough with putting off tomorrow what we should be talking about today. Enough with being afraid to step on someone’s delicate sensibilities when it comes to the Second Amendment. Enough with elected leaders who are too cowardly to confront the National Rifle Association and their ardent supporters. Enough with moms and dads and brothers and sisters and aunts and uncles and pastors and deacons who are afraid to make public the private anguish of mental illness.

Enough! Enough! Enough!

Enough with just asking for thoughts and prayers. Enough with just hugging our children. Enough with leaving flowers and teddy bears at a makeshift memorial.

It’s time for action. It’s time for people of conscience to, in the words of the late civil rights activist Fannie Lou Hamer, be “sick and tired of being sick and tired.”

America, 20 of our children are dead, and we are all paralyzed, not knowing what to do or say. I’ve shed tears for the lives of the innocent children and adults at Sandy Hook Elementary School in Newtown, Connecticut. Many of you have likely done the same.

We witnessed the president of the United States, Barack Obama, stand before the country fighting back tears talking about the lives lost, reminding of us other tragedies involving guns and sick individuals behind the trigger.

And every time this happened, those who refuse to discuss gun control are quick to say, “Now is not the time.”

One day after Kansas City Chiefs linebacker Jovan Belcher shot and killed his girlfriend, Kasandra Perkins, NBC Sports anchor Bob Costas said it was time to talk about this nation’s fascination with guns. Instead of being hailed as an honest communicator, he was vilified for having the audacity to raise the subject at the halftime of a football game.

Have we become such a nation of cowards that we are desperate to not discuss a real issue, instead saying, “Please, shut up so I can watch the game?”

Yet today, we are glued to the television, unable to turn from the scene in Newtown, Connecticut, eager to find every new detail as to what led to the horrific mass murder of a classroom full of kindergartners.

It wasn’t time to talk about this when Rep. Gabby Giffords was shot in the head, and six others were killed in January 2011. It wasn’t time in July 2012 when 12 people were blown away in a movie theater in Colorado. Seven were killed at a Sikh temple near Milwaukee near August, and we were told then, “Now is not the time.”

So, please, exactly when is the time?

This nation, whether we want to admit it not, is one that is fascinated and enraptured with guns. It courses through our veins like heroin shooting through the arms of an addict. We love to see it in our movies, video games, on television, and then we’ll fiercely defend the right to bear arms, all while flagrantly waving the U.S. Constitution in the face of anyone who objects.

There is absolutely no reason why we need as many guns in America. None. It simply shouldn’t be the way of life others are so quick to defend. There is absolutely no doubt that we need tough and stringent gun control. Not solely to prevent murders like those in Connecticut, but to remove the option when someone is angered, depressed or in the case of too many, mentally ill.

And that’s the second issue that it’s time that we come to grips with in this country: We are a nation that has chosen to either medicate or ignore altogether.

“They have a few screws loose.” “You know he’s off his rocker.” We’ve heard all of the terms. We often laugh and dismiss the mentally ill in America, choosing to cross the street when we see the homeless veteran screaming and cussing at anyone who walks by. When it’s time for budget cuts, those most vulnerable often get thrown out first.

For years American cities, counties and states have shirked their responsibility when it comes to the mentally ill, choosing to abandon helping them, but quick to build a new prison to incarcerate them when a law is broken.

Now we wait to see if the Newtown, Connecticut, killer will be the latest Jared Lee Loughner (Gabby Giffords), Seung-Hui Cho (Virginia Tech), or James Holmes (Colorado movie theater all individuals who were described as mentally unstable.

Too often the warning signs were there, but ignored for one reason or another.

Could any of these tragedies have been prevented? No one knows for sure. But I sure as hell would rather try than have to be a first responder and look a parent in the eye and say, “Sir or ma’am, I’m sorry. But your baby is dead, killed in the classroom along with 19 other classmates.”

See, now is the time that they are having that conversation. Now is the time those parents are grieving the loss of their babies. Now is the time parents in Newtown, Connecticut are eschewing Christmas plans to prepare for a funeral.

America, now is the time for us to stop living in denial. We must address guns. We must address mental illness. We must have the courage and conviction to put aside our political views and deal with the task at hand.

America, NOW IS THE TIME.

Retrieved from: http://www.cnn.com/2012/12/14/opinion/martin-gun-control/index.html

Evaluating special education teachers: Implementing the IEP should be the standard

In Education, Education advocacy, School reform, Special Education on Saturday, 15 December 2012 at 09:05

Evaluating special education teachers: Implementing the IEP should be the standard.

animal cruelty is not just animal cruelty…we all suffer.

In Animal Welfare, General Psychology, Humane Education, Personality Disorders, School violence on Saturday, 15 December 2012 at 07:03

i have long espoused the connection between animal cruelty and future deviant/violent behaviors.  i try to explain to those that might not have the same bleeding heart for animals and animal cruelty that i have (it guts me each and every time), should they not be concerned with the violence that the animals suffer (and i don’t really understand how not, but i am sure there are people who believe an animal is a creature for us to have dominion over and we can do what we please or that there are more important causes out there that need help and support), please take note, that choosing NOT to deal HARSHLY with this type of behavior will get us ALL in the long run.  it is said that most serial killers and school shooters were cruel to animals earlier in life.  to me, to ignore such behavior and play it off as something they will ‘grow out of ‘or a result of what is seen on tv, in movies, etc., is negligent knowing the statistics and predictive validity of such behaviors.  you see, those that are cruel to animals, more often than not, “graduate” to levels of cruelty that are inflicted not on animals, but on people.  so, should you not be incensed, disgusted, enraged, gutted, immensely saddened, etc….by the kid who set his dog on fire, or the kid who microwaved his cat, or the sheer magnitude of crimes inflicted upon animals daily with absolutely no regard for their suffering (there are so very many, and they are so very shocking, horrific, and born of pure evil)…should this not sicken you or move you into action, please…realize that at some point people will more likely than not have to deal with the aftermath of this cruelty when it extends to people.  

please, please, please…be aware, be vigilant, and above all, fight for stricter animal cruelty laws.  if not for the innocent animals, then for those that will be on the receiving end of the violence that stems from those that are able to inflict cruelty on animals.

http://jaapl.org/content/30/2/257.full.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792040/

 

Early identification for individuals at risk for antisocial personality disorder

In General Psychology, School Psychology on Saturday, 15 December 2012 at 06:39

Early identification for individuals at risk for antisocial personality disorder

Jonathan Hill, MRCPsych

Abstract

Background Antisocial personality disorder is usually preceded by serious and persistent conduct problems starting in early childhood, and so there is little difficulty in identifying an at-risk group.

Aims To address six key areas concerning the relationship between early conduct problems and antisocial personality disorder.

Method Review of recent research into early identification of and intervention in child conduct problems, following up to possible adult antisocial behaviour.

Results Conduct problems are predictive of antisocial personality disorder independently of the associated adverse family and social factors. Prediction could be aided through identification of subtypes of conduct problems. There is limited evidence on which children have problems that are likely to persist and which will improve; children who desist from early conduct problems and those with onset in adolescence are also vulnerable as adults.

Conclusions The predictive power of the childhood precursors of antisocial personality disorder provides ample justification for early intervention. Greater understanding of subgroups within the broad category of antisocial children and adults should assist with devising and targeting interventions.

The identification of childhood precursors of adult psychiatric disorders offers the possibility of early intervention and hence prevention. In the case of antisocial personality disorder the early indicators are remarkably clear. Starting with Robins’ (1966) classic follow-up of children referred to a clinic for conduct problems, numerous studies have shown that persistent and pervasive aggressive and disruptive behaviours seen before the age of 11 years are strongly associated with persistence of antisocial behaviours through adolescence and into adult life. As Robins described, the risk extends far beyond antisocial behaviours to unstable relationships, unreliable parenting and underachievement in education and at work (Moffitt et al, 2002). This broad constellation of difficulties is reflected in DSM—IV antisocial personality disorder (American Psychiatric Association, 1994). Furthermore, children who do not have conduct problems are very unlikely to subsequently develop antisocial personality disorder (which is rare without a history of conduct problems). Conduct disorder is a specific diagnosis within DSM—IV, which requires antisocial acts seen generally in older children and adolescents. In this paper the terms ‘conduct problems’ and ‘the conduct disorders’ are used to denote serious oppositional, aggressive or antisocial behaviours whether or not they meet DSM criteria for conduct disorder.

