The Child Mind BlogBrainstorm

  • When Medication Mistakes End in Tragedy
    June 21, 2011 Harry Kimball

    The death of a 12-year-old New York boy in 2009 is back in the news after his family recently filed a lawsuit against his psychiatrist and the pharmacy that dispensed the medication that appears to have killed him. Phillipe Gallete had a prescription for bupropion (Wellbutrin is a common brand name) to treat depression, and while the details are unclear his family alleges that mistakes by both his doctor and Wallgreen's led to a dangerously high dose that ultimately killed him.

    The New York Post has it that Dr. Marie St. Clair accidently wrote 2 prescriptions for bupropion, that the pharmacy filled the scrips without noticing the repetition, and that Gallete's mother says she simply followed the dosing instructions on the bottles. Over at the New York Daily News, the interpretation of the lawsuit is a little different; there is no mention of 2 prescriptions, only that the dose was apparently "seven times greater than what should have been ordered" and that Gallete was on the deadly dose for six days until he went into seizures and died.

    Without all the information it's hard to parse this story; but the fact is that bupropion does carry a risk of seizure, though the drug is rarely life-threatening. Most accounts of overdose-some at 5, 10, even 50 times the clinical dosage range-are harrowing but ultimately not fatal. So what can we learn from this? Psychiatric medications, like any medication, carry the risk of side effects. Some of these we call "nuisance side effects," while others are more serious. When a medication is prescribed to a child, the first thing a doctor and the parents have to decide is whether the potential benefits of the drug outweigh the risks. And then the course of medication needs to be closely monitored-something that's especially critical in children, who are growing and changing.

    The fact is that disastrous mistakes are often the result of small slip-ups by a series of people, any of whom could have prevented the outcome. In this case, the parents are busy blaming the doctor and the pharmacy; commenters online are busy blaming all three. All we can say is that more engagement and better information from any or all of those parties could have led to a boy receiving treatment for an illness instead of accidentally ending his life.

     

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  • Exercise That's Not Organized Sports
    June 20, 2011 Caroline Miller

    Gwen Dewar, a biological anthropologist, has some interesting things to say about kids and exercise on babycenter.com. When we talk about how to get them moving more often, she notes, it's usually about geting them into sports or fitness programs. But historically kids weren't getting more exercise because they were playing soccer; they were getting more exercise because they walked or rode their bikes to school, to friends' houses, to do errands for parents. They did labor around the house and yard and (if they lived on one) farm. And they played outside.

    Kids playing outside

    Evidence suggests that the fittest children in North America, she notes, are the Amish and Mennonites. They're leaner and stronger.  It's not because they live in the country—kids in some rural communities  get even less exercise than urban kids do. "Amish and Mennonite kids are more active because they walk everywhere," she writes. "They chop wood and fetch water."

    So not too many American kids are going to be chopping wood or fetching water any time soon, but the takeaway applies to families everywhere: "Physical activity isn’t a class or a game. It’s an integral part of daily life." For more from Gwen Dewar go to parentingscience.com.

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  • 10-Year-Olds Vomiting to Lose Weight
    June 20, 2011 Caroline Miller

    A new study of 16,000 children in Taiwan finds that it's become alarmingly common for kids to make themselves vomit to lose weight as early as 10 years of age. The behavior is said to be more frequent in boys (16 percent) than girls (10 percent), and it appears to be more prevalent in 10- to 12-year-olds (16 percent) than older kids (13 percent of 13- to 15-year-olds and 8 percent in 16- to 18-year-olds).

    The report that's being cited all over is too vague to inspire much credibility, but it stimulates our anxiety that children who are growing up on little-to-no exercise and way-too-much unhealthy food are getting the idea that this is a smart way to avoid the consequences. Not surprisingly, kids who said they were vomiting were more likely to eat fried foods, indulge in night-time snacks, and spend more than 2 hours a day in front of a computer, among other things linked to increased obesity in children. Which is not to say that all the children doing the vomiting were obese, or even overweight.

    Whether or not the study has legs, we seem to be seeing younger and younger children who are image-conscious but are without the tools they need, and the structure they need, to develop healthy bodies. That's disturbing whether or not they're really vomiting.

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  • Again, Death Focuses Debate on Piecemeal Mental Health System
    June 17, 2011 Harry Kimball

    A few weeks ago we were appalled at the story of Jonathan Carey, a teen with autism who was crushed to death by inadequately trained workers at a New York State mental health facility.

    Today we see that the knife cuts both ways. In the New York Times we read about Stephanie Moulton, an eager young social worker employed in Massachusetts' patchwork mental health system, who was murdered earlier this year. The accused killer was a resident at the group home she worked at, a man with schizophrenia and a history of violence and incarceration named Deshawn James Chappell. She was alone in the home with Chappell when she was killed. He was apparently off his medication and has been deemed unfit to stand trial at least for now.

    And we're talking about this issue the same week that congresswoman Gabrielle Giffords was released from a Texas rehabilitation hospital after sustaining grave injuries in the rampage in Tucson earlier this year. Her attacker, Jared Lee Loughner, who failed to kill the representative but succeeded in taking the lives of 6 others, has also been found unfit to stand trial.

