Archive for the 'Musings' Category

Page 5 of 7

Andrea’s buzz

Published on 3 November 2006 in ADHD, Autism, Behavior management, Musings and News. 0 Comments

A person who identifies herself as Andrea maintains a blog called Andrea’s Buzzing About in which she covers a bundle of issues. These are some of the categories she uses: ADD and ADHD, advocacy, auditory processing disorder, autism and Asperger’s, aversives, behaviour management, developmental disabilities, epidemiology, eye contact, IEPs, inclusiveness, injustice, invisible disabilities, Judge Rotenberg Center, Learning Disabilities, learning styles, logical fallacies, medical quackery (and quackery in general), meltdowns, parenting, prosopagnosia, pseudoscience, punishment and rewards, special education, “stimming,” teaching, Tourette’s, and tutoring.

Andrea’s buzz is thoughtful and literate. Although I disagree with some of her views (e.g., her take on aversives doesn’t align with mine), I find her posts worth reading as they provide a good glimpse into her interpretations of her experiences. Because she experiences some pretty interesting events, it’s often enlightening.

Read Andrea’s Buzzing About.

Sphere: Related Content

Reflection reconsidered

Published on 2 October 2006 in Behavior management and Musings. 0 Comments

Over on Mentor Matters, Mrs. Ris has a good post on teachers reflecting about their teaching. She argues that some folks who might dismiss reflection as a popular bit of fluff in teaching—I’m among them—should look at reflection not as writing diary entries about cute incidents, but as serious examination of teaching practices that do and do not promote academic and social growth. It’s a good point. Link to Mrs. Ris’ post.

Sphere: Related Content

Preschool aggression

Published on 1 October 2006 in Acting out, ADHD, Behavior management, Conduct disorder, Families, Musings, News and Research. 0 Comments

Sometimes I just don’t get it.

The following abstract (from PubMed) describes research on use of medications as a treatment for preschoolers with attention deficit hyperactivity disorder, disruptive behavior disorder, and posttraumatic stress disorder. I suspect that the article reports on prior interventions that have been tried in most of the cases described in the study, but I have to wonder whether those interventions were well-conceived and -executed. Afterall, preschoolers are little kids. Most all of them are very susceptible to differential reinforcement. Did anyone test a carefully implemented time-out program with these kids (and I don’t mean one of the bogus take-time-to-get-yourself-together practices that are often labeled “time out”)?

There are surely a few preschoolers who will not respond to effective behavior management practices, and for those children and their families we must turn to additional means of therapy. But, I hope professionals concerned with Emotional and Behavioral Disorders among young children are using well-documented behavior modification procedures as a much earlier line of therapy.

Prog Neuropsychopharmacol Biol Psychiatry. 2006 Sep 26; [Epub ahead of print] Related Articles, Links

Psychopharmacologic treatment of aggressive preschoolers: A chart review.

Staller JA.

Division of Child and Adolescent Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.

Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in a university child psychiatry outpatient clinic from 2001-2004. The most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD), Disruptive Behavior Disorder and Posttraumatic Stress Disorder (PTSD). Medication was prescribed for a majority of the children with prominent aggression; atypical antipsychotics were prescribed with the greatest frequency, followed by stimulants and then alpha agonists-treatment response ratings indicated moderate to marked improved in a majority of the preschoolers who received one or a combination of these medications. Findings support the need for controlled trials of medication in preschoolers with severe aggression.

Sphere: Related Content

School’s in

Published on 30 September 2006 in Behavior management, Musings and News. 0 Comments

One can learn how the school year’s starting for some teachers of students with disabilities by reading blogs. Over on liquidwafflegirl, Jill has a couple of notes about what it’s like during the beginning of the school year for a teacher of students with Emotional and Behavioral Disorders. One can follow along with the trials and tribulations she’s experiencing.

On TeachingLizzie, Beth is documenting her first year of teaching. As one might expect, she’s had some good days, but she’s run into a rough spot or two.

If there’s a theme to these posts, it appears to be behavior management concerns. I can understand, as I recall how important it was to get things right on that score…and how difficult it is to do so when working with students who have been assigned to you because of their difficult behavior. Taking the longer view—putting a strong management system in place and implementing it calmly and faithfully; knowing that it will bring about change over time, that learning how to behave takes time, doesn’t happen in an instant—isn’t easy. Sadly, sometimes I forgot this and sank into the same spots where the kids were: Only able to see the immediate situation, I’d engage in a battle of wills. But those strong, consistent, persistent, and positive management systems do work. I’m hoping that things will go well in these classrooms.

Sphere: Related Content

Secretin does not work

Published on 10 September 2006 in Autism, Musings and Research. 0 Comments

It’s been almost a year since I updated a Web page about secretin as a treatment for autism, and it deserves an update. When I originally wrote the page in the late 1990s, there had been a study suggeting that there might be beneficial effects; I was intrigued and wanted to learn about it because I thought I might use single-subject research methods to examine the effects across a range of dependent variables.

