Monthly Archive for May, 2006

Bi-polar academic

Children with bipolar disorder, whether with or without attention deficit-hyperactivity disorder have deficits in cognitive skills that are associated with lower academic outcomes, according to an abstract for a study to be published in Biological Psychiatry. Here’s the abstract.

Impact of Neurocognitive Function on Academic Difficulties in Pediatric Bipolar Disorder: A Clinical Translation.

Biol Psychiatry. 2006 May 25;

Authors: Pavuluri MN, O’connor MM, Harral EM, Moss M, Sweeney JA

BACKGROUND: Previous research has demonstrated that academic and neuropsychological functions are compromised in pediatric bipolar disorder (PBD). Investigation of the degree to which neuropsychological deficits might contribute to those academic problems is needed to aid in the recognition and intervention for school achievement difficulties in PBD. METHODS: A sample of 55 children and adolescents with PBD with and without attention-deficit/hyperactivity disorder (ADHD) (PBD group, n = 28; PBD+ADHD group, n = 27) were tested with a computerized neurocognitive battery and standardized neuropsychological tests. Age range of subjects was 7-17 years, with the mean age of 11.97 (3.18) years. Parents completed a structured questionnaire on school and academic functioning. RESULTS: Logistic regression analyses indicated that executive function, attention, working memory, and verbal memory scores were poorer in those with a history of reading/writing difficulties. A separate logistic regression analysis found that attentional dysfunction predicted math difficulties. These relationships between neuropsychological function and academic difficulties were not different in those with PBD+ADHD than in those with PBD alone. CONCLUSIONS: In PBD neuropsychological deficits in the areas of attention, working memory, and organization/problem solving skills all contribute to academic difficulties. Early identification and intervention for these difficulties might help prevent lower academic achievement in PBD.

Link to the abstract.

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MST coverage

Multisystemic Therapy (MST) is featured in a New York Times Magazine story about addressing the Emotional and Behavioral Disorders of children in their homes. Given it’s track record for effectiveness, it’s very nice to see the coverage in the story by Paul Raeburn.

Developed over the last 30 years by Scott Henggeler, a clinical psychologist and a professor of psychiatry at the Medical University of South Carolina, [MST] is based on the assumptions that families should remain together and that all of the causes of antisocial behavior should be attacked at once.

Taking his cues from family therapy as well as from social ecology, which emphasizes that behavior is shaped by multiple aspects of the environment, Henggeler studies the ecosystem composed by family, neighborhood, schools, peer groups and the broader community. Instead of removing children from that ecosystem, he tries to change it: solve the drug problems and the legal problems, get kids away from delinquent peers and encourage academic success.

A central idea is to focus on the parents. “We want the therapist to build the competency of the parents, because the parents are going to be there after the therapist leaves,” he says. If the parents can’t handle the job, he might ask an uncle, aunt or grandparent to fill in.

MST therapists like Towell have small caseloads — four to six families at a time. They visit the families every day, if necessary, and are always on call. If the police grab a child at 2 a.m., the therapist can help sort things out. Because of this intensive effort, MST isn’t cheap. It typically lasts four to five months and costs between $5,000 to $7,500 per child. To make it cost-effective, it is directed at kids at high risk of expensive out-of-home placements. If enough of them can be kept at home, the program can pay for itself — and even save communities money.

MST is one of only a handful of “evidence based” programs that have been shown to be effective for violent children. In a recent 14-year evaluation, kids who had been through MST programs had 54 percent fewer arrests and spent 57 percent fewer days in jail. “These programs have a higher success rate than what else is out there,” Henggeler says. The single most important piece of the treatment is getting children away from deviant peers.

Link to Mr. Raeburn’s story. Link to the MST site. Link to a review from Evidence Based Programs.

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JMK honored

Here’s a big shout in honor of my friend, colleague, and co-blogger, Jim Kauffman. He’s just back from Atlanta where he attended the convention of the Association for Behavior Analysis and received an award for his contributions for effective presentation of behavior analysis in the mass media. Jim’s raised questions about a topic that’s sure to provoke some people who do not depend on data, those who know the truth without reference to facts. Here’s a snippet from the abstract of his talk.

In this presentation, Dr. Kauffman raises concern about a new racism often mistaken for cultural sensitivity and cultural competence. It is characterized by the assumption that skin color or heritage, usually said to designate a culture, makes an individual responsive or unresponsive to particular therapies, educational methods, or other efforts to teach, heal, or help.