METHOD

Selective review of findings published over the past 10 years in childhood predictors of antisocial personality disorder, and consideration of issues still to be addressed in relation to early identification of individuals at risk.

RESULTS

Clinical policy

From a clinical and policy perspective, the strength of the continuity from conduct problems to antisocial personality disorder is ample grounds for making strenuous efforts to prevent the appearance of aggressive and disruptive behaviours in young children, and to intervene early once they have been identified. It is not the purpose of this paper to review the evidence for the effectiveness of prevention programmes and of early interventions for conduct problems, but a brief summary highlights the need for further refinements in early identification. A small number of adequately designed randomised controlled trials of preventive programmes to reduce conduct problems have been carried out, some of which have yielded promising results. Equally, whereas there have been some significant improvements, often the effects have been quite small; and some studies have shown no benefits (LeMarquand et al, 2001). There is substantial support for the effectiveness of parent management training programmes in reducing overall levels of conduct problems in children (Kazdin, 2000), and for the effectiveness of stimulants where conduct problems are associated with attention-deficit hyperactivity disorder (ADHD) (Swanson et al, 2001). Nevertheless, there has been considerable variability in outcomes. Parent training has been found to be less effective for the higher-risk families characterised by socio-economic disadvantage, marital discord or single parent status, high parental stress and maternal unresolved loss or trauma (Routh et al, 1995Kazdin, 1997). Children with more severe or chronic problems or with comorbid conditions are less likely to do well (Ruma et al, 1996). Evidence of the long-term effectiveness of psychosocial treatments for conduct problems, and of stimulants for conduct problems comorbid with ADHD, is lacking.

Early identification

It may be that the problem will be solved simply through better treatment techniques; however, attention to six issues in early identification may also be of value in generating ideas for the development of interventions. First, conduct problems in young children are associated with many other adverse factors such as ineffective parenting practices, discordant and unstable families, poor peer relationships and educational failure. It is important to clarify whether it is the child’s disorder that requires early identification, or these associated factors or both. Second, conduct problems in childhood are generally identified on the basis of a broad cluster of behaviours. The identification of subtypes may lead to a better understanding of underlying mechanisms, and hence to improved matching of treatment to clinical needs. Third, in approximately 50% of children with early conduct problems these do not persist into adolescence and adult life. Ways of distinguishing persisters and desisters are needed. Fourth, given the intractability of behaviour problems in some young children, we need to ask whether identification at an earlier age is possible. Fifth, the adult outcomes of children who show early conduct problems and then desist, and of those whose problems start in adolescence, need to be considered. Finally, we need to attend to the adult outcomes that we are attempting to anticipate. It may be that specific antisocial outcomes have different antecedents from those of antisocial personality disorder.

What is predictive?

It is possible that, because conduct problems are associated with a wide range of adverse individual, family and social factors, the conduct problems per seare not the antecedents of antisocial personality disorder but are markers for these other difficulties that are the true antecedents. In general, the evidence supports conduct problems as true antecedents (Farrington et al, 1990). For example, studies that have assessed both conduct problems and quality of peer relationships, and then followed children over several years, have consistently found that early conduct problems predict later antisocial behaviours (Tremblay et al, 1995Woodward & Fergusson, 1999). By contrast, the role of peer relationships has been less clear. This should not, however, be interpreted to mean that the associated factors are unimportant. For example in the Dunedin Multidisciplinary Health and Development Study, violent crime at the age of 18 years was predicted by the combination of temperamental lack of control (quick to show negative emotions when frustrated, poor impulse control) and number of changes of parental figure before the age of 13 years, which probably reflected a range of family adversities (Henry et al, 1996).

Sources of heterogeneity in the conduct disorders

Longitudinal studies from childhood to adulthood have used a wide range of ways to characterise conduct problems. Generally they have made use of summary scores generated from a range of questionnaires completed by teachers and parents (Farrington et al, 1990Fergusson et al, 1996Moffitt et al, 1996). The consistency of the findings may suggest that it does not matter much how the problem is defined. Equally, there are pointers to potentially important kinds of heterogeneity. Children with conduct problems and hyperactivity/inattention differ from those with ‘ pure’ conduct disorder in that their problems are more severe and likely to persist, and they are more likely to have neuropsychological deficits (Lynam, 1996). Lynam (1998) has argued that children with attention-deficit hyperactivity problems are ‘fledgling psychopaths’, implying that they are more likely to show in adult life the combination of callousness, superficial charm and antisocial behaviour that characterises a sub-group of adults with antisocial personality disorder. Frick and colleagues give priority to callous—unemotional traits in childhood. In a series of studies they have demonstrated that children with antisocial problems who exhibit these traits differ from other children with antisocial problems (Barry et al, 2000) in apparently having fewer verbal deficits (Loney et al, 1998) and in coming from families that are not characterised by dysfunctional parenting practices seen generally in the conduct disorders (Wootton et al, 1997). Children exhibiting callous—unemotional traits may also have a deficit in processing behavioural evidence of distress in others. Associations between scores assessing callous and unemotional characteristics and a reduced ability to recognise fear and sadness have been shown in young adolescents recruited in mainstream schools and children with identified emotional and behavioural problems (Blair & Coles, 2003;Stevens et al, 2001).

Loeber et al (1993) have proposed that three contrasting patterns of childhood antisocial problems reflect different pathways for different behaviour patterns: an ‘overt’ pathway characterised by bullying, followed by early fighting and proceeding to more serious violence; a ‘covert’ pathway starting with lying and stealing, and going on to more serious damage to property; and an ‘ authority conflict’ pathway in which oppositional and defiant behaviours are prominent.

A further distinction, between ‘reactive’ and ‘ proactive’ antisocial behaviours, cuts across this three-category typology. Reactive acts occur in response to actual or perceived threat from others, whereas proactive behaviours are initiated by the individuals (Dodge & Coie, 1987). Reactive aggression is thought to involve angry retaliation, in contrast to the cold unprovoked calculation of proactive aggression. Dodge et al (1997) reported that, compared with children showing proactive aggression, ‘reactive’ children were more likely to have been physically abused, to have poor peer relationships, to have shown aggression from an earlier age and to have attention-deficit and hyperactivity symptoms. A central idea in Dodge’s model is that reactive aggression is mediated by a readiness to perceive hostile intent in the actions of others. However, the evidence for this is inconsistent. At this stage these can be considered as promising subtypes that may lead to a more precise specification of mechanisms, and hence provide pointers to different kinds of intervention. Longitudinal studies to determine whether they differ in course are needed.

Who are the persisters and desisters?

We have already referred to the poor outlook of children with both conduct disorder and ADHD symptoms. On the basis of retrospective reports within a large epidemiological study, Robins & Price (1991) found that the number of childhood antisocial problems is associated with risk of antisocial personality disorder. Studies within childhood provide some further clues regarding risk of persistence. Loeber et al (2000) found that early fighting and hyperactivity predicted persistence of antisocial behaviours over a 6-year period among boys referred for conduct problems. In a prospective study of a representative general population sample from ages 7-9 years to 14-16 years, persisters had the highest levels of family adversity and lower IQ and self-esteem (Fergussonet al, 1996). Children with early conduct problems that did not persist had levels of these risk factors that were intermediate between those of persisters and of children who lacked early behavioural problems. Persisters were more likely than those whose early antisocial behaviours had remitted to have a deviant peer group in adolescence. Whether this was a reflection or a cause of persistence is not clear; however, it is consistent with Sampson and Laub’s argument that a key factor in determining persistence may be the presence or absence of social bonds and controls (Sampson & Laub, 1994).

Earlier predictors

We might suppose that, given the stability of conduct problems from the age of 3 years onwards, earlier precursors should be readily identifiable. However, the findings have been inconsistent. For example, the idea has been extensively investigated that early ‘difficult’ temperament, comprising traits such as predominantly negative emotions and ready frustration, contributes to irritable parenting, which in turn increases the risk for conduct problems. Studies using assessments of temperament based on parental reports have yielded some positive findings, but these are vulnerable to parental attributions. Recent studies have failed to demonstrate consistently that observational measures of temperament made in the first year of life predict later conduct problems (Belsky et al, 1998Aguilar et al, 2000). Early attachment difficulties might be expected to increase the risk for later conduct problems. Here again the evidence is not convincing (Hill, 2002). It is likely that the quality of parenting in infancy is predictive of later conduct problems (Belsky et al, 1998) and it may be that the most promising approaches to the identification of early predictors will examine specific interactions between infant characteristics and early social experience (Shaw et al, 1996Belsky et al, 1998).