What I learned at that time made me skeptical, however. What I learned when I subsequently revised the page has confirmed my reservations about using secretin therapeutically. Professor Peter Sturmey of Queens College (City University of New York) reviewed the research on secretin and found that it has not been shown to have benefits.

1: Res Dev Disabil. 2005 Jan-Feb;26(1):87-97.

Secretin is an ineffective treatment for pervasive developmental disabilities: a review of 15 double-blind randomized controlled trials.

Sturmey P.

Department of Psychology, Queens College and The Graduate Center, The City University of New York, CUNY, Flushing, NY 112367, USA. psturmey@aol.com

In 1998, Horvath et al. [Horvath, K., Stefanatos, G., Sokolski, K. N., Wachtel, R., Nabors, L., & Tildon, J. T. (1998). Improved social and language skills after secretin administration in patients with autism spectrum disorders. Journal of the Association of the Academy of Minority Physicians, 9, 9-15] reported an uncontrolled trial of secretin with three participants with autism, which apparently resulted in significant behavioral improvement. Subsequently, secretin was widely used. Sandler et al. [Sandler, A. D., Sutton, K. A., SeWeese, J., Girardi, M. A., Sheppard, V., & Bodfish, J. W. (1999). Lack of benefit of a single dose of synthetic human secretin in the treatment of autism and pervasive and developmental disorder. The New England Journal of Medicine, 341, 1801-1806] reported the first double-blind trial of secretin with negative results. This article is a review of 15 double-blind trials of secretin. Almost none of the studies reported any significant effects and none concluded that secretin was effective. Transient effects of secretin, including both minor benefits and behavioral deterioration were reported, probably due to multiple statistical tests. Four papers reported data on differential responding in sub-groups of participants, including those with gastrointestinal symptoms. These effects were not replicable. At this time there is no robust evidence that secretin is an effective treatment for pervasive developmental disorders.

Evidence such as this does not appear to have detered people from recommending secretin. As a Google search reveals, the Internet is alive with recommendations for it.

Most of the recommendations seem predicated on personal experience rather than science. This is probably the most difficult kind of false evidence to discount. When people have seen something with their own eyes, it’s hard for them to accept contradictory evidence. The problem, of course, is they may not have seen what they saw had they not expected it: “I wouldn’t have seen it if I didn’t believe it.”

This problem revives my interest in conducting research on secretin. I’d like to study whether (a) child behavior and (b) adults’ reports of child behavior change when children with autism are given placebo or secretin. My hunch is that the child behavior will not change, but that some adults will report improvement, even when the child receives placebo.

Link to the Pub Med abstract of Professor Sturmey’s review (same content as quoted here). Link to contact information for Professor Sturmey.

Sphere: Related Content

Please delurk soon

Published on 27 August 2006 in Musings. 0 Comments

de-lukring button EBD Blog is joining Sheryl’s promotion of National De-lurking Week on Paper Napkin. I’m looking for a place to put this image in the navigation elements at the right. Suggestions welcome; leave them [ahem] in the comments on this post.

Sphere: Related Content

Letter to editors

Published on 9 August 2006 in Autism, Families, Musings, News and Policy. 0 Comments

Here’s the text of my letter to the editors of the Charlottesville Daily Progress regarding the editorial to which I referred yesterday:

The Daily Progress got a lot right with its editorial entitled “Protecting mentally ill” (8 August 2006). As the editorial noted, this is a complex problem that is exacerbated by deinstitutionalization, the behavior of individuals with disabilities, and the legitimate need of officers to protect the public. Efforts by the task force convened by the Public Defender Office and other law enforcement officials to provide training for local police officers in handling difficult encounters with individuals with Emotional and Behavioral Disorders certainly deserve praise, and I am glad that the Progress recognized the merits of the effort.

However, the Progress editorial writer overlooked an important aspect of this issue: Law enforcement interactions with children and youths with Emotional and Behavioral Disorders. Sad news reports from Boise, ID, Denver, CO, and other areas describe terrible incidents—including the death of children with autism—as a consequence of confrontations between officers and children.

Fortunately, around the country law enforcement officials, public-interest groups, and researchers have worked together to develop curricula to help law enforcement personnel resolve untoward encounters between police officers and children with disabilities. I hope our local officials do not overlook the need to include training for officers in use of effective methods when they encounter problems with children and youth who have Emotional and Behavioral Disorders.

Sphere: Related Content

What is insubordination?

Published on 30 June 2006 in Musings and News. 3 Comments

If you teach, administer, or are simply concerned about special education and you haven’t been following Miss Dennis’ accounts of teaching in the Bronx, you owe it to yourself to scurry on over to Your Mama’s Mad Tedious and catch up. That’s a link to her blog over there in the list on the sidebar under “blogroll.”