He doubts that what is effective for individuals of one culture are likely to be ineffective for individuals of another culture. Way to go, Jim.

Link to the ABA Web site and to the notes from the ABA newsletter about the awardees.

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Braggin’ mom

Over on a blog called “Nut House,” Sissy has an entry about an event indicating her son’s progress. As with many personal blogs, I have little way to check this story, but it’s still pretty interesting on its own merits. It’s great that the the boy got an award (and what an award!) and that his mother is proud of him.

Hey yall I have to brag a little bit!!! I got a call from My youngest sons school on Monday saying that they are going to give Luke a award and a prize with it. They wanted us to be there. So today i woke up and went to the school to watch them give him the award.

Link to Sissy’s entry.

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Literacy and behavior problems

Here’s an abstract from PubMed discussing links between behavior disorders and literacy problems.

Literacy and mental disorders.

Curr Opin Psychiatry. 2006 Jul;19(4):350-354

Authors: Maughan B, Carroll J

PURPOSE OF REVIEW: This review examines recent evidence on the comorbidity between literacy problems and psychiatric disorder in childhood and discusses possible contributory factors. RECENT FINDINGS: Recent studies confirm the substantial overlap of literacy problems with a range of emotional/behavioural difficulties in childhood. Literacy problems and inattention may share genetic influences, contributing to associations with attention deficit hyperactivity disorder. To an extent, links with conduct problems may be also mediated by attentional difficulties. In addition, findings suggest bidirectional influences whereby disruptive behaviours impede reading progress and reading failure exacerbates risk for behaviour problems. Associations between literacy problems and anxiety disorders are not entirely mediated by inattentiveness. Rather, comorbid anxiety disorders seem likely to arise from the stressors associated with reading failure. Findings in relation to depression are less consistent, but suggest that poor readers may be vulnerable to low mood. Children with autism seem more likely to face problems in reading comprehension than the decoding difficulties more prominent in other disorders. SUMMARY: Literacy problems are associated with increased risks of both externalizing and internalizing disorders in childhood, with different mechanisms likely to be implicated in each case. When comorbid problems occur, each is likely to require separate treatment.

PMID: 16721162 [PubMed - as supplied by publisher]

Link to the PubMed source.

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Foster Care MH needs

Over on Adoption Blogs, Bill posted an entry about the mental health needs of children in foster care and adults who were in foster care as children. He describes evidence summarized from several studies, especially a large retrospective study (sponsored by the Casey Family Programs) of neaerly 500 alumni of foster care.

At the Oregon Social Learning Center, there are projects examining ways to prevent mental health problems of children in foster care. Of all the clinical research groups studying families, OSLC has one of the strongest records for developing and testing beneficial treatment methods. Patti Chamberlain, Phil Fisher, Joe Price and their colleagues are working on the foster children projects. If you’re interested in how to do it well, learning from these folks probably would be of help.

Link to Bill’s entry on Adoption Blogs. Link to
OSLC’s page describing projects.

By the way, the Casey Family Programs is one of a cluster of philanthropic projects affiliated with members of the family of Jim Casey, founder of United Parcel Service. Among the others are the Marguerite Casey Foundation (“helping low-income families strengthen their voice and mobilize their communities”), Jim Casey Youth Opportunities Initiative (“help youth in foster care make successful transitions to adulthood”), and the Annie E. Casey Foundation (“build better futures for disadvantaged children”).

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New blog

There’s always a bit of risk in referring to another blog. Not only does one not know whether the content is accurate (I can say, “Fact check.”), but one can’t even be sure that the blog will be active enough to merit return visits. However, I can’t resist pointing at this new source: The Good, Bad, and Ugly & My special ed classroom, by Katherine McNeil.

A big part of the impetus for referring to Ms. McNeil (who apparently has a doctorate) is that the initial post to the blog has a sense of humor. Check it yourself.

Anybody know these folks? Into what category should I put this post? Acting out? Behavior management?

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Expulsion

While I was away I missed a humane and thoughtful reflection on expulsion by Mrs. Ris.

ADHD differences by ethnicity

An article in Journal of the National Medical Association examined data about the characteristics of attention deficit-hyperactivity disorder among African-American and Caucasion children. The abstract does not report the outcomes of the study, so one will need to go to the source to get the results.

Deficits in diagnosis, treatment and continuity of care in African-american children and adolescents with ADHD.