Desisters and later onsets

We have focused so far on boys who show early conduct problems that persist into adult life. It has generally been assumed that those whose conduct problems remit have ‘recovered’. However, recent evidence from the Dunedin Study suggests that although these children are not at increased risk for antisocial outcomes, they are by no means free of difficulties (Moffitt et al, 2002). At the age of 26 years they had higher rates of depression and anxiety disorders, both self- and informant-rated, and they were socially isolated, with few friends. They shared the poor educational and work records of the life-course persistent group who were antisocial as adults. Likewise, those with onset in adolescence, provisionally termed by Moffitt ‘ adolescence limited’, were not free of problems by the age of 26 years. Compared with those who were not significantly antisocial in childhood or adolescence, these young men had higher rates of documented and self-reported drug and property crimes, and their informants reported more depression and anxiety symptoms.

Heterogeneity within antisocial personality disorder

Thus far in this paper the assumption has been made that the DSM-IV antisocial personality disorder category best summarises the antisocial outcomes of interest. There is little doubt that it succeeds as a broad-brush characterisation of antisocial behaviour and associated wider social dysfunction. However, it lacks specificity. In common with all DSM diagnoses, it requires the presence of a number of maladaptive behaviours or mental states identified from a larger set. Hence, the requirements can be met in numerous ways. This may limit the investigation of more specific causal factors, and so a more precise specification of the adult antisocial outcomes may be needed.

The identification of ‘psychopathic disorder’ makes the point. DSM-IV antisocial personality disorder is present in 50-80% of convicted offenders, but a much smaller group of 15-30% are judged to have characteristics such as grandiosity, callousness, deceitfulness, shallow affect and lack of remorse (Hart & Hare, 1989). These individuals are more likely than other offenders to have a history of severe and violent offences, and they may also have a distinctive deficit in interpersonal sensitivity. In a comparison of prisoners with and without psychopathic disorder, the groups did not differ in their ability to attribute correctly happiness, sadness and embarrassment to protagonists in short stories. However, in response to guilt stories, those with psychopathic disorder were more likely to attribute happiness or indifference to the protagonists (Blair et al, 1995). It has been proposed that psychopathy is associated with a failure to inhibit aggression in response to signs of distress in others, arising from a deficit in processing behavioural evidence of that distress (Blair et al, 1997). There is supportive evidence that, compared with other offenders, adults with psychopathic disorder have reduced autonomic responses to distress cues (Chaplin et al, 1995Blair et al, 1997). As we saw earlier, a subgroup of children with antisocial problems who exhibit callous—unemotional traits has been identified that may parallel adults with psychopathic disorder. No studies have yet tested for continuity between child and adult psychopathic traits by following these children into adult life.

DISCUSSION

Children at risk for future antisocial personality disorder are readily identified, but evidence on the long-term effectiveness of prevention and treatment programmes is limited. Some progress has been made in identifying subgroups of children with antisocial problems in which different causal processes operate, and therefore for which there are different treatment needs. The available research does not yet tell us whether differences in the patterning, or associated features, of childhood conduct problems are predictive of distinctive adult outcomes. If is possible that this review was subject to selection bias.

Clinical Implications and Limitations

CLINICAL IMPLICATIONS

  • The identification and treatment of conduct problems in early childhood are central to the prevention of antisocial personality disorder.
  • The conduct disorders are heterogeneous in the patterning and course of symptoms, with implications for matching treatment to type of problem.
  • There is considerable heterogeneity within antisocial personality disorder, so that there is a need to identify specific early indicators of particular adult antisocial outcomes.

LIMITATIONS

  • Most of the research reviewed in the article refers to antisocial personality disorder in males.
  • Few longitudinal studies of general populations have included sufficient numbers of antisocial children to explore heterogeneity.
  • Little is known about very early indicators of children at risk for the development of conduct problems.

Footnotes

  • * Paper presented at the second conference of the British and Irish Group for the Study of Personality Disorders (BIGSPD), University of Leicester, UK, 31 January to 3 February 2001.

References

  1. Aguilar, B., Sroufe, L. A., Egeland, B., et al (2000) Distinguishing the early-onset/persistent and adolescence-onset antisocial behaviour types: from birth to sixteen years. Development and Psychopathology12, 109-132.
  1. American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). Washington, DC: APA.
  1. Barry, C. T., Frick, P. J., DeShazo, T. M., et al (2000) The importance of callous—unemotional traits for extending the concept of psychopathy to children. Journal of Abnormal Psychology109, 335 -340.
  1. Belsky, J., Hsieh, K-H. & Crnic, K. (1998) Mothering, fathering, and infant negativity as antecedents of boys’ externalising problems and inhibition at age 3 years: differential susceptibility to rearing experience?Development and Psychopathology10, 301 -320.
  1. Blair, R. J. R. & Coles, M. (2003) Expression recognition and behavioural problems of early adolescence. Cognitive Development, in press.
  1. Blair, R. J. R., Sellars, C., Strickland, I., et al (1995) Emotion attributions in psychopathy. Personality and Individual Differences19, 431-437.
  1. Blair, R. J. R., Jones, L., Clark, F., et al (1997) The psychopathic individual: a lack of responsiveness to distress cues? Psychophysiology34,192 -198.
  1. Chaplin, T. C., Rice, M. E. & Harris, G. T. (1995) Salient victim suffering and perceptual responses of child molesters. Journal of Consulting and Clinical Psychology63, 249 -255.
  1. Dodge, K. A. & Coie, J. D. (1987) Social information-processing factors in reactive and proactive aggression in children’s peer groups. Journal of Personality and Social Psychology53, 1146 -1157.
  1. Dodge, K. A., Lochman, J. E., Harnish, J. D., et al (1997) Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultative youths. Journal of Abnormal Psychology106,37-51.
  1. Farrington, D. P., Loeber, R. & Van Kammen, W. B. (1990) Long-term criminal outcomes of hyperactivity—impulsivity—attention-deficit and conduct problems in childhood. In Straight and Devious Pathways from Childhood to Adulthood (eds L. N. Robins & M. R. Rutter), pp. 62 -81. New York: Cambridge University Press.
  1. Fergusson, D. M., Lynskey, M. T. & Horwood, L. J. (1996) Factors associated with continuity and changes in disruptive behaviour patterns between childhood and adolescence. Journal of Abnormal Psychology24,533 -553.
  2. Hart, S. D. & Hare, R. D. (1989) Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population. Psychological Assessment: A Journal of Consulting and Clinical Psychology1, 211 -218.
  1. Henry, B., Caspi, A., Moffitt, T. E., et al (1996) Temperamental and familial predictors of violent and non-violent criminal convictions: from age 3 to age 18. Development Psychopathology32, 614 -623.
  1. Hill, J. (2002) Biological, psychological and social processes in the conduct disorders. Journal of Child Psychiatry and Psychology43, 133 -164.
  1. Kazdin, A. E. (1997) Parent management training: evidence, outcomes and issues. Journal of the American Academy of Child and Adolescent Psychiatry36, 1349 -1356.
  1. Kazdin, A. E. (2000) Treatment of conduct disorders. In Conduct Disorders in Childhood and Adolescence (eds J. Hill & B. Maughan). Cambridge: Cambridge University Press.
  1. LeMarquand, D., Tremblay, R. & Vitaro, R. (2001) The prevention of conduct disorder: a review of successful and unsuccessful experiments. InConduct Disorders in Childhood and Adolescence (eds J. Hill & B. Maughan). Cambridge: Cambridge University Press.
  1. Loeber, R., Wung, P., Keenan, K., et al (1993) Developmental pathways in disruptive child behaviour. Development and Psychopathology,5, 101-132.
  1. Loeber, R., Green, S. M., Lahey, B. B., et al (2000) Physical fighting in childhood as a risk factor for later mental health problems. Journal of the American Academy of Child and Adolescent Psychiatry39, 421 -428.
  2. CrossRefMedline
  1. Loney, B. R., Frick, P. J., Ellis, M., et al (1998) Intelligence, psychopathy, and antisocial behaviour. Journal of Psychopathology and Behavioural Assessment20, 231 -247.
  1. Lynam, D. R. (1996) The early identification of chronic offenders: who is the fledgling psychopath? Psychological Bulletin120, 209 -234.
  1. Lynam, D. R. (1998) Early identification of the fledgling psychopath: locating the psychopathic child in the current nomenclature. Journal of Abnormal Psychology107, 566 -575.
  1. Moffitt, T. E., Caspi, A., Dickson, N., et al (1996) Childhood-onset versus adolescent-onset antisocial conduct in males: natural history from 3 to 18. Development and Psychopathology8, 399 -424.
  1. Moffitt, T. E., Caspi, A., Harrington, H., et al (2002) Males on the life-course persistent and adolescence-limited antisocial pathways: follow-up at age 26. Development and Psychopathology14, 179 -207.
  1. Robins, L. N. (1966) Deviant Children Grown-Up: A Sociological and Psychiatric Study of Sociopathic Personalities. MD: Williams and Wilkins.
  1. Robins, L. N. & Price, R. K. (1991) Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiological Catchment Area Project. Psychiatry542, 116 -132.
  1. Routh, C. P., Hill, J. W., Steele, H., et al (1995) Maternal attachment status, psychosocial stressors and problem behaviour: follow-up after parent training courses for conduct disorder. Journal of Child Psychology and Psychiatry36, 1179 -1198.
  1. Ruma, P. R., Burke, R. V. & Thompson, R. W. (1996) Group parent training: is it effective for children of all ages? Behavior Therapy27, 159-169.
  1. Sampson, R. J. & Laub, J. H. (1994) Urban poverty and the family context of delinquency: a new look at structure and process in a classic study. Child Development65, 523 -540.
  1. Shaw, D. S., Owens, E. B., Vondra, J. I., et al (1996) Early risk factors and pathways in the development of early disruptive behavioural problems.Development and Psychopathology8, 679 -700.
  1. Stevens, D., Charman, T. & Blair, R. J. R. (2001) Recognition of emotion in facial expressions and vocal tones in children with psychopathic tendencies. Journal of Genetic Psychology162, 201 -211.
  1. Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., et al (2001) Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry40, 168 -179.
  1. Tremblay, R. E., Masse, L. C., Vitaro, F., et al (1995) The impact of friends’ deviant behaviour on early onset of delinquency: longitudinal data from six to thirteen years of age. Development and Psychopathology7,649-668.
  1. Woodward, L. J. & Fergusson, D. M. (1999) Childhood peer relationship problems and psychosocial adjustment in late adolescence.Journal of Abnormal Child Psychology27, 87-104.
  1. Wooton, J. N., Frick, P. J., Shelton, K. K., et al (1997) Ineffective parenting and childhood conduct problems: the moderating role of callous—unemotional traits. Journal of Consulting and Clinical Psychology65, 301-308.