    These crimes, just like the death of Carey, are horrible. But we must stress that the incidence of violence in people with schizophrenia is roughly the same as in the general population. And unfit to stand trial also means in need of serious medical attention. In an earlier era, these men would have been locked up for life with little chance of a meaningful existence, little access to effective care, little hope for recovery. With deinstitutionalization, we may have put them in a similar spot—with a higher body count. It is becoming very clear that our solution to providing care to people with severe and debilitating mental illness, whether it is schizophrenia or autism, is just not working. And yet we're told that we need to cut even more funding. The fact is that the people closest to this system—the patients and the people who care for them day to day—are being served very poorly by it, sometimes to the point that lives are lost. There are victims on both sides, and the only winner seems to be the bottom line.

     

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  • Trying Too Hard to Make Kids Happy
    June 15, 2011 Caroline Miller

    "If you've got 20 minutes a day to spend with your kid, would you rather make your kid mad at you by arguing over cleaning up his room, or play a game of Boggle together?"  It's a question posed by a Harvard child psychologist in an excellent, provocative piece in the Atlantic on whether parents are undermining their children by trying too hard to make them happy. And whether, not incidentally, we do it to make ourselves happy. "We don't set limits," the psychologist concludes, "because we want our kids to like us at every moment, even though it's better for them if sometimes they can't stand us."

    Trying Too Hard to Make Kids Happy Lorri GottleibThe piece, by Lori Gottleib, argues that lavishing too much praise and too few limits on kids can make them them fragile, insecure and noncommittal adults. But the "conflict or Boggle" choice reminds me of what I hear repeatedly from parents of children (lovely, smart, talented children, I might add) with disruptive behavior problems (not-welcome-in-preschool-level problems). The moms tell me they so wanted their time with their kids to be fun, to be nurturing, to be conflict-free, they found it very difficult to exercise authority.

    That's where Parent-Child Interaction Therapy comes in, to teach parents how to restructure the relationship so that they're setting clear limits and enforcing them, unemotionally. It's amazing the effect it can have on children, who learn that whining, negotiating, and tantrums won't budge their parents, who are comfortably in charge. As one mom put it, her son has done a 180 in terms of his behavior. "He listens and responds appropriately most of the time. He has gained tremendous control over his behavior and emotions. And at home I have a lot more confidence as a parent, and I see that he responds to it. Whenever I have a weak moment, he might say, 'Mom, is that a direct command?' or 'Mom, should I really be able to do this?' "

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  • Abuse of Developmentally Disabled in Spotlight
    June 14, 2011 Beth Arky

    At the last in a series of legislative hearings in Albany on abuse of the developmentally disabled, a New York state official yesterday cited increased reporting of incidents to the police as evidence of recent progress. Courtney Burke, the state's new commissioner of the Office for People With Developmental Disabilities, which oversees the facilities called out in a recent New York Times expose, noted that about 60 percent of allegations are now being reported directly to law enforcement vs. 17 percent before she took office in March.

    Burke's figures—which suggest that there are still hundreds of cases of alleged abuse going unreported—show some improvement but fall far short of the kind of substantial reform obviously needed.  And these cases are just the tip of the iceberg in a system known for cover-ups and a lack of transparency and oversight.

    The hearings were prompted by a series of shocking reports by the  Times' Albany Bureau Chief Danny Hakim that have blown the lid off the "culture of abuse" that led to the death of Jonathan Carey, a 13-year-old with autism who was suffocated by a "caregiver" who improperly restrained him in a van in 2007. Hakim notes in today's piece that Burke has proposed a bill to bar the agency from hiring people convicted of violent crimes or sex offenses-though not other convicted felons.

    A petition is circulating calling for several laws based on bills drawn up by Michael Carey, Jonathan's father and a tireless advocate for the developmentally disabled.

    It calls on state leaders to put basic safety measures in place, including surveillance cameras in facilities and transport vehicles, which might have prevented Jonathan's death. It calls for improved background checks of applicants' records, the lack of which has led to the "recycling" of past abusers from one facility to another, and real protections for whistleblowers. Finally it calls for better supports and services by well-trained caregivers to allow more children and adults with disabilities to live at home with loved ones rather than in residential settings.

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  • Debunking Myths About Military Families
    June 13, 2011 Caroline Miller

    Krystel Spell, a mother of two who writes a blog called Army Wife101, has an appealing guest piece on babycenter.com about the stereotypes civilians have about military families. Since the families of the men and women who defend our country deserve not only gratitude from the rest of us but attention to the tremendous stress they are under—emotional and financial—it's worth a look.  Misconceptions she addresses include the myth that military families don't pay taxes and that they pop out kids as fast as possible because the government pays them more for each dependent.

    For those who think these families are swimming in dough, she notes that starting pay for a private is $1467 a month. "Even during deployments," she adds, "service members only receive $575 extra monthly, which in my opinion is not enough to get shot at."

