EBD Blog

I remember a conversation with Joanie when we were both working at a private school in southern California. We were discussing the effects of holidays on children. She contended that she wasn’t sure whether Halloween or Christmas was more difficult for them. Her analysis—sort of a low-level psychology—was that it was a toss-up. Halloween was hard because it allowed the kids to be freaky without getting in trouble for it, but they had to think about the sanctions that would befall them for behaving badly. Christmas was hard for them because they knew that they would only get presents if they had been good, and they had to wonder whether they had been good.

Only later I realized how strongly the analysis is founded on Western, Christian views of the world.

Collaboration among agencies serving children and youths with emotional and behavioral disorders, often referred to as “wraparound services,” is widely accepted as a requisite for effective help. The Kalamazoo (MI, US) Gazette has a report on a local project that provides wraparound services.

Thousands of children in Kalamazoo County have emotional problems. Many of them receive no treatment whatsoever, and others receive fragmented help through one agency alone, or conflicting advice from multiple agencies. So it was clear that community mental health services had much more to do.

Link to the article.

The U.S. Food and Drug Agency (FDA) has recommended that health-care professionals who prescribe one of the widely used drugs for treating Attention Deficit Disorder should switch patients to other comparable drugs. The FDA cited potential for liver damage in its alert about the drug, Cylert, and generic versions of it (pemoline). Cylert, will continue to be available through pharmacies and wholesalers until supplies are exhausted

The Agency has concluded that the overall risk of liver toxicity from Cylert and generic pemoline products outweighs the benefits of this drug. In May 2005, Abbott chose to stop sales and marketing of Cylert in the U.S. All generic companies have also agreed to stop sales and marketing of this product (Pemoline tablets and chewable tablets). Cylert is a central nervous system stimulant indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). This product is considered second line therapy for ADHD because of its association with life threatening hepatic failure

Link to the FDA statement.

Follow-up research shows that adolescents who have emotional and behavioral disorders are likely to have psychiatric problems nearly 30 years later, according to a study entitled “Continuities between Emotional and Disruptive Behavior Disorders in Adolescence and Personality Disorders in Adulthood,” by Margareth Helgeland, Ellen Kjelsberg, and Svenn Torgersen. The article is published in the American Journal of Psychiatry (2005, volume 162, pp. 1941-1947) which requires a subscription, but the abstract is available via Pub Med. Link.

This has little too do with the emotional and behavior disorders experienced children and youths, but it reminds me that there are still folks around who attribute meaning to their interpretations of others’ dreams. Usually, intrapsychic—Freudian or Jungian—interpretations of dreams assign symbolic meanings to them. Writing for the Cox News Service, Terri Jo Ryan, reported a long string of dreams and their deep, dark, secret meaning (sorry if the sarcasm dripped onto your keyboard).

Nightmare: Someone is trying to break into the home.

Meanings: The intruder is often an inner psychological figure who may represent some shameful or unwanted part of yourself who is breaking into your consciousness. Some new insight is about to emerge from the darkness.

Nightmare: Catastrophic disaster — earthquake, avalanche, flood, fire or storm.

Meanings: Disasters represent emotional upheaval — an earthquake, our world is being shaken up; an avalanche, feeling overwhelmed and buried by some situation we find ourself in; a flood, being caught up in the currents of everyday life and not feeling on solid ground; a fire, being consumed by passion, rage or some other strong feeling that may feel out of control.

Disaster can be a positive image indicating a significant change by tearing down old patterns of behavior, a turning point of opportunity, or it may be a warning of something valuable in life that’s falling apart or being swept away.

There are many other, even-richer examples. Anyone who does this with children and youth should be required to show proof that their interpretations are accurate, no?

Link to Ms. Ryan’s article, which appeared in the Middletown (OH, US) Journal.

Given the remarkable value of brain-scanning research in reading problems, it is little surprise that people are interested in potential applications with other human behaviors and, especially, with emotional and behavioral disorders. However, progress in localizing functions related to depression, anxiety, and such have been slow in coming, according to a report by Benedict Carey in the New York Times.