i have no words right now…

In General Psychology, School Psychology, School violence, Uncategorized on Friday, 14 December 2012 at 17:14

http://www.neahin.org/blog/school-crisis-resources.html

http://www.neahin.org/educator-resources/school-crisis-guide.html

Depression, Other Psychosocial Disorders Linked to Stroke

In Anxiety, Mood Disorders, Well-being on Friday, 14 December 2012 at 08:35

Depression, Other Psychosocial Disorders Linked to Stroke

Pauline Anderson

Older adults who are depressed, stressed, or dissatisfied with their life are at increased risk of suffering a stroke and of dying from a stroke, a new study has found.

The study showed that those who faced the highest level of psychosocial distress had a significantly increased risk of having a stroke and up to 3 times the risk of stroke mortality compared with those with the least amount of distress.

“Our findings clearly document important adverse effects of psychosocial distress on cerebrovascular disease risk in the elderly,” write the authors, including senior author Susan Everson-Rose, PhD, associate professor of medicine and associate director of the Program in Health Disparities Research, University of Minnesota, Minneapolis.

The study is published online December 13 in Stroke.

Distress Score

The study used data from the Chicago Health and Aging Project (CHAP), an ongoing, longitudinal study investigating chronic illnesses in elderly residents of 3 adjacent neighborhoods in Chicago, who represent a broad range of socioeconomic backgrounds. Researchers conducted baseline interviews to gather information on medical history, cognitive health, socioeconomic status, behavioral patterns, and psychosocial characteristics, repeating the interviews in 3-year cycles.

The second cycle of interviews (1997 to 1999) assessed the broadest range of psychosocial characteristics and served as the baseline for the current analysis, which included 4120 mostly black and female participants whose average age was 77 years. Most had a high school education and an average of 1 chronic condition; 13.1% reported a history of stroke.

For information on stroke hospitalizations, researchers accessed the Centers for Medicare and Medicaid Services Medicare Claims data (because some participants were involved in a health maintenance organization, only 2649 participants were analyzed for rates of incident stroke). To verify deaths, the authors used linkages with the National Death Index.

To assess psychosocial distress, investigators created a distress score that factored in 4 psychosocial measures: depressive symptoms, perceived stress, neuroticism (a personality domain characterized by anxious, angry, and vulnerable traits), and life satisfaction. The higher the score is, the higher the distress.

The study showed a dose-response pattern of risk for incident stroke. Relative to the least distressed quartile, the hazard ratios (HRs) for the second, third, and fourth quartiles were 1.27 (95% confidence interval [CI], 0.98 – 1.65; P = .067), 1.44 (95% CI, 1.10 – 1.87; P = .0068), and 1.54 (95% CI, 1.16 – 2.04;P = .0025), respectively, in a model adjusted for age, race, and sex. Associations were reduced after adjustment for stroke risk factors.

With distress modeled categorically and adjusting for age, race, and sex, participants in the highest quartile had nearly a 3 times (HR, 2.97; 95% CI, 1.81 – 4.88; P < .0001) greater risk of dying from stroke relative to those with the lowest distress scores. Those in the third quartile had nearly 2 times the risk (HR, 1.98; 95% CI, 1.19 – 3.30; P = .0091).

Analyses of stroke subtypes revealed that distress was significantly related to incident hemorrhagic strokes, but not to ischemic strokes after adjustment for covariates.

Behavioral Factors

Psychological and behavioral factors may play a role in raising stroke risk. Very distressed people may be less likely or less able to comply with treatment recommendations or to maintain a healthy lifestyle.

“Our most distressed participants were less physically active, and had a higher prevalence of cardiovascular disease and diabetes mellitus, suggesting potentially greater disease burden in this group, which could make lifestyle management more challenging,” the authors write. However, in this study, controlling for these factors had little effect on the relationship between distress and either stroke mortality or hemorrhagic strokes.

The pathways by which distress increases stroke risk are not fully understood, said the authors. Possible mechanisms may involve hypothalamic-pituitary-adrenal dysregulation related to stress that may increase circulating catecholamines, endothelial dysfunction, and platelet activation, culminating in a hypercoaguable state.

Neuroendocrine and inflammatory effects of chronic stress and negative emotional states may also contribute to the increased risk. However, the authors pointed out that these pathways are probably more important for ischemic than hemorrhagic stroke and that the current study found much stronger findings for hemorrhagic stroke.

The study lacked data on inflammatory and neuroendocrine biomarkers that might have shed more light on pathways that may link psychosocial distress to stroke risk. Another limitation was that CHAP doesn’t include imaging data that might provide important information about the types of strokes experienced by study participants. Also, the study assessed psychosocial distress at just one point in time, so it couldn’t determine whether distress levels changed or whether such changes influenced stroke risk.

Dr. Everson-Rose is supported in part by a grant from the National Institute on Minority Health and Health Disparities (NIMHD).

Stroke. Published online December 13, 2012.

Retrieved from: http://www.medscape.com/viewarticle/776137?src=smo_neuro

power to the teachers!

In Education, Education advocacy, Pedagogy, School reform on Friday, 14 December 2012 at 08:31

http://www.huffingtonpost.com/2012/12/12/boston-school-turnaround-_n_2285795.html?ncid=edlinkusaolp00000003

Facebook Use May Lead to Loss of Self-Control

In Social Media on Friday, 14 December 2012 at 08:27

Facebook Use May Lead to Loss of Self-Control

Participating in online social networks can have a detrimental effect on consumer well-being by lowering self-control among certain users, according to a new study in the Journal of Consumer Research.
“Using online social networks can have a positive effect on self-esteem and well-being. However, these increased feelings of self-worth can have a detrimental effect on behavior. Because consumers care about the image they present to close friends, social network use enhances self-esteem in users who are focused on close friends while browsing their social network. This momentary increase in self-esteem leads them to display less self-control after browsing a social network,” write authors Keith Wilcox (Columbia University) and Andrew T. Stephen (University of Pittsburgh).

