EBD Blog

Summer in the US finds children and youths out of school and, perhaps, less vulnerable to some of the problems that are associated with the social and academic demands that are part of schooling. As a result, perhaps fewer of the familiar problems illustrated in this poster are apparent during summer.

If summer seems like a relief from such problems, though, that could be an important indicator that those very problems need to be addressed. A few weeks away from school probably will not cure them. Those same difficulties may still be occurring, just less obviously, and they are likely to recur soon.

Individuals or the families of children who experience the kinds of problems noted in the poster should consult the resources available from the US government’s Substance Abuse and Mental Health Services Administration. One will not find easy cures there, but by carefully perusing the resources available one can learn what signs to monitor and where to go to get help.

The image is hot. Click it to get to a good starting place.

In the US state of Michigan, a major health insurance provider will now reimburse families for the cost of providing therapy for children with autism. The case, Johns v. Blue Cross Blue Shield of Michigan, arose because Blue-Cross-Blue-Shield denied payment for behavioral treatment often called “ABA” to the family of a child with Autism. The case was settled in favor of the family last week.

Represented by Gerard Mantese, Mr. Christopher Johns alleged that the insurer should pay for the therapy for his son under the provisions of the policy. The insurance company refused and Mr. Johns sued. During depositions, Mr. Mantese and others on the Mr. Johns’ legal team learned of a draft memorandum identifying the behavioral therapy as effective and that a representative of the insurer would probably elect the behavioral therapy if that representative had a child with Autism.

Because Mr. Johns’ complaint was part of a class action suit, many other families will also benefit from the settlement. In an independent analysis of the case, Tresa Baldas discussed the implications.

The $1 million class action settlement from Blue Cross Blue Shield of Michigan comes amid a legislative wave in which a growing number of a states are passing laws that require insurance companies to pay for autism treatments and screenings. To date, 13 states have such laws, the most recent being Connecticut, Colorado and Nevada. New Jersey is currently considering an autism bill, and Pennsylvania’s law goes into effect July 1.

The June 17 Michigan settlement, meanwhile, has autism advocates hopeful that insurance companies will stop claiming that behavioral therapy for autistic children is experimental, and start paying for it.

“It is a significant victory for the families, obviously, and it marks a trend, hopefully, that insurance companies will start to look at autism treatment differently,” said Areva Martin, an attorney at Los Angeles-based Martin & Martin who is currently handling about 30 autism cases. She believes the labeling of autism treatments as experimental is “absurd.”

I wonder what this will mean for the California rules that do not expressly exclude behavioral therapies, but set requirements for deciding whether they are reimbursable (see my earlier post on that story).

Link for a quasi-news article about the settlement. Read another of the law firm’s press releases. Here’s link to Ms. Baldas’ analysis of the case.

Even though many schools in the US have closed for the summer or are about to do so, I want to remind folks that this is not a good time to take a break from considering the mental health needs of children and youth. Although they are likely to wax and wane over time, mental health problems don’t take many vacations.

Learn more about US resources for individual children and youths who have emotional and behavioral disorders by surfing the rich resources assembled by the Substance Abuse and Mental Health Services Administration (SAMSHA) of the US Department of Health and Human Services. Although some of the materials may be a tad out of date (e.g., prevalence figures have been updated for some disorders such as Autism), there are still plenty of valuable materials available from SAMHSA.

Go there! Compare what you see learn there with what’s available at other trustworthy sites. Learn what to do and from whom help is available.

Adolescents who are at risk for later episodes of major depressive disorders differ from their peers who are not at risk on multiple measures of rapid eye movement (REM) and hypothalamic-pituitary-adrenal (HPA) activity during sleep, according to a study by Uma Rao and colleagues that appeared this fall in Neuropsychopharmacology . Early depressive episodes that occur during adolescence are strongly associated with other later problems in other areas such as interpersonal relationships, pregnancy, educational attainment, employment, and suicidal behavior; finding predictors of later problems is important for primary and secondary prevention.

Rao and colleagues compared youths at risk for major depressive disorder with peers using electroencephalographic (EEG) and HPA measures. They then followed the youths for 5 years and correlated their EEG and HPA measures with the chances of later episodes of depression. Here’s the abstract:
Continue reading ‘Sleep predictors of later depression’

Writing in the Chicago (IL, US) Tribune, Trine Tsouderos has published an informed and valuable story about the use of Lupron to treat Autism.

Desperate to help their autistic children, hundreds of parents nationwide are turning to an unproven and potentially damaging treatment: multiple high doses of a drug sometimes used to chemically castrate sex offenders.

The therapy is based on a theory, unsupported by mainstream medicine, that autism is caused by a harmful link between mercury and testosterone. Children with autism have too much of the hormone, according to the theory, and a drug called Lupron can fix that.

“Lupron is the miracle drug,” Dr. Mark Geier of Maryland said after meeting with an autistic patient in suburban Chicago.

Geier and his son developed the “Lupron protocol” for autism and are marketing it across the country, opening clinics in states from Washington to New Jersey. In the Chicago area, the treatment is available through Dr. Mayer Eisenstein, a family practitioner in Rolling Meadows.

As is usually the case with these sorts of therapies, testimonials are the main source of evidence about effectiveness. There are no controlled studies of pharmacotherapy with Lupron for children with Autism. The drug, which decreases secretion of gonadotropins, is legitimately used in treating prostate or breast cancer, endometriosis, uterine fibroids, or precocious puberty.

Link to “‘Miracle drug’ called junk science: Powerful castration drug pushed for autistic children, but medical experts denounce unproven claims.” Also, see a companion piece entitled “Autism doctor: Troubling record trails doctor treating autism,” in which Patricia Callahan and Ms. Tsouderos provide a detailed report of the history of one of the physcians in the Chicago area, Dr. Mayer Eisenstein, who has been prescribing Lupron for children with Autism.

The Council for Children with Behavior Disorders (CCBD), an international group concerned about children and youths with EBD, published statements about the use of seclusion and restraint with students. Although the documents appear to be in preliminary form, they began circulating on the Internet today, so I’m posting copies of the PDFs here. Watch for an update of them.

• CCBD’s Position Summary on Physical Restraint & Seclusion Procedures in School Settings
• CCBD’S Position Summary on the Use of Physical Restraint Procedures in School Settings
• CCBD’S Position Summary on the The Use of Seclusion in School Settings

Link to the CCBD Web site.

Reporting on US National Public Radio’s Morning Edition, Joanne Silberner presented a story about police officers handling incidents in which they encounter people with emotional and behavior disorders who are behaving in ways that appear threatening to the officers. Although her story uses adult cases for illustrations, this topic should also be of interest for youths who have EBD and for the families of children with EBD.

Here’s an excerpt from Ms. Silberner’s report.

It’s a situation no one wants to see: An armed police officer is called because someone is in the throes of a psychotic episode. “How the officer handles that situation can have a significant impact,” says Russell Laine, head of the International Association of Chiefs of Police.
Continue reading ‘Officer training for handling incidents’

The recently published study by Rossignol and colleagues about hyperbaric oxygen therapy (HBOT) for Autism has generated lots of commentary and is sure to lead to more. Because it is a treatment study and employs more careful methods than are common in many of the therapies promoted these days, I sat up and said, “Hmm. I ought to read this one.”

So I did. And I found it to be, indeed, a cut above much of the ersatz research that’s passed off as evidence in the Autism arena. But, I found some concerns, too.

Those concerns led me to poke about a bit on the Internet to see whether there were any others who were raising questions. There are. And I still have some more poking to do. But, I thought I ought to record my concerns. Thus this post.

Continue reading ‘Does Rossignol et al. show HBOT’s effective?’

The US National Academies Press announced the publication of a book entitled Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities that discusses prevention of problems during childhood, adolescence, and young adulthood. Edited by Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, the book represents the work of the Board on Children, Youth and Families. It is available in hardback, as a PDF, or online (the last option is free).

Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of younger populations which often carryover into adulthood. The costs of treatment for mental health and addictive disorders, which create an enormous burden on the affected individuals, their families, and society, have stimulated increasing interest in prevention practices that can impede the onset or reduce the severity of the disorders.

Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations (such as children and youth in the child welfare system), school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations.

Preventing Mental, Emotional, and Behavioral Disorders Among Young People updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders, focusing special attention on the research base and program experience with younger populations that have emerged since that time.

Researchers, such as those involved in prevention science, mental health, education, substance abuse, juvenile justice, health, child and youth development, as well as policy makers involved in state and local mental health, substance abuse, welfare, education, and justice will depend on this updated information on the status of research and suggested directions for the field of mental health and prevention of disorders.

Link to the press release or the ordering page.

The University of Pennsylvania Collaborative on Community Integration has published its latest newsletter. To view this newsletter in fully formated form, click here. You can also find this issue and previous ones in the newsletter archive on the UPenn Collaborative Web site.

Continue reading ‘UPenn newsletter June 08′

In a systematic review of the research about parent training, Jennifer Wyatt Kaminski and colleagues of the US Centers for Disease Control identified factors that contribute to the effectiveness of programs that help parents manage the problematic behavior of their children. Of the 18 factors that they examined, only five proved to be important. Parent training programs that taught parents to respond consistently to problems, practice positive interactions, use time out, and required them to practice these skills with their own children led to greater effects on children’s externalizing behavior, but those that emphasized promoting children’s social skills had smaller effects on externalizing behavior.
Continue reading ‘Effective child management for parents’