Not long ago, scientists predicted that these images, produced by sophisticated brain-scanning techniques, would help cut through the mystery of mental illness, revealing clear brain abnormalities and allowing doctors to better diagnose and treat a wide variety of disorders. And nearly every week, it seems, imaging researchers announce another finding, a potential key to understanding depression, attention deficit disorder, anxiety.

Yet for a variety of reasons, the hopes and claims for brain imaging in psychiatry have far outpaced the science, experts say.

Nevertheless, there are encouraging glimpses of potential. In a study just presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry, researchers from the University of Illinois Chicago reported that they have mapped differences in the amygdala and cognitive regions of the brains of adolescents with and without bipolar disorder. The team found that youths with bipolar disorder had increased activation in the amygdala when shown words with negative associations and greater activity in parts of the brain associated with pleasure when shown words with positive associations. In contrast, for the non-disorded students, the cognitive areas of the brain were activated by words with positive and negative associations.

“This study is very exciting because it shows that negative emotions affect cognition differently than positive emotions in these kids,” said Dr. Mani Pavuluri, associate professor of psychiatry at UIC’s Institute for Juvenile Research and the Center for Cognitive Medicine, and lead author of the study.

Link to Mr. Carey’s story (registration required). Link to the UIC news release on the study by Pavuluri et al.

Water is a good thing for humans to drink, but water in excess is deadly. There are two recent stories in which parents have forced children to consume excess liquid and the children have died. This is not appropriate method for treating child behavior problems.

National news sources have reported about the death of Casandra Killpack after her parents—at least one of them—forced her to consume excessive amounts of water as therapy for having sneaked sips of other children’s liquid. Justin Hill, covering the story for the Salt Lake Tribune (UT, US), provided this description of some of the testimony.

Cassandra Killpack had been made to ingest water “far in excess” of the body’s need at least five hours before EMTs arrived at her Springville home, a doctor who wrote an article on child abuse and water intoxication testified Wednesday.

The water killed Cassandra in 2002, said Allen Arieff, a professor at the University of California-San Francisco. By the time, medical personnel came to help her, “she was gone,” he said.

“The treatment had no effect on the outcome,” testified Arieff, who specializes in kidney diseases.

As it turns out, it wasn’t the first time Jennete Killpack, now on trial with her husband for killing Cassandra, gave her 4-year-old adopted daughter water as punishment.

During an interview with police, Killpack admitted she gave Cassandra about 30 ounces of water after she sneaked some water the week before her daughter started therapy at the now-defunct Cascade Center for Family Growth.

The second story comes from my neighborhood and has been covered by Sarah Barry of the Charlottesville (VA, US) Daily Progress. It is the story of a doctor whose child appeared to have been abused repeatedly. In addition to a fracture and burns, the child was forcibly overhydrated.

Dr. Iain Gainov, a former pediatrician at the University of Virginia, was convicted Friday of felony child abuse but acquitted of five other charges. He could face up to 10 years in prison.

Judge Paul M. Peatross Jr. ruled that prosecutors had shown sufficient evidence that Gainov had intentionally harmed his infant daughter, Megan, on the morning of March 1, when she had to be taken to the hospital for water intoxication.

Although it is not clear whether Dr. Gainov was using water as therapy, Ms. Killpack apparently thought she was. It is clear that neither should not have forced so much water on their children. They surely needed better ways to address the problems they had with the children’s behavior.

Link to Mr. Hill’s story. Link to Mr. Hill’s paper’s coverage of the conviction of Ms. Killpack, Casandra’s mother. Link to an ABC News story apparently based on an interview with the Killpacks.

Link to Ms. Barry’s stories about the opening of Dr. Gainov’s trial and the guilty verdict.

What do you think are the most important articles, chapters, or books about Emotional and Behavioral Disorders (EBD)? If someone who did not have a background in special education for children and youths with EBD were to need a reading list of materials that, over a period of time, have continued to be important, what should be on that list?

Please click on comments and provide a citation to those publications that you consider parts of the classic literature in EBD.

Rules (abitrary, to be sure):

• Please provide full citation using the style recommended in the Publication Manual of the American Psychological Association
• Originally published at least 10 years before being posted here.
• One citation per comment (so I can aggregate them into a data base more easily later).