Online social networks are having a fundamental impact on society. Facebook, the largest, has over one billion active users. Does using a social network impact the choices consumers make in their daily lives? If so, what effect does it have on consumer well-being?

A series of interesting studies showed that Facebook usage lowers self-control for consumers who focus on close friends while browsing their social network. Specifically, consumers focused on close friends are more likely to choose an unhealthy snack after browsing Facebook due to enhanced self-esteem. Greater Facebook use was associated with a higher body-mass index, increased binge eating, a lower credit score, and higher levels of credit card debt for consumers with many close friends in their social network.

“These results are concerning given the increased time people spend using social networks, as well as the worldwide proliferation of access to social networks anywhere anytime via smartphones and other gadgets. Given that self-control is important for maintaining social order and personal well-being, this subtle effect could have widespread impact. This is particularly true for adolescents and young adults who are the heaviest users of social networks and have grown up using social networks as a normal part of their daily lives,” the authors conclude.


References:
Keith Wilcox and Andrew T. Stephen. “Are Close Friends the Enemy? Online Social Networks, Self-Esteem, and Self-Control.” Journal of Consumer Research: June 2013.

University of Chicago Press Journals. (2012, December 14). “Facebook Use May Lead To Loss Of Self-Control.” Medical News Today.

Retrieved from
http://www.medicalnewstoday.com/releases/253936.php.

ADHD drugs do not raise risk of serious heart conditions in children, study shows

In ADHD, ADHD child/adolescent, ADHD stimulant treatment on Thursday, 13 December 2012 at 08:22

ADHD drugs do not raise risk of serious heart conditions in children, study shows

GAINESVILLE, Fla. — Children taking central nervous system stimulants such as Adderall and Ritalin do not face an increased risk of serious heart conditions during treatment, according to a new University of Florida study that confirms findings reported in 2011. Published in the British Medical Journal in August, the study contributes to a decade-long clinical and policy debate of treatment risks for children with attention deficit hyperactivity disorder, or ADHD.

“This is a question that has been lingering for about 10 years,” said Almut Winterstein, a pharmacoepidemiologist and a professor in pharmaceutical outcomes and policy in the UF College of Pharmacy.

Stimulant drugs are one of the most commonly prescribed medications for children — after antibiotics and antidepressants, Winterstein said.

Winterstein’s results show that every year, children have an approximately one in 30,000 risk of suffering a severe cardiac event. She found no increased risk for children who were taking stimulant drugs. A cardiac event includes sudden cardiac death, heart attack or stroke, and is typically caused by underlying heart disease. These results confirm previous study conclusions that there are no serious cardiac events resulting from short-term use of central nervous system stimulant drugs by children and young adults.

In 2007, Winterstein conducted the first large population study to investigate the risk associated with the use of central nervous system stimulants in children and young adults between ages 3 and 20. Published in the journal Pediatrics, her results showed a 20 percent increase in emergency clinic or doctor’s office visits with cardiac-related symptoms, but no increase in death or hospital admission for serious heart conditions.

In that study, she analyzed records from 55,000 children under Medicaid who had ADHD and were undergoing treatment between 1994 to 2004. But this population was still not large enough to determine if these drugs were indeed safe for children, Winterstein said.

The new study, funded by the Agency for Healthcare Research and Quality and in part by the National Center for Advancing Translational Sciences, examines a larger U.S. population of 1.2 million youths eligible for Medicaid programs in 28 states. It follows a similarly large investigation published in December 2011 in The New England Journal of Medicine by Dr. William O. Cooper, who looked primarily at privately insured patients.

“We complemented Dr. Cooper’s study by utilizing Medicaid patients who are typically more vulnerable and at higher risk for serious adverse events,” Winterstein said. “This allowed us to examine patients with severe underlying heart conditions who received stimulants.”

Although the study confirmed there are no short-term effects from central nervous system stimulants, the study did not reveal how these drugs affect patients in the long term.

“Neither of the studies was able to answer what happens in the long term,” Winterstein said. “It’s an important issue to address, but we won’t be able to answer the question until this generation of ADHD children, who began using stimulant drugs in the 1990s, reaches adulthood into their 50s, 60s and 70s.”

Another concern the study raised to UF researchers is related to children who were on continuous stimulant medication for more than 10 years into their adulthood. The effects of even minor increases in blood pressure and heart rate over a sustained period of time are unknown, Winterstein said.

A decade ago, when initial alarms were raised about stimulant use in children, health-care providers were cautious, but now the practice has increased with the knowledge of little risk of serious effects.

Dr. Regina Bussing, a professor in the UF College of Medicine’s division of child and adolescent psychiatry, said concerns about possible serious cardiovascular risks may have resulted in children not getting needed ADHD treatment.

“Dr. Winterstein and her colleagues’ study yields important information for clinicians,” Bussing said.

Recommended evaluation practices should continue for young patients, Bussing said, including cardiovascular monitoring. Parents will still be advised to stop medication and take the child to the emergency room should he or she develop sudden onset of chest pain or shortness of breath, but the study alleviates doctor and parent concerns for the most serious cardiovascular events.

Though her research does cast a positive light on the safety of central nervous system stimulants, Winterstein agrees that parents should continue to seek medical care if symptoms arise. She also has concerns about the increasing use of stimulant drugs for children without weighing the long-term risks and benefits.

Retrieved from: http://news.ufl.edu/2012/10/31/child-stimulant/

chasing tails…not just for dogs!

In Education, Pedagogy on Thursday, 13 December 2012 at 08:19

Why Do Educators Appear to be Chasing Their Tails?

Four key findings in Promoting Healthy Minds Primed for Learning:
1) A baby’s brain at birth is the least developed organ. An analogy often used is that the brain is like a house built from the bottom up. The brain continues to develop through connections created by sensory experiences from birth onwards.

2) IQ is not fixed at birth. The baby’s experiences physiologically change the brain creating more connections. The quality and richness of the experiences have a major effect on learning and brain development.

3) Learning is life-long but there are critical sensitive periods of time when the brain functions like a giant sponge absorbing specific information.

4) Emotions effect learning. Strong negative emotions have the capacity to weaken the wiring of the brain.

With thoughts of the key neurological findings above I find it concerning that the current focus on ‘content and assessment’ reduces the time teachers have to plan and implement strategies that support how children learn and an environment that is supportive of learning and risk-taking.

It seems to fit into the ‘chasing the tail’ syndrome. There are specific standards that must be reached by students at particular timeframes. The pressure to meet these performance measurements results in class teachers believing that there is ‘little time’ for social emotional wellbeing development. Time is spent in planning, moderating, implementing and assessing. There is little time to ‘catch up’ students falling behind or for the repetition that is necessary for memory storage.

At the end of the term, exhausted teachers gather their assessment together and wonder what went wrong for a proportion of their students. It is not only ‘at risk’ students who have under-performed. Several students will have failed to meet expected standards.

Often the needs of socially and economically disadvantaged students are targeted for learning readiness intervention and support. However there are many and varied reasons for the inhibition of learning as can be seen in the range of students who do not achieve to their expected potential. Conflict in the home, terminal illness in the family, natural disasters, friendship problems, bullying and many other misfortunes lead to strong emotions affecting how students view their world.

The whole concept of ‘intelligence’ is changing. Children with ‘healthy minds’ and ‘inner strengths’ have an increased capacity to achieve social, emotional and cognitive wellbeing and reach expected performance measures within appropriate timelines. But if their inner worlds are in turmoil and they do not commence each day with a focus on building onto their inner strengths, their ability to use higher order thinking skills will be compromised.
I’m hoping that there will be an end to this ‘Chasing the Tail’ syndrome sooner rather than later for the future wellbeing of our young students.

Retrieved from: http://www.ready2resource.com.au/why-do-educators-appear-to-be-chasing-their-tails/

DSM-V…pick and choose

In General Psychology on Thursday, 6 December 2012 at 13:18

DSM-5 Is a Guide Not a Bible: Simply Ignore Its Ten Worst Changes

Allen Frances, Professor Emeritus, Duke University

This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM-5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public — be skeptical and don’t follow DSM-5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the 10 changes that make no sense.

Brief background. DSM-5 got off to a bad start and was never able to establish sure footing. Its leaders initially articulated a premature and unrealizable goal — to produce a paradigm shift in psychiatry. Excessive ambition combined with disorganized execution led inevitably to many ill-conceived and risky proposals.

