________________________________________________________________
Tuesday,
September 8,
2009
Vol. 13 No. 95
TREATMENT
Are Autistic Kids In The Foster Care System Being Over Medicated?
RESEARCH
Scientists Find Three New Gene Links To Alzheimer's
Learning Disability Researcher Says Facebook Better for Memory
EDUCATION
Schools Cope With Challenge of Educating Autistic Students
Mothers Question Schools Ability to Assist Special Needs Students
Schoolyard Bullies, Victims Have Problems Later On
Fired Teaching Assistant Who Reported Abuse By Teacher Is Suing Dept. of Education
MEDIA
Free Online Autism Course
COMMENTARY
Why Current Thinking About Autism Is Completely Wrong
The Real Health Care Scare
TREATMENT
Are Autistic Kids In The Foster Care System Being Over Medicated?
is.gd/32wUA
Who should we as a society be watching out for more than kids with disabilities who are in foster care? They are kids. They are disabled. They don’t have their parents to advocate for them. They are our responsibility once they enter into the foster care system.
What if they are being over medicated? One subject that comes up a lot in the online autism community is the use of psychotropic medication on autistics. Note that the following is my opinion and not from the paper: medications, including psychtropic medications, have their place and can be beneficial, but great care and monitoring must be taken to insure that they are appropriately used. Psychotropic medications should not be used as chemical restraints.
That is why I was very interested when I saw that this paper was going to be published in Pediatrics: State Variation in Psychotropic Medication Use by Foster Care Children With Autism Spectrum Disorder is.gd/32xCh .
The paper has been out for a while but I couldn’t blog it right away. I wanted to take the time to do this paper justice. In the end, I don’t know if I have as I’m trying to find a good “voice” for this post. I keep switching between trying to give an uncolored presentation of the data and being outraged.
Yes, outraged.
The paper authors are David M. Rubin, MD, MSCE, Chris Feudtner, MD, PhD, MPH, Russell Localio, PhD, and David S. Mandell, ScDd.
If you are a regular reader of this blog, you may know that I have a great admiration for Dr. Mandell and his group. He asks important questions, often about groups like autistic racial/ethnic minorities or about autistic adults. Groups I consider to be the underdogs in the struggle for recognition and services in the autism communities.
Who could be more of an underdog than disabled kids in foster care? One of the reasons the authors give for studying autistic kids in the foster care system is: Second, beyond the cumulative impact of trauma on psychiatric symptoms after maltreatment, children with ASD in foster care are particularly vulnerable to the social and psychological disruptions that foster care placements can create, such that an excessive variation in the use of psychotropic medications between states may indicate problems in the ability of different foster care systems to achieve placement stability for these children or adequately provide for their well-being.
My read on that—autistic kids are more vulnerable to being traumatized by the foster care system, and the states using more meds may be worse at being able to care for these kids.
The authors list a number of factors that could play into this, including lack of resources and lack foster parent or caseworker training. One big factor—the possibility that these kids are frequently moved around. This is hard on all kids, but is obviously going to be especially tough on ASD kids.
+ Read more: is.gd/32wUA
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. . . Read, then Forward
the Schafer Autism Report.
$35 for 1 year - or free!
www.sarnet.org
• • •
RESEARCH
Scientists Find Three New Gene Links
To Alzheimer's
By Kate Kelland. is.gd/32swM
Reuters - Scientists have found three new major genetic links to Alzheimer's, affecting up to 20 percent of people with the brain-wasting disease, and said on Sunday it was the most significant such discovery in 15 years.
Two large studies found that the three new genes join the better-known APOE4 gene as significant risk factors for the most common cause of dementia.
"If we were able to remove the detrimental effects of these genes through treatments, we could reduce the proportion of people developing Alzheimer's by 20 percent," Julie Williams, a professor of Neuropsychological Genetics at Britain's Cardiff University, told a news conference in London.
Alzheimer's disease affects more than 26 million people globally, has no cure and no good treatment. The need for effective remedies is pressing, with the number of cases forecast to go beyond 100 million by 2050.
Current drugs can only delay the symptoms endured by patients, who lose their memories, the ability to find their way around and to care for themselves.
Williams, who led one of the two studies published in Nature Genetics, said that in Britain alone, eradicating the effects of the three new genes would mean almost 100,000 people could avoid the disease.