    And she acknowledges the unflattering stereotype that military wive are busy cheating on their husbands while the latter are conveniently deployed in war zones. "The majority of us are loving supportive spouses who are proud of our heroes and who are committed to them and their careers. The last thing most of us would want to do is put the stress of infidelity on them while they’re protecting our country." We might add that if you want to talk about the high divorce rate in military families, you might look at the stress repeat deployments puts on everyone in the family.

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  • Report Casts Doubt on Effectiveness of Autism Screening and Early Intervention
    June 13, 2011 Harry Kimball

    A review of the research on screening and early intervention for autism in young children has produced an unorthodox conclusion: don't do either. The article appears in Pediatrics, the journal of the American Academy of Pediatrics, which does not seem particularly keen on the association. (Opinions "are those of the authors and not necessarily those of the AAP," a spokeswoman tells Miriam Falco, who wrote up the brouhaha for CNN.) To tell the truth, Falco doesn't seem particularly impartial, either. "The report's authors are cerebral palsy experts at McMaster University in Ontario," she writes, while experts who actually "diagnose, treat, and study children with autism"—my emphasis—"said they were puzzled and concerned by the new report's conclusions." Is this a case of specialists wandering too far outside their comfort zone?

    The AAP suggests screening at 18 and 24 months, meaning that pediatricians go through a simple checklist to determine whether children are developing typically or could be showing signs of a developmental disorder. But "good screening tools and efficacious treatment is lacking," the report states. Autism is a real problem, the authors admit; they just want to "find the children who truly have autism and find ways to help them" that aren't our current interventions, which do "not significantly improve the cognitive outcomes of children."

    Experts south of the border aren't buying it. They point out that any screening tests are often used in conjunction with a doctor's periodic observation of a child for signs and symptoms. And early intervention is effective and proven so, they tell Falco; the Canadian researchers just didn't consider the studies with positive results. This isn't just an academic issue: there is real worry it could unintentionally sabotage families' access to care if insurance companies can point to a paper in a journal that says the interventions don't work.

    "I would hope our debate would lead to an action," one of the authors tells Falco. Let's hope that action is to better educate both the medical establishment and the public about the proven preventative measures and interventions for autism while at the same time striving to make them better—not throwing the proverbial baby out with the bathwater.

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  • Do Girls Have a Natural 'Immunity' to Autism? Could Be
    June 10, 2011 Harry Kimball

    Drawing from the same sample population as Child Mind Institute Scientific Research Council member Matthew State (see here), geneticist Michael Wigler has completed a parallel study and made some pretty bold statements about the causes of autism, the gender disparities in diagnosis, and possible related disorders. Wigler and his team undertook an analysis of the 1000 families of the Simons Simplex Collection with an eye towards bolstering what he calls his "unified theory of autism," a theory that hasn't found overwhelming favor in the wider community.

    NeuronWhat is this shocking theory? Wigler has proposed that while autism is, indeed, heritable—passed from parents to children—the great majority of cases of the developmental disorder arise from "de novo," or spontaneous, genetic mutations in the reproductive cells of the parents. Seems unlikely? Stay tuned.

    By studying the genome of the parents, siblings, and the affected child in the Simons Simplex Collection, Wigler has concluded that there are perhaps 300 or more specific places in the genome that, if a mutation occurs, leads to autism. Hence, all that is needed to account for a majority of the cases we see is for a mutation to hit a relatively large target.

    Since mutations occur with equal frequency across gender, Wigler needs to explain why four times as many boys are diagnosed with autism as girls. Here is Wigler's big leap: He concludes that there are many girls with the same mutations as their male counterparts who are not symptomatic. Among those girls who are diagnosed, he notes, the damage done by mutation was much more extensive than the boys.

    So that means that women are "resistant" to symptomatology, but can also be carriers, passing on the mutations to their children through simple hereditary transfer.

    These carrier girls "may encounter difficulties at later stages of their lives that manifest as a different diagnostic category," he told ScienceDaily. It's "most likely to be one with a gender bias opposite that of ASD" like anorexia, he said. This seems to be idle speculation. But backing up a theory of autism with good data, a theory that could lead to prevention and new treatments, is alright in my book. The study is in Neuron.

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  • Study: Mental Health Is Top Concern for Youth
    June 9, 2011 Web MD

    A sturdy, healthy, and carefree childhood is increasingly a myth: a report from the World Health Organization (WHO) identifies the three main causes of disability in individuals ages 10 through 24 worldwide to be neuropsychiatric disorders, unintentional injuries, and infectious and parasitic diseases. Researches used disability adjusted life-years (DALYS) to compute their results, which estimate how many years of life are lost due to both premature deaths and disabilities related to these specific causes. They found that, for the age range, neuropsychiatric disorders contribute to 45% of years lost due to disability; unintentional injuries contributed 12%, infectious and parasitic diseases 10%. The report comes as no surprise to mental health experts. "Increasingly, we are starting to realize the onset of about half of all lifetime cases of mental illness begin by age 14," says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness (NAMI). The report spells out a need to target new prevention strategies at teens and young adults.

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