Earlier this year, Miss Dennis reported that she wouldn’t prepare IEPs for students whom she didn’t teach. It made sense to me (and I thought I’d put an entry here or over on Teach Effectively, but I can’t find it).

Now, Miss Dennis reports that her supervisor charged her with insubordination because of her action. The story provides a fascinating commentary on teaching special education. Just what is insubordination? When should someone agree to do something inappropriate?

Sphere: Related Content

FC again

Published on 22 June 2006 in Autism, Musings, News, Policy and Research. 0 Comments Tags: , .

Over on SpedPro.org, a couple of my colleage and I have posted a statement expressing dismay about the support offered by Time magazine in two May 2006 issues for Facilitated Communication.

We the undersigned register our dismay about Time magazine’s support of Facilitated Communication in the 10 May 2006 article entitled “‘Helping’ Autistic People to Speak” and 15 May issue entitled “Inside the Autistic Mind” by Claudia Wallis. Time might as well have endorsed cold fusion or phlogiston as give Facilitated Communication a favorable review.

Link to the statement.

Sphere: Related Content

Autistic expectations

Published on 6 June 2006 in Autism, Musings and News. 0 Comments

Cammie McGovern, mother of an 10-year old with autism, wrote about parents’ actual or alleged contributions to the deaths of three individuals with autism as a springboard to make an important point about parents’ expectations for their children. Writing in the New York Times (NY, US), she argues that families need to be told that total recovery and normalcy are not appropriate expectations for children with autism.

Clearly there is a message in the recent deaths about the urgent need to increase support for the rising number of families struggling with autism. Having an autistic child is estimated to cost a family $10,000 to $50,000 a year in out-of-pocket expenses for medical treatment, therapy and education. With 50 new diagnoses of autism in this country every day, support services are already too stretched to meet the need.

But as much as I’d like to fault government policy, I suspect it is not entirely to blame. There’s another issue that hits closer to home and is harder for most parents of autistic children to be candid about. When your child is initially diagnosed, you read the early bibles of hope: “Let Me Hear Your Voice,” “Son-Rise” and other chronicles of total recovery from autism. Hope comes from a variety of treatments, but the message is the same: If you commit all your time, your money, your family’s life, recovery is possible. And who wouldn’t do almost anything ? mortgage a home, abandon a career or move to be closer to doctors or schools ? to enable an autistic child to lead a normal life?

Now, as the mother of a 10-year-old, I will say what no parents who have just discovered their child is autistic want to hear, but should, at least from one person: I’ve never met a recovered child outside the pages of those old books. Not that it doesn’t happen; I’m sure it does. But it’s extraordinarily rare and it doesn’t happen the way we once were led to believe.

Ms. McGovern’s column raises very important ideas. If not all, most of the students with whom we work will never completely shake the problems they have. Too often, we educators have unrealisitic expectations for our students. We can help them to lead more normal lives, but we are not going to cure anyone of all those problems. As adults, these individuals are still going to have mannerisms, quirks, gaps, and other irregularities in their behavioral and skill repretoirs.

It’s fine to have high expectations, but not unrealistic expectations. Too-high expectations have deleterious consequences. For example, too-high expectations can lead us to hope for miraculous improvements, increasing our willingness to adopt untested methods our our vulnerability to scam artists. We need a good dose of realistic thinking. Thanks, Ms. McGovern.

Link to Ms. McGovern’s editorial.

Sphere: Related Content

Insurance ills

Published on 2 May 2006 in Musings and News. 0 Comments

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.

Sphere: Related Content

ADHD numbers

Published on 23 March 2006 in ADHD and Musings. 0 Comments

Over on Psych Central, John Grohol has an entry about accurate diagnosis and treatment of ADHD. Mr. Grohol, who sometimes publishes direct copies of others’ articles but appears to have written this one himself, muses about whether ADHD is over-diagnosed, referring to a couple of news stories on the topic coming from publications in Great Britain. I recently heard a local news interview with a school psychologist who also contends that ADHD is over-diagnosed and medications over-prescribed.

Although I’m sympathetic with the argument that we need to help parents and teachers use better behavior management and instructional procedures and agree that doing so would help reduce problems commonly associated with ADHD, I’d be interested in the evidence for these claims of over-diagnosis. The trick in conducting such studies, in my view, is to know a true level of ADHD so that one can assess whether prevailing levels are too high or too low. How does one determine this standard?

Link to the entry on Psych Central. The radio interview with was on With Good Reason, but that show’s Web site does not provide a link to the audio nor a transcript.

Sphere: Related Content

Bad Behavior has blocked 823 access attempts in the last 7 days.