These were vigorously opposed. More than 50 mental health professional associations petitioned for an outside review of DSM-5 to provide an independent judgment of its supporting evidence and to evaluate the balance between its risks and benefits. Professional journals, the press, and the public also weighed in — expressing widespread astonishment about decisions that sometimes seemed not only to lack scientific support but also to defy common sense.

DSM-5 has neither been able to self correct nor willing to heed the advice of outsiders. It has instead created a mostly closed shop — circling the wagons and deaf to the repeated and widespread warnings that it would lead to massive misdiagnosis. Fortunately, some of its most egregiously risky and unsupportable proposals were eventually dropped under great external pressure (most notably ‘psychosis risk,’ mixed anxiety/depression, Internet and sex addiction, rape as a mental disorder, ‘hebephilia,’ cumbersome personality ratings, and sharply lowered thresholds for many existing disorders). But APA stubbornly refused to sponsor any independent review and has given final approval to the 10 reckless and untested ideas that are summarized below.

The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good. Yesterday’s APA approval makes it likely that DSM-5 will start a half or dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society.

The motives of the people working on DSM-5 have often been questioned. They have been accused of having a financial conflict of interest because some have (minimal) drug company ties and also because so many of the DSM-5 changes will enhance Pharma profits by adding to our already existing societal overdose of carelessly prescribed psychiatric medicine. But I know the people working on DSM-5 and know this charge to be both unfair and untrue. Indeed, they have made some very bad decisions, but they did so with pure hearts and not because they wanted to help the drug companies. Their’s is an intellectual, not financial, conflict of interest that results from the natural tendency of highly specialized experts to over value their pet ideas, to want to expand their own areas of research interest, and to be oblivious to the distortions that occur in translating DSM-5 to real life clinical practice (particularly in primary care where 80 percent of psychiatric drugs are prescribed).

The APA’s deep dependence on the publishing profits generated by the DSM-5 business enterprise creates a far less pure motivation. There is an inherent and influential conflict of interest between the DSM-5 public trust and DSM-5 as a best seller. When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM-5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only — so that DSM-5 publishing profits can fill the big hole in APA’s projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM-5 preparation.

This is no way to prepare or to approve a diagnostic system. Psychiatric diagnosis has become too important in selecting treatments, determining eligibility for benefits and services, allocating resources, guiding legal judgments, creating stigma, and influencing personal expectations to be left in the hands of an APA that has proven itself incapable of producing a safe, sound, and widely accepted manual.

New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs — often by primary care doctors after brief visits. Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs. APA is not competent to do this.

So, here is my list of DSM-5’s 10 most potentially harmful changes. I would suggest that clinicians not follow these at all (or, at the very least, use them with extreme caution and attention to their risks); that potential patients be deeply skeptical, especially if the proposed diagnosis is being used as a rationale for prescribing medication for you or for your child; and that payers question whether some of these are suitable for reimbursement. My goal is to minimize the harm that may otherwise be done by unnecessary obedience to unwise and arbitrary DSM-5 decisions.

1) Disruptive Mood Dysregulation Disorder: DSM-5 will turn temper tantrums into a mental disorder — a puzzling decision based on the work of only one research group. We have no idea how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children. During the past two decades, child psychiatry has already provoked three fads — a tripling of Attention Deficit Disorder, a more than 20-times increase in Autistic Disorder, and a 40-times increase in childhood Bipolar Disorder. The field should have felt chastened by this sorry track record and should engage itself now in the crucial task of educating practitioners and the public about the difficulty of accurately diagnosing children and the risks of over-medicating them. DSM-5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.

2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.

3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. Since there is no effective treatment for this ‘condition’ (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.

4) DSM-5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.

5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM-5 has instead turned it into a psychiatric illness called Binge Eating Disorder.

6) The changes in the DSM-5 definition of autism will result in lowered rates — 10 percent according to estimates by the DSM-5 work group, perhaps 50 percent according to outside research groups. This reduction can be seen as beneficial in the sense that the diagnosis of autism will be more accurate and specific — but advocates understandably fear a disruption in needed school services. Here the DSM-5 problem is not so much a bad decision, but the misleading promises that it will have no impact on rates of disorder or of service delivery. School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.

7) First time substance abusers will be lumped in definitionally in with hard-core addicts despite their very different treatment needs and prognosis and the stigma this will cause.

8) DSM-5 has created a slippery slope by introducing the concept of Behavioral Addictions that eventually can spread to make a mental disorder of everything we like to do a lot. Watch out for careless overdiagnosis of Internet and sex addiction and the development of lucrative treatment programs to exploit these new markets.

9) DSM-5 obscures the already fuzzy boundary been Generalized Anxiety Disorder and the worries of everyday life. Small changes in definition can create millions of anxious new ‘patients’ and expand the already widespread practice of inappropriately prescribing addicting anti-anxiety medications.

10) DSM-5 has opened the gate even further to the already existing problem of misdiagnosis of PTSD in forensic settings.

DSM-5 has dropped its pretension to being a paradigm shift in psychiatric diagnosis and instead (in a dramatic 180 degree turn) now makes the equally misleading claim that it is a conservative document that will have minimal impact on the rates of psychiatric diagnosis and in the consequent provision of inappropriate treatment. This is an untenable claim that DSM-5 cannot possibly support because, for completely unfathomable reasons, it never took the simple and inexpensive step of actually studying the impact of DSM on rates in real world settings.

Except for autism, all the DSM-5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. Painful experience with previous DSMs teaches that if anything in the diagnostic system can be misused and turned into a fad, it will be. Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and ‘behavioral addictions’ will soon be mislabeled as psychiatrically sick and given inappropriate treatment.

People with real psychiatric problems that can be reliably diagnosed and effectively treated are already badly shortchanged. DSM-5 will make this worse by diverting attention and scarce resources away from the really ill and toward people with the everyday problems of life who will be harmed, not helped, when they are mislabeled as mentally ill.

Our patients deserve better, society deserves better, and the mental health professions deserve better. Caring for the mentally ill is a noble and effective profession. But we have to know our limits and stay within them.

DSM-5 violates the most sacred (and most frequently ignored) tenet in medicine — First Do No Harm! That’s why this is such a sad moment.

Retrieved from: http://www.huffingtonpost.com/allen-frances/dsm-5_b_2227626.html?utm_source=Alert-blogger&utm_medium=email&utm_campaign=Email%2BNotifications

DSM-V…out with the old and in with the new…

In Autism Spectrum Disorders, General Psychology, Psychiatry, School Psychology on Thursday, 6 December 2012 at 11:20

http://www.cbsnews.com/8301-204_162-57556754/aspergers-syndrome-dropped-from-american-psychiatric-association-manual/

welcome to your 13th year of high school…

In Education on Thursday, 6 December 2012 at 09:20

13th Grade: At Miami Dade College And Across Florida, A Crisis of Unprepared Freshmen

By Sarah Gonzalez, Mc Nelly Torres and Lynn Waddell

Florida Center For Investigative Reporting

Shakira Lockett was a pretty good student in elementary, middle and high school. The Miami Dade County native says she typically earned As and Bs in English classes. Math was always something of a struggle for Lockett. Still, she got through her high school exit exam with a passing grade and went on to graduate from Coral Gables Senior High School in 2008.

She went straight to Miami Dade College. Then, something unexpected happened: She flunked the college placement exams in all three subjects – reading, writing and math. That didn’t mean she couldn’t attend the school; all state and community colleges in Florida have an open-door policy, which means everyone is accepted. But it did mean she had to take remedial courses before she could start college-level work.

“When they told me I had to start a Reading 2 and Reading 3 class, I was like, ‘Serious?’” Lockett said. “Because I’ve always been good at reading.”

Lockett, who is now 22, spent a year-and-a half taking remedial classes before she could start her first college-level class to count toward her degree in mass communication and journalism. The seven extra courses cost her $300 each.

Lockett found having to take remedial classes discouraging. “It makes you feel dumb,” Lockett said. “And you ask yourself, ‘Is there something wrong with me?’”

Lockett’s experience actually is quite normal in Florida. In 2010-11, 54 percent of students coming out of high school failed at least one subject on the Florida College System’s placement test, according to an investigation by the Florida Center for Investigative Reporting and StateImpact Florida. That meant nearly 30,000 students – high school graduates – had to take at least one remedial course in college.

Florida’s remedial education needs are much greater than in many other states. Nationwide, about 40 percent of all first-year students need remedial education before they can enroll in credit-bearing courses, according to the Alliance for Excellent Education, a Washington, D.C.-based policy and advocacy group.