She said the findings were the most significant genetic discoveries for Alzheimer's in the 15 years since APOE4 was found to be linked, and said drug companies had shown a keen interest in their research.
MORE GENES OUT THERE TO CATCH Williams and colleagues at Cardiff's Medical Research Council Centre for Neuropsychiatric Genetics and Genomics carried out a genome-wide association study -- a scan of the entire genetic map -- involving more than 16,000 people from eight countries. They identified two new genes -- called Clusterin and PICALM -- that increase the risk of developing Alzheimer's.
A second genome-wide study conducted by Philippe Amouyel and colleagues at the Institut Pasteur de Lille in France, studied more than 6,000 people with Alzheimer's and nearly 9,000 healthy people in France, Belgium, Finland, Italy and Spain. They identified Clusterin and a third gene called CR1.
Amouyel said the disease risks associated with each gene were difficult to quantify, and said all three genes were relatively common. The scientists also stressed that an as yet unknown combination of many genetic and other environmental factors cause Alzheimer's.
The researchers said Clusterin may explain 10 percent of Alzheimer's cases, PICALM around 9 percent and CR1 4 percent. By comparison, 20 to 25 percent of Alzheimer's cases are linked to APOE.
Three gene variations have also been associated with rare, early-onset forms of Alzheimer's that run in families. Identifying the genes can help researchers understand the underlying causes of a disease and design drugs to fight them.
Michael Owen, director of the Cardiff centre, said their study also found evidence that other genes could play a role in the risk of developing Alzheimer's.
"It's a bit like we have been fishing with a fishing net and we've pulled out some fish. We know there are more fish there, and with a finer mesh net we can catch them," he said.
The Cardiff team now plans a further study involving 60,000 participants to look deeper into genetic causes of Alzheimer's.
• • •
Learning Disability Researcher Says
Facebook Better for Memory
By Chris Crum. is.gd/32m6p
Results from a recent study indicate that Facebook may actually be good for your brain, while services like Twitter and YouTube may not be, at least when it comes to the part of the brain that deals with memory.
The study was led by Dr. Tracy Alloway, Director of the Centre for Memory and Learning in the Lifespan at the University of Sterling in Scotland. Alloway has a PhD in Cognitive Psychology and has worked on several government-funded projects dealing with memory and learning.
"My research interest is in how working memory impacts learning in typically developing children, as well as in those with ADHD, Autism, Language Impairments, Dyspraxia, and Learning Disabilities," says Alloway. "I have numerous international collaborations to investigate whether assessments of working memory are culture-fair, or if a child’s background, as indexed by language, culture, and income differences, mediates the relationship between working memory and learning."
According to Alloway, keeping up with friends on Facebook stretches the working memory in a way that Twitter and YouTube cannot do. "On Twitter you receive an endless stream of information, but it's also very succinct," Alloway is quoted as saying. "You don't have to process that information." She applies the same rationale to texting.
"Your attention span is being reduced and you're not engaging your brain and improving nerve connections," she says.
If Facebook really is better for our brains than Twitter, it's a good thing Facebook seems to be doing everything it can to become more like Twitter, despite its much, much larger piece of the market share.
• • •
EDUCATION
Schools Cope With Challenge of
Educating Autistic Students
By Carol McGraw in The Gazette, Colorado. is.gd/32kFY
It’s mid-morning, and Teresa Wright is relaxing on her living room couch, sighing that familiar sigh mothers everywhere emit after a hectic morning getting the kids off to school.
But Wright has more on her mind than making sure the kids have their lunches and homework assignments. Three of her five sons — an 11-year-old and 9 year old twins — have autism spectrum disorder, and over the years, she and her husband, Patrick, have worked endlessly to make sure the boys’ school experiences have been productive.
She has nothing but praise for Fountain-Fort Carson School District 8, where her children attend classes. But even though D-8’s program for autistic students is considered one of the best in the area, she says, having autistic children in any school system is a never-ending job of making sure they’re getting the education they need.
“I tell parents new to autism that you have to advocate for your child all the time."
More and more parents have been learning that lesson in recent years as the number of students with autism has exploded. One in every 150 children is diagnosed with an autism spectrum disorder; 14 years ago only one in 10,000 children was thought to have it. In Colorado, the number jumped from 246 students in 1998 to 2,416 in 2008.
Faced with this dramatic increase, public school systems are struggling to give autistic students the best education they can in the least restrictive environment, as required by federal law. But finding money and trained workers to get the job done makes it difficult.
“It affects our budget greatly,” says Brian Printz, executive director of special programs in District 8, which has one of the highest number of autistic students in the region. “Our most expensive kids can cost $60,000 a year if they need to participate in special programs outside the district. Or if they have a para-professional for one-on-one support and other specialists, it can easily cost $25,000 to $40,000.” Other districts report similar costs.
While school districts get federal and state funds to help meet the needs of disabled students, that still covers only about 20 percent of the extra cost of educating them, Printz says. The rest must come from the district budget.
The costs can be astronomical for severely autistic students, who often need intense, one-on-one instruction to master not only rudimentary classroom subjects, but basic life skills such as eating, toilet training, and verbal and non-verbal communication.
Schools programs better, but not perfect The Wrights know all too well what schools are up against in trying to meet the needs of the growing population of autistic children — and what a good program can do to help them.
+ Read more: is.gd/32kFY
• • •
Mothers Question Schools Ability
to Assist Special Needs Students
By Eric Fossell for wsaz.com . is.gd/32ptU
Huntington, W.Va. (WSAZ) – Seeing her son come home from school in tears after classmates called him “Retard” and placed a “Kick Me” sign on his back marked the turning point for Mary Calhoun Brown.
Likewise, Kim Scott pulled her son out of Cabell County Schools after a diagnosis of bipolar disorder failed to bring him the educational attention she said he needed.
Both mothers decided to home school their sons, and they’re on a mission to educate parents and educators about the lack of resources in public and private schools for kids with behavioral and mood disorders.
Throughout our region – in West Virginia, Ohio and Kentucky – suicide ranks as one of the top three leading causes of death for 11- to 18-year-old youths, according to the latest statistics from the Centers for Disease Control and Prevention. Furthermore, 90 percent of youth suicide victims had a major psychiatric disorder – typically bipolar disorder or depression.
Scott, whose 13-year-old son suffers from bipolar disorder, said a lack of knowledge and trained staff in private and public schools makes the issue even more traumatic, especially during the middle school years.
“There’s absolutely no training, even though people have been talking about this for years,” she said. “It’s the worst statistics of any disability group,” she added, referring to youths with behavioral and mood disorders.
Kathy McCoy, special education director for Cabell County Schools, confirmed that not every middle school is equipped to deal with some mood and behavioral disorders.
“We do not have a self-contained classroom at every middle school for students with severe behavioral difficulties,” she said. “We do have such a classroom at both high schools (Huntington and Cabell Midland). Everything depends on the needs of the student. We try to keep kids in their home schools if at all possible."
Both Scott and Brown, whose 14-year-old son was diagnosed with Asperger’s syndrome (commonly known as a mild form of autism), said they’re fortunate to have the resources and time to home school their sons.
“We struggled all through 6th grade,” Brown said. “My son cried ever day. I told him, ‘I’ll give you two years at home.’ "
While home schooling is a personal choice with obvious benefits, it has isolation drawbacks – even for kids with special needs, said Cabell County Schools Superintendent Bill Smith.
+ Read more: is.gd/32ptU
• • •
Schoolyard Bullies, Victims
Have Problems Later On
By Amy Norton. is.gd/32tUU
Reuters Health - School children who bully or are victims of bullying may face higher risks of anxiety, depression and other psychological disorders later in life, a new study finds.
The study, which followed more than 5,000 children in Finland, found that boys and girls who were frequently bullied were at greater risk than their peers of needing psychiatric treatment in their teens or early 20s.
The same was true of boys who were perpetrators of the bullying -- with the highest risks of mental health problems seen among boys who were both perpetrators and victims.
The findings, reported in the Archives of General Psychiatry, add to evidence that schoolyard bullying can have substantial psychological consequences -- and that, at least among boys, those who are both bullies and victims are the most troubled of all.
"Parents and teachers should be aware that frequent school bullying should not be considered normal behavior, but has potentially serious consequences," lead researcher Dr. Andre Sourander, of the University of Turku in Finland, told Reuters Health in an email.
The study included 5,038 children who were followed from the age of 8 until age 24. At the outset, just over 6 percent of boys and almost 4 percent of girls were being frequently bullied, based on reports from the children, their parents and teachers.
Of boys, 6 percent routinely bullied other kids, while almost 3 percent were both bullies and victims. Among girls, less than one percent were either bullies or "bully-victims."
The researchers used Finland's system of national registers to follow the study group's rate of psychiatric hospital admissions and prescriptions for antidepressants, anti-anxiety drugs and anti- psychotics.
Overall, one-third of boys who had been both bullies and victims ended up taking a psychiatric medication at some point between the ages of 13 and 24, while 17 percent were admitted to a psychiatric hospital. That compared with rates of 12 percent and 5 percent, respectively, among boys who had not been involved in bullying.
Among girls, 32 percent of those who had been frequently bullied were eventually prescribed a psychiatric medication, compared with 16 percent of girls who had not been bullied. Meanwhile, 12 percent of victims were hospitalized for psychiatric treatment, versus 4 percent of other girls.
When the researchers considered the children's emotional health and behavior at the start of the study, only boys who were already showing problems were at increased risk of later psychiatric conditions.
But with girls, those who were bullied were at heightened risk of later problems even if they initially showed no emotional or behavioral difficulties.
It's not clear why this gender difference exists, according to Sourander's team, but it's possible that different forms of bullying have different long-term effects, they note. With boys, bullying is often overt and physical, while for girls, it is more likely to come in the "subtle" form of teasing, gossip and exclusion.
One of the main messages from the findings, Sourander noted, is that schools need to keep bullying incidents from escalating.
"The education systems are of central importance (in) early detection," he said. "Failure of the school system to take preventive action should be considered a failure to discharge the school authority's duty of care."
SOURCE: Archives of General Psychiatry, September 2009.
• • •
Fired Teaching Assistant Who Reported Abuse By Teacher Is Suing Dept. of Education
By Dorian Block NY Daily News is.gd/30gNS
A teaching assistant who says she was fired for reporting abuse by a teacher - using a bogus cover story - is suing the Department of Education for $500,000.
Elba Rivera, who worked at Public School 32 in the Belmont section of the Bronx, said she saw special education teacher Helene Sorkin violently push a 10-year-old into a door Feb. 14, 2007.
"She yelled at him. He sucked his teeth at her. She didn't like that so she grabbed him against his arm and slammed him against the wall," Rivera said yesterday.
"She kept on shoving him in the stomach and screaming at him. She said, 'Go ahead, to tell his parents, that nobody would believe him and no one would care.'...She shoved him 10 or 11 times."
Rivera reported the incident in an e-mail to the Education Department, but claimed she was a relative of the student to protect her identity, according to the suit filed in Bronx Supreme Court. Sorkin was not disciplined, and Rivera was fired last September for "filing a false report of corporal punishment," the suit says.
The suit claims Sorkin forced students to sign a form denying the incident happened. The mother of one student told the Daily News her daughter did witness it.
+ Read more: is.gd/30gNS
• • •
MEDIA
Free Online Autism Course
By Janet Harriett.
The Open University has a free online course, The Autistic Spectrum, From Theory to Practice, which provides an overview of psychological research into Autism Spectrum Disorders. The course is written at a college undergraduate level. Units focus on:
* Identifying autism and autism spectrum disorders
* Mapping the spectrum
* Cognitive and social explanations of autistic conditions
* Biological explanation of autistic conditions
* Helping autistic people
In addition to the unit text, the course includes suggestions for further reading The Open University estimates that the full course takes about 20 hours to work through. If you are interested in learning more about autism and ASD, this OpenCourseWare is an excellent resource to start with is.gd/32yO8.
• • •
COMMENTARY
Why Current Thinking About Autism
Is Completely Wrong
By Mark Hyman, MD, Practicing physician and pioneer in functional medicine on huffingtonpost.com. is.gd/32o26
"Autism is caused by poor mothering." That was the belief of the medical community until the late 1960s.
"Autism is a genetic brain disorder." That is what most people -- and most of the medical community -- believe today.
I'm here to tell you that neither one of these statements is true.
Think about it. Rates of autism have skyrocketed over the years, from an estimated 1 child in 3,000 to just 1 in 150 kids today. Sure, wider criteria for diagnosis and better detection might explain some of it -- but not an increase of this magnitude.
The real reason we are seeing increasing rates of autism is simply this: Autism is a systemic body disorder that affects the brain. A toxic environment triggers certain genes in people susceptible to this condition. And research supports this position.
Today I will review some of this research and explain how imbalances in the 7 keys systems of the body may be the real cause--and thus the real cure--of autism.