J Natl Med Assoc. 2006 Feb;98(2):233-8

Authors: Hervey-Jumper H, Douyon K, Franco KN

Despite the evidence that attention-deficit/hyperactivity disorder (ADHD) is not just a diagnosis of whites, it often goes undiagnosed and is underresearched in the African-American population. There are higher rates of delinquency, incarceration, teen pregnancy and sexually transmitted diseases associated with inadequate or delayed treatment of ADHD. Afrcan Americans generally respond well to treatments, but access to evaluation, medication and psychotherapy is limited or absent for many, The purpose of this research is to compare descriptive characteristics of African-American children with ADHD to age-matched Caucasian children with the same diagnosis. Age at diagnosis, treatment offered, perception of outcome, adherence, comorbid symptoms and frequency of follow-up were collected retrospectively from charts of children treated in the sections of child and adolescent psychiatry and pediatric neurology.

PMID: 16708509 [PubMed - in process]

Link to the PubMed entry.

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NY lauches project

The Office of Mental Health in New York (US) has launched a project it calls the largest investment in new children’s mental health services in the state’s history. Here’s the lead from the news release:.

OMH CELEBRATES NEW ERA OF CHILDREN’S MENTAL HEALTH AND WELLNESS IN NEW YORK STATE

Sesame Workshop Joins OMH For Celebration and Launch of Tile Project

ALBANY, NY — (05/17/2006; 1200)(EIS) — With Sesame Street’s walkaround Elmo greeting guests as they arrived, Sharon E. Carpinello, RN, PhD, Commissioner of the New York State Office of Mental Health, (OMH) was joined today (Wed. May 17) at the Executive Mansion by representatives of Sesame Workshop, the nonprofit educational organization behind Sesame Street, as well as families, State and local officials, care providers and other stakeholders to celebrate children’s mental health and wellbeing in New York State.

Link to the news release.

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Mental health awareness

As faithful readers of EBD Blog (all three of you, and you know who you are!) know, I think that only some children who need help for Emotional and Behavioral Disorders are getting help, whether from schools or other agencies. A US national group of non-governmental organizations is sponsoring activities to promote awareness of children’s mental health needs, an effort that deserves recognition and support. We still are, to paraphrase Jim Kauffman, “count the missing millions” of children and youths whose problems are ignored, overlooked, or rationalized away.

The National Mental Health Association (NMHA), National Association of Social Workers (NASW) and the National Federation of Families for Children’s Mental Health (FFCMH) have formed a joint partnership to celebrate National Children’s Mental Health Awareness Day, as part of a growing need to promote children’s mental health. In honor of this historic day, the group will host a luncheon briefing Monday, May 8, in Washington, DC where the Substance Abuse and Mental Health Services Administration (SAMHSA) will release key findings from its 2005 national evaluation of the Comprehensive Community Mental Health Services Program for Children and Their Families, or Systems of Care.

Link to the group’s press release.

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Insurance ills

A complex set of factors—including insurance billing policies, stigma, and non-recognition of problems—is keeping thousands of Utah children and youths from receiving mental health services, according to Dennis Romboy and Lucinda Dillon Kinkead of the Deseret Morning News (UT; US). In an extended feature story, Mr. Romboy and Ms. Kinkead provide an insightful description of problems in securing therapy for individuals with bi-polar or other disorders.

As is popular in contemporary journalism, Mr. Romboy and Ms. Kinkead sprinkle in several case studies to illustrate the problems. They lead with an example of a young woman who is now in college but has had bi-polar disorder for many years.
Importantly, one of the cases they discuss is the daughter of Utah Attorney General Mark Shurtleff, someone who has clout but has had to work hard to secure services.

Although their story includes examples of individual cases, Mr. Romboy and Ms. Kinkead also interviewed experts on mental health, including a person speaking for insurance providers. Another of their experts in Sherri Wittwer, executive director of the Utah chapter of the National Alliance on Mental Illness; Wittwer helped explain the difficulty many parents encounter.

Parents know exactly what to do if their child gets hurt on a skateboard: Go to the emergency room. If their child has a fever, they make an appointment with the family doctor. But what does a parent do when their child’s brain doesn’t seem to be working right?

“People don’t know where to turn for mental health services,” said Wittwer.

It’s not likely they have a family psychologist or psychiatrist. Even if they did, it might take weeks to get in. Preauthorization might be needed. And there’s no guarantee their insurance carrier would pay for treatment until the child became well.

Link to Mr. Romboy’s and Ms. Kinkead’s story. It’s very good to have this sort of coverage of Emotional and Behavioral Disorders.

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