The numbers are worse at Miami Dade College, Lockett’s school. There, 63 percent of high school graduates take at least one remedial course upon enrollment. Many of them are, like Lockett, shocked to find out that they weren’t ready for college despite having a high school diploma.

The cost of being unprepared

There’s a price to all these students showing up at Florida’s 28 community and state colleges unprepared. The students must pay for – and the state must subsidize – the remedial coursework. The costs of remedial education, shared by students and the state, have jumped from $118 million in 2004-05 to $168 million in 2010-11.

Most of the state’s cost is spent on non-traditional students – students who return to college after being out of school for a while. But according the Florida Department of Education, about one-third of the cost of remedial education is spent on students who are fresh out of Florida high schools.

Education experts say part of the problem is that a high school diploma has never been the same thing as a certificate of college readiness. There’s a curriculum gap between what high school students are taught and what they need to know going into college. And it’s been an ongoing problem that state educators have not addressed until recently.
Former Florida Governor Jeb Bush has been a proponent of the state’s high school exit exam – the FCAT. But now the conservative education advocate admits the test was never meant to determine whether students are prepared for college.

“It’s really a gateway to graduate from high school, not to be college ready,” he told StateImpact Florida in an interview.
Bush said it’s evident the test is flawed since many high school students can’t graduate because they can’t pass the FCAT, which only tests 10th-grade level academic skills.

“Or worse yet, as you said, 50 percent of our students need remedial work to be able to take a college course,” he said.
Lenore Rodicio is Vice Provost for Student Achievement Initiatives at Miami Dade College. She said until high school curriculum aligns with college curriculum, state and community colleges need to fill in the gaps by offering remedial courses, also known as “developmental education.”

“One of the downfalls of developmental education,” Rodicio said, “is that students get stuck in a cycle where they don’t pass their courses and have to take multiple semesters of the developmental courses before they go in to college-level work.”

Remedial classes do not count toward a college degree. Each class runs an entire semester. And students cannot enroll in college classes until they pass all their remedial courses. But Rodicio said offering remedial courses allows Florida colleges to keep their doors open and give all students the opportunity to get a college education.

A down side, Rodicio said, is that students who fail a remedial class are less likely to make it to the finish line of graduation.

Inside a Remedial Class

At Miami Dade College, the final project for students in most remedial writing classes is to write a single paragraph by the end of a semester.

“We’re looking to see that students can focus a topic, maintain a main idea, develop that point, support that point, use transitions,” said Associate Professor Michelle Riley. And she said it’s very difficult for many of them.
During a recent remedial reading class, Riley showed students a sentence on the white board.

It read: “The bandage was wound around the wound.”

The professor asked students to read the sentence aloud. Many got stuck on the last word – pronouncing the word “wound” (sounds like “boomed”) the same way they pronounce “wound” (sounds like “ground”).

The course is one step above the lowest remedial reading level offered at Miami Dade College. Students study the difference between denotations and connotation – the difference between a word’s dictionary definition and its cultural or emotional association.

Miami high school teacher Vallet Tucker said she isn’t surprised to hear what students are learning in remedial college courses. She teaches honors English at Miami Northwestern and said her average 10th-grade student reads at a 7th-grade reading level.

“And I have honors students,” she pointed out.

“This is 10th-grade material and they’re not there yet. The vocabulary is not where it should be –the stamina for reading,” she said. “I look at some of my students and say, ‘I wish we could read this novel,’ but they’re not there yet.”

FCAT Focus of Criticism

Standardized testing has been a big part of public education in Florida for more than a decade. The Florida Comprehensive Assessment Test – the FCAT – debuted in 1998. It’s used as a tool to assess high school students, determine their class placement and decide whether they can graduate from high school.

But over time, FCAT has also become a management tool. Students’ scores on that test now determine school funding levels, teacher evaluations, and starting this year teacher pay. FCAT scores also help determine whether a school itself stays open or is shut down for poor performance.

Critics of the FCAT say teachers, under pressure to help students achieve higher test scores, have emphasized test-taking skills over core subject lessons. Students are taught to memorize facts and eliminate answers on multiple-choice questions.

“From the time a child is in kindergarten, every option that a child is given has four answers for which two or three can be easy eliminated,” said Raquel Regalado, a Miami-Dade school board member. “Unfortunately, life doesn’t give you four options for which two or three can be easily eliminated. And that’s the problem.”

The FCAT has become more rigorous over the years in reading, writing and math. But the material doesn’t align with what is tested on the college entrance exam.

Policy makers have understood this for a while. In 2006, the research arm of the Florida Legislature, widely known by its acronym OPPAGA, studied remedial education in community colleges. The study concluded that the FCAT created a disconnect between the skills taught in public schools and those needed in college.

Success on the FCAT, the state accountability office found, “does not ensure students are prepared for college-level work.” OPPAGA noted that despite previous reports pointing out the same problems, state education leaders and legislators had not reviewed the effectiveness of the FCAT.

Matthew Ladner, a policy and research adviser for Jeb Bush’s Foundation for Excellence in Education, is a defender of FCAT. He said the test, emphasized when Bush was governor, helped increase the high school graduation rate. In the 2010-2011 school year, Florida graduated the most students, and students of color, in the state’s history. Lander sees it as not surprising that some of those students would struggle at the college level.

“So we should not view the fact that these students then go on to an institution of higher education and have to take a remedial course necessarily as a catastrophic failure,” Ladner said. “This is sort of a process on the way to success in the sense that a lot of those students in Florida higher education institutions today would have dropped out of high school 15 years ago.”

The increasing number of people entering college, he said, may be a factor in rising remedial education numbers.

Damaging Illusion

In Florida, the current situation has contributed to a damaging illusion among many students. Some who excel in public school and do well on the FCAT graduate thinking they are well prepared for higher education, only to find they’re not ready at all.

Shakira Lockett felt she was ready for college. The reality for her, though, was that she needed extensive remedial work at Miami Dade College. She finally completed her two-year journalism program in May – two years later than she’d expected going in.

It wasn’t easy. “I had to push myself where I need to be to make my parents proud of me and to make myself proud,” Lockett said. “Because I really want to be something in life.”

Many students can’t make it all the way through. Research shows that students who require remedial education are less likely to earn a degree than students who don’t require remediation.

Lockett can attest to this. She still remembers when her first remedial class instructor challenged her classmates to continue to make it to the finish line. Many of her classmates went on to the next remedial course with her. But when Lockett finally got her degree, those students didn’t share the stage with her.

“None of my friends were behind me,” Lockett said. “None of the people that I knew. It was just me. And I felt really, really accomplished.”

The Florida Center for Investigative Reporting is a nonprofit news organization supported by foundations and individual contributions. For more information, visit fcir.org. StateImpact Florida is an educating reporting project of NPR, WUSF in Tampa and WLRN in Miami. For more information, visitstateimpact.npr.org.

Retrieved from: http://www.huffingtonpost.com/2012/12/04/miami-dade-college-remedial-freshman-florida-colleges_n_2237082.html?ncid=edlinkusaolp00000003&ir=Education

are you getting enough???

In Fitness/Health on Thursday, 6 December 2012 at 09:02

sleep quiz:

http://www.webmd.com/sleep-disorders/rm-quiz-sleep?ecd=soc_tw_120612-am_rmq_sleep

more controvery regarding the dsm-v…

In General Psychology on Sunday, 2 December 2012 at 11:46

DSM-5 R.I.P?

Yesterday, the proposed new DSM-5 revision of the American Psychiatric Associations “Bible of Psychiatry” came under yet more criticism.

Aaron T. Beck, the father of currently-mega-popular cognitive behavioural therapy,started it off with an attack on the upcoming changes to one diagnosis, Generalized Anxiety Disorder; but many of the points also apply to the other DSM-5 proposals:

The lack of specific features, which is the primary issue for GAD, will not be addressed in DSM-5. The hallmark of the condition will remain pathological worry, although it also characterizes other disorders. Likewise, the proposed behavioral diagnostic criteria lack specificity for GAD, and it is not clear how these will be assessed. The proposed changes will lower the diagnostic threshold for GAD in DSM-5… many currently subthreshold cases will qualify for this diagnosis. The likely inclusion of many such “false-positives” will result in an artificial increase in the prevalence of GAD and will have further negative consequences.

Then from across the Atlantic, and also across the psychotherapy-vs-medication divide, came another piece of criticism. The authors are all associated with the European Medicines Agency (EMA, Europe’s equivalent of the FDA), or with national drug regulators. Although they’re writing in a personal capacity, this is still big news if you ask me.

