EBD Blog

“Are we too quick to medicate children?” Melissa Healy asks this question in the headline of an article in the Los Angeles Times. She also weaves the related question—”Are we able to discriminate between normal and atypical behavior?”—into her article.

These are generally sensible questions. They reflect issues of real concern in the scientific community. But, when the headline asks whether we presrcibe medications too quickly, one can guess the answer pretty readily. Unless I’m way off base, would many readers expect the answer to be “no?”

Indeed, the article is nearly chockfull of critical concern about diagnoses, labeling, and treatment. Ms. Healy cites research results (without revealing some of the sources) and quotes at least a half dozen experts. Some of these experts would probably be consider advocates by some of the other experts.

As is de rigeur in contemporary journalism, Ms. Healy leads (and closes) with a case example. She tells the story of a 38-year-old mother who takes her 11-year-old daughter to a psychiatrist, because the girl’s “behavior and performance in school were exemplary, but an ill-tempered outburst had gotten the preteen kicked out of a Girl Scout troop she had joined at age 5. The girl was confused and heartbroken over her ejection.”

Katie’s maternal instincts tell her she must protect her child. But from what, she asks — a disease that threatens health, happiness and future? A bogus label applied to an admittedly challenging kid? Or drugs with potentially harmful and little-studied side effects?

And protect her exactly how — by resisting or by medicating?

In general, this is not a dispassionate examination of the question under which Ms. Healy’s article appears. I say this not because I disagree with her slant, but because the treatment is sensational and poorly informed. Had she gone more deeply into the topic, she would have learned about effective behavioral treatments that provide viable alternatives to medicaiton for many child behavior problems. Instead, she stuck with the hidden-mysteries view of Emotional and Behavioral Disorders of children.

Link to Ms. Healy’s article.

How many students have Emotional and Behavioral Disoders? Is it 1%, 5%, 10%, or even more? What is the true prevalence of EBD?

Some children and youth with problems in the emotional and behavioral area have difficulties that do not rise to the level of Emotional and Behavioral Disorders. Reasonable adults know that every individual experiences bumps along the road. But what counts as a legitimate Emotional or Behavioral Disorder, not just a bump in the road?

This begs the question of how we define EBD. That’s a serious issue, one that policy makers should examine. And they should turn to the extant data about what’s normal. There are plenty of data that address this point.

The philosophical side of the question about what is normal turns, in part, on the question of whether “normal” is defined as what’s “right” or what’s “average” (borrowing from Ullman & Krassner). Some behavior among children and youth (say, sexual contact with peers) may be common (i.e., average) but not socially acceptable (i.e., ideal). Societies must wrestle with this matter, and social mores (e.g., religious views) often enter in the discussion.

But, another way to examine this matter is to ask how often people (parents, teachers, and individuals themselves) report that children and youth display behaviors that are so unusual that they are abnormal. Is, for example, Jim’s nosepicking such a problem (he really gouges the nostrils all day long!) that it’s more frequent and more severe (deeper pentration) than 99% of other children? Well, if the answer is “yes” and we consider nosepicking an inappropriate behavior, then it’s a problem. It’s abnormal.

It turns out that researchers have lots of data about the important others’ (parents, teachers) ratings of of children and youths’ behavior. Some kids do things that are generally out of the range or normal often and over extended periods of time. Sometimes, multiple raters—parents and teachers or teachers over several years—give similar ratings to the same youths.

If there is convergence among these ratings, wouldn’t one think that they represent problems worth examining? I’d say, “Yes.”

My colleagues and I are examining all the empirical studies we can find that report data about the prevalence of emotional and behavioral problems among school children. If we find that scientifically trustworthy studies show a higher prevalence of EBD among school children than the percentage of students identified by the research samples, we’ll have to suggest alternative explanations for the findings.

What might those explanations be? Why are more (or fewer) students with EBD identified in the US schools than are pesent in the population, according to prevalence research?

Under the headline “Schools hope mental health screenings will help end stigma,” Heather Parker reported that Carlsbad (NM, US) High School will conduct screenings for mental illness among students. The school will use grant funds to help identify students who might be at risk for depression, suicide, or other problems and, therefore, in need of further evaluation.

With parent permission, 475 ninth grade students will be screened for signs of depression and suicidal tendencies.

“This effort is part of the Garrett Lee Smith Memorial Suicide Prevention Grant the school district received,” said Janey Lynn, wellness and prevention coordinator at CHS.

I have to guess this effort will raise some of the same concerns as educators have see with Teen Screen (see here for an EBD Blog post and related comments).

Link to Ms. Parker’s article.

The annual meeting of Teacher Educators for Children with Behavioral Disorders (TECBD), now named after Rob Rutherford who founded it, will be held 15-17 November 2007 in Tempe (AZ, US). Steve Forness, Cheryl George, and John Maag are among the people who’ll be speaking this year.

Every year, EBDBlog has announced the call for papers, so this is nothing new. There is still time to propose a presentation for this year’s meeting. Potential presenters may submit proposals for sessions using the TECBD site.

Link to the Web site for TECBD. Link for proposing presentations.

Earlier this week, the Charleston (WV, US) Daily Mail carried a story entitled “Black children with autism diagnosed later” that reported about the problem of false negative identifications by ethnicity. The story recounts the case of a boy named Ronnie who went through a string of other diagnoses before being identified as having autism.
Continue reading ‘Ethnicity and diagnosis’

NARSAD: The Mental Health Research Association announced its grants for 2007, including 23 Distinguished Investigators and 222 Young Investigators. The awards represent more than $15 million in grants, and many of them are relevant to Emotional and Behavioral Disorders among children and youths.
Continue reading ‘NARSAD 2007′

A group of researchers affiliated with the University of California Davis and the University of California Los Angeles examined whether very young children respond when their names are called. They found that infants at risk for autism (their older siblings have autism), when compared with infants who were not at high risk of developing the autism, required more calls of their names before responding.
Continue reading ‘Early identification of autism’

Teen Screen, an effort to screen for suicide among adolescents, got a good push from Charles Q. Choi. Writing in Scientific American, Mr. Choi (or, his headline writer) asked the eminently sensible question, “If mental illness is epidemic among teenagers, why isn’t screening for it routine?” He runs through the facts and figures, drawing on the case of Laurie Flynn and Ms. Flynn’s 17-year-old daughter Shannon’s attempted suicide, to make the case for screening, especially among adolescents with Emotional and Behavioral Disorders.

Teens with mental disorders are at even greater risk—roughly 90 percent of teens who died by suicide had a psychiatric illness at the time of their deaths, according to research by child psychologist David Shaffer at Columbia University. Nearly two thirds of youth who die by suicide exhibit psychiatric symptoms for more than a year beforehand, which makes this time a significant window for potential intervention.

Although it has strong supporters such as National Alliance on Mental Illness, Teen Screen has detractors such as Psych Search (an organization that opposes psychiatry and pharmcological treatment of Emotional and Behavioral Disorders). One detractor, Teen Screen Truth whose express purpose “is to provide the truth on mental health screening programs by presenting information gathered from various sources on the Internet,” decries the effort, claiming “that the intended treatment for those so labeled is psychiatric drugging, using antidepressants and mood-altering drugs such as Ritalin, Xanax, Celexa, Paxil, Zoloft, Prozac, Thorazine, Luvox and other similar drugs which are known by the FDA (and the pharmaceutical companies) to cause depression, violence, suicide and homicide.” Without providing a thorough review of the arguments posed on Teen Screen Truth, let me say that I think a careful reading of the objections by someone who is passingly familiar with the literature on Emotional and Behavioral Disoders and assessment would reveal that the arguments are exaggerated and predicated on mistaken (perhaps even misrepresentative) analyses of the evidence.

Link to Mr. Choi’s Scientific American article. Link to TeenScreen. Here is a link to NAMI’s page about Teen Screen. For those who want to examine the details of the counter case (check the out-of-context quote from Professor Shaffer!), here’s a link to TeenScreenTruth. And, here’s a link to the apparently Scientology-associated Psych Search critique of Teen Screen.

BlackEnterprise.com has an extended article on using prevention and early intervention to avoid identifying African-American students as having disabilities. From the abstract:

In this article, the author encourages the use of prevention and early intervention methods to prevent and reduce overrepresentation of African American students in the special education categories of mental retardation, emotional disturbance, and specific learning disability. The author discusses ways to adapt A. A. Ortiz’s (2002) “Prevention of School Failure and Early Intervention for English Learners” to meet the needs of African American learners. The author also provides examples of daily school practices to improve the education of African American learners and possibly reduce their representation in special education, as well as enhance the quality of schooling for all students.

Link.

The most recent of a series of books examining the characteristics, causes, treatment, and consequences of antisocial behavior in children and youths, this volume by the Oregon Social Learning Center (OSLC) team examines the behavioral processes that build and sustain deviant interactions between children and their families (as well as teachers and others). Professors Patterson and Reid have been working on this topic for more than 40 years and they have examined these processes using many different scientific methods. They have assembled chapters from an all-star cast of people with whom they have worked during that time and the contributed chapters cover both the development of and intervention in antisocial behavior.

Reid, J. B., Patterson, G. R., & Snyder, J. J. (Eds.). (2002). Antisocial behavior in children and adolescents: A developmental analysis and model for intervention. Washington, D.C., American Psychological Association.

Learn more about the book from a page on the Web site of the American Psychological Association. To learn more about the OSLC, check the link in the sidebar. During my graduate studies, I worked with this research group for a bit more than a year; I learned a tremendous amount from the interactions and readings I had during that period.