I am inviting submissions for EBD here. If you have some recommendations about classics in Learning Disabilities or educational practices, please see the comparable entries on LDBlog.com or TeachEffectively.com.

The Council for Children with Behavior Disorders (CCBD) is seeking nominations for officers of the organization. CCBD is a large, active community of people concerned with the education of children and youths with Emotional and Behavioral Disorders. It is a valuable group to which to contribute.

The deadline for nominees to submit information is October 30, 2005. Nominations and supporting materials should be mailed to: CCBD, PO Box 24246, Stanley, KS 66283, may be faxed to 913-239-0550 or may be emailed to Jamie@ccbd.net. Questions may be directed to: Sandra Keenan, Nominations and Elections Chair, skeenan@air.org.

Link for more information.

This is a follow-up note about the editorial published anonymously and to which I referred a couple of days ago. There is a Web site at http://WNCMentalHope.org where one can get copies of the editorial and, eventually, other materials related to supporting kids who have emotional and behavioral disorders and the families of those kids.

In a column written anonymously for the Ashville Citizen-Times (NC, US), the father of a 12-year old child with bipolar disorder provided a glimpse into the life of his family. It is an account that clearly captures the anguish of the situation.

How to convey what life is like with nerves constantly frayed? When your child’s moan causes every muscle in your body to tighten, because that moan might grow into a growl, and that growl into a rage that might last an hour or more?

How to convey what life is like when your child holds knives to his throat or tries to jump from your car, when he destroys things that are most precious to him, when he attacks you and his siblings, when he does everything in his power to provoke you and then sobs uncontrollably when the episode has passed?

The father also notes myriad other concerns (e.g., financial consequences) and discounts typical misunderstandings of emotional and behavioral disorders (e.g., they are caused by lack of discipline). It’s a little off the topic of this blog—not about education— but worth the time to read.

Link to the column. (Note that there paper’s editor explains the exception to her paper’s rules about publishing anonymous columns in an accompanying column and that there is accompanying editorial about failures in North Carolina’s system of mental health care.

Concerns raised over the past 18 months about problematic side effects of selective serotonin reuptake inhibitors (SSRIs) in children appear to be affecting the frequency with which those drugs are prescribed, according to a story by Shankar Vedantam that appeared in the Washington Post (DC; US). Mr. Vedantam focused his story on the research standards used to determine whether the U.S. Food and Drug Administration approve drugs for clinical use.

Warnings that drugs such as Prozac, Paxil and Effexor can increase suicidal behavior in some children have resulted in a nearly 20 percent drop in U.S. pediatric prescriptions of the widely used antidepressants and have triggered deep concerns about the quality of current data on psychiatric drugs, doctors and regulators said.

The unprecedented fall of what were once considered wonder drugs comes as a series of taxpayer-funded analyses have systematically undermined the claims of industry-funded drug trials, raising thorny questions about the ways in which psychiatric drugs are being tested, marketed and used.

Mr. Vedantam obtained quotations from physicians and others who argue that the standard 12-week trials for approval of a drug are too brief. “‘The problem is we don’t have enough good data,’ said Thomas Laughren, director of the division of psychiatry products at the Food and Drug Administration. ‘All of our data are focused on the short term.’”

This is a sensible analysis, in my view. I infer from my admittedly scanty knowledge about the data available that the increased risk of suicide among children taking these drugs may be limited to a subset of all children for whom they are prescribed. Without carefully developed and long-term longitudinal study, we cannot know which children are in that higher-risk group. But, who wants to conduct the study where it is necessary to expose children to greater risk for suicide? Not I.

Using these drugs with our children requires that we exercise substantial care. Poeple serving children who have emotional and behavioral disorders should adhere to the dictim, “primum non nocere,” that is usually attributed to Hippocrates.

Links to coverage on the matter:

• Link to Mr. Vedantam’s story;
• 2004 Testimony by Robert Temple, MD, examining not only the research on suicidality but also on the effectiveness of these drugs;
• 2004 NIMH public information statement;
• Alliance for Human Research Protection story on prescription rates.