These authors start out by saying that the EMA is broadly in favour of DSM reform, but they then attack one of the key DSM-5 innovations – the move towards ‘dimensional measures‘ of symptoms in addition to diagnoses:

One of our main concerns is related to potential future [drug] indications based on an effect on a dimension that is independent of diagnostic categories (although we acknowledge that non-specific claims are common in other areas, such as analgesics for pain). As an example, cognitive impairments are common in psychiatric disorders, but they do not have a unique clinical pattern or a unitary cause.

 

We therefore believe that, at present, such a cross-cutting approach may increase heterogeneity in patient populations and make the assessment of the benefit–risk balance more difficult. Similarly, the use of dimensions as key secondary end points in many different diagnostic categories may lead to pseudospecific indications and polypharmacy. As a general rule, a therapeutic indication should be a well-recognized clinical entity that is clearly distinguishable from other conditions…

They also echo Beck in warning of over-diagnosis and over-medicalization:

Current proposals to reclassify some conditions that were subthreshold or prodromal as distinct syndromes or disorders could have implications for clinical trials. The inclusion of milder or very early cases of psychiatric disorders may lead to an increase in the number of non-disordered (false-positive) patients in clinical trials, and to an increase in the placebo effect, as less severe cases are more likely to respond to placebo. It may therefore be difficult to show a statistically significant difference [of drug over placebo]…

This raises another highly controversial issue: the risk of medicalization of the normal population. In this respect, a strong concern comes from the proposal to remove bereavement exclusion from the criteria for major depressive disorder, implying that all individuals with ‘normal grief’ might be considered as patients in the future.

Regular readers will remember that I’ve covered both overdiagnosis screwing up clinical trials, and the bereavement debate.

Two and a half years ago, shortly after the first draft of the DSM-5 was made public, I predicted that the eventual release of DSM-5 would be a non-event because, by then, it would have been widely debated and criticized, destroying the illusion of expert consensus that any such document must have in order to succeed.

I think events have borne this out. An awful lot of professionals, patients, and their relatives, will reject the changes in favour of sticking with the DSM-IV or other criteria. Without swift and general acceptance, a document like the DSM is just paper. It seems increasingly likely that the DSM-5 is going to be dead on arrival.

Starcevic V, Portman ME, & Beck AT (2012). Generalized anxiety disorder: between neglect and an epidemic. The Journal of nervous and mental disease, 200 (8), 664-7 PMID: 22850300

Florence Butlen-Ducuing et al (2012). DSM‑5 and clinical trials in psychiatry: challenges to come? Nature Reviews: Drug DiscoveryDOI: 10.1038/nrd3811

Retrieved from: http://neuroskeptic.blogspot.co.uk/2012/08/dsm-5-rip.html

ease the symptoms of depression with one easy step!

In Fitness/Health, Mood Disorders on Saturday, 1 December 2012 at 10:31

Physical Exercise Eases the Symptoms of Depression in Children Growing Up in Unsafe Neighborhoods

26 November 2012

Living in unsafe neighborhoods may impact children’s mental health. However, physical activity has been found to be related to lower levels of depressive symptoms among children. A recent study of 89 children aged 9-12 found that physical activity may buffer the relationship between unsafe neighborhoods and child depressive symptoms.

Children living in unsafe neighborhoods are more likely to be depressed. Improving neighborhood safety is perhaps the clearest way to improve the situation, but it’s not always easy to make quick community changes that will benefit children. Given that many neighborhoods will continue to be unsafe, recent research has focused on understanding factors that help break the link between neighborhood safety and depression and therefore inform intervention efforts.

One of these factors is physical activity. Activities such as aerobic exercise and competitive sports teams have benefits for child development – and lower levels of depressive symptoms are just one of these.

One of the challenges is that children who live in unsafe neighborhoods tend be less in engaged in physical activity compared to those in living safer neighborhoods. This is largely due to the lack safe areas for exercise.

Physical activity as a buffer

Child psychologists Sonia L. Rubens and Paula J. Fite from the University of Kansas decided to look at data on depressive symptoms, physical activity and neighborhood safety. They examined whether physical activity acts as a moderator between neighborhood safety and depressive symptoms in school-age children.

They expected children who were physically more active to report fewer depressive symptoms than those who lived in similar areas but weren’t physically active.

The study included 50 boys and 39 girls aged 9-12 from a metropolitan US community with approximately half a million residents. Participants and their caregivers were recruited from neighborhoods that varied in socioeconomic status. The majority of children were Caucasian, and about 27% of the sample received public assistance. Both children and caregivers were asked questions about neighborhood, delinquency, after-school activities, parenting, and peers.

Not surprisingly, there was a significant relationship between living in an unsafe neighborhood and high levels of depressive symptoms. Further, depressive symptoms were more serious for minority (non-Caucasian) youth.

The relationship between neighborhood safety and physical activity was different for children who were physically active and those who weren’t. Among those who participated in any sort of physical activity – whether school sports or other games – living in an unsafe neighborhood did not make depression more likely. However, among those who didn’t participate in any physical activity, children who lived in unsafe neighborhoods were more likely to be depressed than those who lived in safer areas.

The implications for intervention

The study implies that engaging in some physical activity may ease the effect of unsafe neighborhood on child mental health. Providing better options for physical activity for children living in such neighborhoods may be an important next step in prevention and intervention efforts. It may also be a cost-effective way to improve outcomes, as other research suggests.

Meeting this challenge will require practical assistance as well as encouragement, given the lack of safe spaces to play in some of these neighborhoods.

It is likely that physical activity is a buffering factor that is more relevant for children growing up in unsafe neighborhoods that to those living in safer neighborhoods. Namely, the children living in safer neighborhoods reported the lowest levels of depressive symptoms even when they were not engaged in physical activity. That may indicate that these children benefit from other protective factors that are not available to children living in less safe neighborhoods.

Any caveats?

This study comes with several limitations that affect the generalizability of the findings. The sample was small, and the study was based on a questionnaire at a single point in time rather than following children and their families across time. It is not possible to tell from this study, for example, whether a lack of exercise led to depression for children in unsafe neighborhoods, or whether their depression came first and caused them to avoid sports and games – or both.

Either way, establishing that physical activity changes the nature of the link between depression and neighborhood safety may help program designers and commissioners consider community-based interventions for children who live in unsafe neighborhoods.

**********

Reference
Rubens, S. L., & Fite, P. J. (2012). The influence of physical activity in the relation between neighborhood safety and depressive symptoms among school-age children. Child Indicators Research, 2. DOI 10.1007/s12187-012-9155-5.

Retrieved from: http://www.preventionaction.org/research/physical-exercise-eases-symptoms-depression-children-growing-unsafe-neighborhoods/5908

keeping it classy, harvard…NOT!

In Education on Saturday, 1 December 2012 at 06:17

Several Harvard students received a racist pamphlet on Friday advertising a club to which ‘no fucking jews’ were allowed but “coloreds” were “ok” the Harvard Crimsonreported.

The pamphlets, which were delivered in sealed envelopes under students’ dorm room doors, advertised “Harvard’s Newest Final Club” i.e. one of Harvard’s 14 single sex social clubs. The club, called the “Pigeon” (perhaps a play on the Final Club propensity to name their establishments after animals) was ostensibly promoting a party situated in a local frozen yogurt shop. The attire was dubbed “Semi-bro.”

At the top of the pamphlet, three virtues: Inclusion, Diversity, Love were listed with three respective footnotes at the bottom of the page. Inclusion’s was “Jews need not apply.” Diversity’s was “Seriously, no fucking Jews. Coloreds OK,” and Love’s was “Rophynol” — probably a misspelling of the date-rape drug rohypnol.

Final Clubs are no strangers to controversy. In November, the Crimson reported that a female final club, the Sablière Society reportedly filmed themselves pretending to be homeless for an initiation event.

In the comments section of the article, the university’s Dean of Students Evelynn M. Hammonds made a statement, saying,

As Dean of the College, and as an educator, I find these flyers offensive. They are not a reflection of  the values of our community. Even if intended as satirical in nature, they are hurtful and offensive to many students, faculty and staff, and do not demonstrate the level of thoughtfulness and respect we expect at Harvard when engaging difficult issues within our community.

Retrieved from: http://www.huffingtonpost.com/2012/11/30/racist-harvard-finals-club-flier_n_2219468.html?ncid=edlinkusaolp00000003

%d bloggers like this: