The Autism Wars

By Amy Harmon
The New York Times - News Analysis
Originally published April 7, 2012

THE report by the Centers for Disease Control and Prevention that one in 88 American children have an autism spectrum disorder has stoked a debate about why the condition’s prevalence continues to rise. The C.D.C. said it was possible that the increase could be entirely attributed to better detection by teachers and doctors, while holding out the possibility of unknown environmental factors.

But the report, released last month, also appears to be serving as a lightning rod for those who question the legitimacy of a diagnosis whose estimated prevalence has nearly doubled since 2007.

As one person commenting on The New York Times’s online article about it put it, parents “want an ‘out’ for why little Johnny is a little hard to control.” Or, as another skeptic posted on a different Web site, “Just like how all of a sudden everyone had A.D.H.D. in the ’90s, now everyone has autism.”

The entire story is here.

Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis.

By Katrin Bruchmuller, Jurgen Margraf, and Silvia Schneider

Journal of Consulting and Clinical Psychology, Vol 80(1), Feb 2012, 128-138.

 

Abstract

 

Objective: Unresolved questions exist concerning diagnosis of ADHD. First, some studies suggest a potential overdiagnosis. Second, compared with the male–female ratio in the general population (3:1), many more boys receive ADHD treatment compared with girls (6–9:1). We hypothesized that this occurs because therapists do not adhere to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV) and International Classification of Diseases (10th rev.; ICD–10) criteria. Instead, we hypothesized that, in accordance with the representativeness heuristic, therapists might diagnose attention-deficit/hyperactivity disorder (ADHD) if a patient resembles their concept of a prototypical ADHD child, leading therapists to overlook certain exclusion criteria. This may result in overdiagnosis. Furthermore, as ADHD is more frequent in males, a boy might be seen as a more prototypical ADHD child and might therefore receive an ADHD diagnosis more readily than a girl would.

 

Method: We sent a case vignette to 1,000 child psychologists, psychiatrists, and social workers and asked them to give a diagnosis. Four versions of the vignette existed: Vignette 1 (ADHD) fulfilled all DSM–IV/ICD–10 criteria of ADHD. Vignettes 2–4 (non-ADHD) included several ADHD symptoms but stated other ADHD criteria were nonfulfilled. Therefore, an ADHD diagnosis could not be given. Furthermore, boy and girl versions of each vignette were created.

 

Results: In Vignettes 2–4 (non-ADHD), 16.7% of therapists diagnosed ADHD. In the boy version of these vignettes, therapists diagnosed ADHD around 2 times more than they did with the girl vignettes.

 

Conclusions: Therapists do not adhere strictly to diagnostic manuals. Our study suggests that overdiagnosis of ADHD occurs in clinical routine and that the patient's gender influences diagnosis considerably. Thorough diagnostic training might help therapists to avoid these biases.

The raid on your medical records

By Karen Angel
New York Daily News-Opinion
Originally Published April 1, 2012

After I got laid off from my job last November, I started shopping for health insurance and a funny thing happened: BlueCross BlueShield emailed me someone else’s application.

The only similarity between me and this other applicant was that we’re both named Karen. I live in New York; she lives in Virginia. We have different last names, different Social Security numbers, different health histories. I know this because all of it was contained in the application BlueCross emailed to me — and under federal law, all of it is supposed to be confidential.

By emailing me the other Karen’s health-insurance application, BlueCross violated the Health Insurance Portability and Accountability Act. An angry consumer could find plenty of grounds — breach of confidentiality, negligence — to sue.

The entire story is here.

Sensitive personal information missing on 800,000 California residents

By Steven Harmon
Mercurynews.com
Originally published March 29, 2012

In a puzzling breach of security, computer storage devices containing identification information of 800,000 Californians using the state's child support services have disappeared.

The Department of Child Support Services reported Thursday the data devices were lost March 12 en route to California from the Colorado facilities of IBM, one of the contractors in charge of the storage devices.

Authorities have begun to notify customers by mail about the incident, warning them that the devices include names, addresses, Social Security numbers, driver's license numbers, names of health insurance providers and employers.

The entire story is here.

How the FDA forgot the evidence: the case of donepezil 23 mg

By Lisa M Schwartz & Steven Woloshin
British Journal of Medicine
Published March 22, 2012

What is the difference between 20 and 23? If you said three, you are off by millions—of dollars in sales, that is—at least from the perspective of Eisai, the manufacturer of donepezil (marketed as Aricept by Pfizer).

A little context helps make the maths clearer. Donepezil, the biggest player in the lucrative market for Alzheimer’s disease treatments, was a blockbuster, with over $2bn in annual sales in the United States alone. But the drug, first approved in 1996, had reached the end of the road: the patent expired in November 2010. Investors call this “going over the cliff,” an anxious reference to plummeting sales as market share is lost to generic competitors. Necessity, however, is the mother of invention. Just four months before the expiry of the patent, the US Food and Drug Administration (FDA) approved a new dose for moderate to severe Alzheimer’s disease: donepezil 23 mg. Is 23 an odd number? Not really, when you consider that you cannot get to 23 mg using the 5 mg and 10 mg doses that were going generic. The “new” 23 mg product would be patent protected for three more years.

Now it was time for the marketing to begin. In addition to their sales force, the manufacturers deployed dedicated teams of “Aricept 23 mg clinical nurse educators” to reach prescribers. They focused particularly on “priority targets”—neurologists and high volume facilities for the long term care of people with Alzheimer’s disease—to promote the idea that “there are no ‘stable’ AD [Alzheimer’s disease] patients—therefore aggressive treatment is required.

The entire story is here.

Thanks to Ken Pope for the information.

It’s Too Late to Apologize: Therapist Embarrassment and Shame

By Rebecca Klinger, Nicholas Ladany, and Lauren Kulp
The Counseling Psychologist
For reprints, contact Rebecca Klinger via the hyperlink provided

Abstract

The purpose of this study was to identify events in which therapists felt embarrassment, shame, or both in a therapy session and to investigate the relationship of the embarrassing-shameful events with the therapist reactions. Ninety-three therapists participated in this study, and the most frequent events reported were having a scheduling mistake, forgetting or confusing client information, being visibly tired, falling asleep, and arriving late. Implications and need for further research, particularly concerning the effects of therapist embarrassment and shame on therapy process and outcome, are discussed.

Introduction

Embarrassment and shame are common self-conscious emotions often addressed in the psychotherapy literature (Gilbert, 1997; Leith & Baumeister, 1998; Lewis, 1971; Tangney, 2002; Tracy & Robins, 2004). In fact, exploring the embarrassment and shame felt by clients is frequently an integral part of thetherapeutic process (Gilbert, 1997; Pope, Sonne, & Greene, 2006; Sorotzkin, 1985). Therapist embarrassment and shame, however, have rarely been inves- tigated even though therapist embarrassment and shame are believed to have an important effect on the therapeutic relationship (Pope et al., 2006) and cli- ent outcome (Covert, Tangney, Maddux, & Heleno, 2003; Leith & Baumeister, 1998; Pope et al., 2006). The primary purpose of our study was to identify events in which therapists felt embarrassment, shame, or both in a therapy session and the corresponding reactions of the therapist.

The link to the article is here.

For reprints, contact Rebecca Klinger via the hyperlink provided above.

Thanks to Gary Schoener for this information.

Vignette 12: A Request for Assistance

Dr. Lilith Crane, a psychologist from a small rural campus, calls you on the phone for a consultation.

Dr. Crane currently works with an undergraduate student, Dan, on issues related to self-esteem and depression.  An ongoing theme in therapy revolves around his sexual orientation.  Dan recently came out to his parents, who were accepting of his gay orientation and lifestyle.  From that positive experience, Dan wants to start a support organization for other GLBTQ students on campus. 

Dan explained to Dr. Crane that this group would be student-led and meet on campus.  He does not view it as a therapy group.  Dan’s vision is that the group would meet periodically to provide one another with support, to do problem solving, to share information and personal struggles, and perhaps to provide some psycho-educational work on campus.  Dan indicates that they may also want to engage in fundraising in order for GLBTQ students to attend state or national events.

Dan asked a number of faculty members to be the faculty advisor of this group.  While most were supportive, all declined the invitation (likely because the campus is small and in a conservative area of the state).

Out of options, Dan asked Dr. Crane to be the faculty advisor.  Dr. Crane applauded and appreciated the student’s energy and creativity, but indicated some concern about dual role with the student.  She told the student that she would think about the request prior to answering.

Dr. Crane is questioning the pros and cons of being the psychologist and the faculty advisor.  Dr. Crane feels ambivalent because of their therapeutic relationship, but also wants to help Dan because he appears to have limited options.

What are the possible downsides to entering the dual relationship?

What are the possible steps Dr. Crane can take to mitigate any potential difficulties?

What are other steps that the psychologist may want to take in this situation?

Arkansas court strikes down law banning teacher-student sex

By Douglas Stanglin
USA Today
Originally published March 30, 2012

The Arkansas Supreme Court has struck down a law banning sexual contact between teachers and students, saying people over 18 have a constitutional right to engage in a consensual sexual relationship.

In its ruling, the high court sided with David Paschal, 38, a history and psychology teacher at Elkins High School who is serving a 30-year prison sentence after admitting to having a five-month consensual sexual relationship with an 18-year-old student, the Associated Press reports.

READ: The court's full decision.

Chief Justice Jim Hannhan wrote that the law on sexual contact between students under 21 and public school employees such as teachers, coaches and principals "criminalizes sexual conduct between adults."

The entire story is here.

Dual-Relationship Dilemmas of Rural and Small-Community Psychologists

Dual Relationships in Rural and Small Community Psychologist