A New Understanding of Autism
Dramatic scientific discoveries have taken place during the last 10 to 20 years that reveal the true causes of autism -- and turn conventional thinking on its head. For example, Martha Herbert, MD, a pediatric neurologist from Harvard Medical School has painted a picture of autism that shows how core abnormalities in body systems like immunity, gut function, and detoxification play a central role in causing the behavioral and mood symptoms of autism.
She's also given us a new way of looking at mental disease (and disease in general) that is based on systems biology. Coming from the halls of the most conservative medical institution in the world, this is a call so loud and clear that it shatters our normal way of looking at things.
Everything is connected, Dr. Herbert says. The fact that these kids have smelly bowel movements, bloated bellies, frequent colds and ear infections, and dry skin is not just a coincidence that has nothing to do with their brain function. It is central to why they are sick in the first place! Yet conventional medicine often ignores this.
My friend and mentor, Sidney Baker, MD -- a pioneer in the treatment of autism as a body disorder that affects the brain -- often says, "Do you see what you believe or do you believe what you see?"
The problem in medicine is we are so stuck in seeing what we believe that we often ignore what is right in front of us because it doesn't fit our belief system. Nowhere is this true more than in the treatment of autism.
This is in the front of my mind, because I see so many behavioral symptoms in kids from learning disabilities to attention-deficit hyperactivity disorder (ADHD) and even autism.
And I see the rates of medication use skyrocketing for these kids -- from stimulants to anti-psychotics (one of the fastest growing drug categories) to anti-seizure medicine, and more. There is another way ... Let me tell you a story about a little boy I saw recently.
Sam's Case: Autism as a Systemic Disorder
+ Read more: is.gd/32o26
• • •
The Real Health Care Scare
By James Moore, Author, Communications Consultant, Novelist Manque', Genial Wiseacre, huffingtonpost.com. is.gd/32r7S
In all of the white-hot vitriol being spewed over a national health care plan, very little attention is being directed at the pharmaceutical companies and the potential conflicts of interest involving the doctors doing their research. In America, we are generally of the belief that by the time a drug or vaccine has made it into the marketplace there has been enough testing conducted by the FDA and objective physicians and researchers that we can trust its safety. Frequently, we are wrong. Great profit tempts drug manufacturers to deceive or cut corners to get more quickly to the market. Pfizer recently agreed to pay $2.3 billion in fines as a penalty for marketing drugs "off label," which means for other than their prescribed purpose. Merck, too, has a $4.85 billion legal settlement for Vioxx, a painkiller that doubled the risk of stroke and heart attack, and Eli Lilly agreed to almost $1.5 billion in penalties for illegal marketing of its top-selling anti-psychotic drug. .
Those numbers may look big but they are nothing compared to revenues. Pfizer earned $44.2 billion last year and can handily absorb the penalty. Industry experts don't expect the off label marketing to end because the profitability is so great. With this kind of money at stake, willful deception with off label marketing, and a public record of failure, why are we so inclined to readily accept drugs and vaccines from these manufacturers?
As autumn approaches, we are once more being whipped into a frenzy about H1N1 and a need for another vaccination. Imagine the profits if only it were government mandated. I am not anti-vaccine. I am, however, pro-full disclosure. Vaccinations are one of the most important advancements in medical history. Nonetheless, when they became huge profit centers, the numbers of vaccines on the schedule for our children rose to the point where there are now 42 recommended and, in many cases, most are required for admission to public school facilities. Because we are inclined to trust our physicians and federal regulators, we generally take the needle.
But we need to look more closely. The internecine relationships between drug companies and researchers and their institutions deserve constant scrutiny. As an example, the highest-profile proponent of vaccines like the MMR for children, Dr. Paul Offit has been made a wealthy man by Merck, the pharmaceutical giant that manufactures MMR. Offit did not conduct the research on the MMR (Measles-Mumps-Rubella) vaccine but sold a patent to Merck for a vaccine against rotavirus, which causes diarrhea in children. Children's Hospital of Philadelphia (CHOP), where Offit works, sold its royalty rights on the vaccine, which, according to a financial analyst firm's filing, netted the hospital $153 million. Based on hospital distribution guidelines, Offit, as the inventor, appears to have earned as much as $45 million for his 30 percent share.
+ Read more: is.gd/32r7S
Note: The opinions expressed in COMMENTARY are those of the author and
do not necessarily represent the views of the Schafer Autism Report.
