Psychologists are using research-backed behavioral interventions that effectively treat children with ADHD.
By Rebecca A. Clay
February 2013, Vol 44, No. 2
Print version: page 44
Because of his attention-deficit/hyperactivity disorder (ADHD), the 10-year-old boy rarely even tried to answer the questions on the math and language arts worksheets his fourth-grade teacher asked students to complete during class. Not only that, he often bothered the students who did.
Then the teacher made an important change to the boy's worksheets: She wrote the correct answers on them with invisible markers so that the boy could reveal the correct answer by coloring over the space as soon as he finished a question. The teacher also randomly inserted stars he could uncover by coloring and told him he would earn a reward for collecting four stars. The strategy paid off: The boy was soon answering every question and getting 84 percent of them correct.
Giving immediate feedback is just one of many simple and effective behavioral approaches to improving children's attention, says psychologist Nancy A. Neef, PhD, who described the invisible marker experiment in a chapter on treating ADHD she co-authored in the 2012 "APA Handbook of Behavior Analysis." With ADHD affecting an estimated 7 percent of American children ages 3 to 17, psychologists are developing behavioral interventions that parents, teachers and others can use to help kids focus and control their impulses. Others are conducting research that demonstrates that more exercise and longer sleep can help.
That's good news for kids, says Neef, who believes that parents, teachers and pediatricians are sometimes too quick to jump to prescribing medication for ADHD.
"Particularly in the case of stimulant medications, which are the most common treatment for ADHD, we don't know an awful lot about the long-term side effects," says Neef, a professor of special education at The Ohio State University.
And medication doesn't address problems related to children's academic performance and relationships with family members, peers and others. "Even though medication can be effective and very helpful, it's not a panacea," Neef says.
Behavioral interventions
Surprisingly, nonpharmacological approaches are also controversial, especially among the medical community.
"If you read the professional guidelines for psychiatrists or sometimes pediatricians, the treatment that is emphasized for kids with ADHD is a pharmacological one," says Gregory A. Fabiano, PhD, an associate professor of counseling, school and educational psychology at the State University of New York at Buffalo.
The entire story is here.
Wednesday, February 13, 2013
If Medications Don’t Work, Why Do I Prescribe Them Anyway?
By Steve Balt, Psychiatrist
Thought Broadcast Blog
Originally posted January 4, 2013
I have a confession to make. I don’t think what I do each day makes any sense.
Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice. I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions. I figured that an independent practice would permit me to be a more effective psychiatrist, as I wouldn’t be encumbered by the restrictions and regulations of most of today’s practice settings.
My experience has strengthened my long-held belief that people are far more complicated than diagnoses or “chemical imbalances”—something I’ve written about on this blog and with which most psychiatrists would agree. But I’ve also made an observation that seems incompatible with one of the central dogmas of psychiatry. To put it bluntly, I’m not sure that psychiatric medications work.
Before you jump to the conclusion that I’m just another disgruntled, anti-medication psychiatrist who thinks we’ve all been bought and misled by the pharmaceutical industry, please wait. The issue here is, to me, a deeper one than saying that we drug people who request a pill for every ill. In fact, it might even be a stretch to say that medications never work. I’ve seen antidepressants, antipsychotics, mood stabilizers, and even interventions like ECT give results that are actually quite miraculous.
But here’s my concern: For the vast majority of my patients, when a medication “works,” there are numerous other potential explanations, and a simple discussion may reveal multiple other hypotheses for the clinical response. And when you consider the fact that no two people “benefit” in quite the same way from the same drug, it becomes even harder to say what’s really going on. There’s nothing scientific about this process whatsoever.
And then, of course, there are the patients who just don’t respond at all. This happens so frequently I sometimes wonder whether I’m practicing psychiatry wrong, or whether my patients are playing a joke on me. But no, as far as I can tell, I’m doing things right: I prescribe appropriately, I use proper doses, and I wait long enough to see a response. My training is up-to-date; I’ve even been invited to lecture at national conferences about psychiatric meds. I can’t be that bad at psychiatry, can I?
The entire blog post is here.
Thought Broadcast Blog
Originally posted January 4, 2013
I have a confession to make. I don’t think what I do each day makes any sense.
Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice. I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions. I figured that an independent practice would permit me to be a more effective psychiatrist, as I wouldn’t be encumbered by the restrictions and regulations of most of today’s practice settings.
My experience has strengthened my long-held belief that people are far more complicated than diagnoses or “chemical imbalances”—something I’ve written about on this blog and with which most psychiatrists would agree. But I’ve also made an observation that seems incompatible with one of the central dogmas of psychiatry. To put it bluntly, I’m not sure that psychiatric medications work.
Before you jump to the conclusion that I’m just another disgruntled, anti-medication psychiatrist who thinks we’ve all been bought and misled by the pharmaceutical industry, please wait. The issue here is, to me, a deeper one than saying that we drug people who request a pill for every ill. In fact, it might even be a stretch to say that medications never work. I’ve seen antidepressants, antipsychotics, mood stabilizers, and even interventions like ECT give results that are actually quite miraculous.
But here’s my concern: For the vast majority of my patients, when a medication “works,” there are numerous other potential explanations, and a simple discussion may reveal multiple other hypotheses for the clinical response. And when you consider the fact that no two people “benefit” in quite the same way from the same drug, it becomes even harder to say what’s really going on. There’s nothing scientific about this process whatsoever.
And then, of course, there are the patients who just don’t respond at all. This happens so frequently I sometimes wonder whether I’m practicing psychiatry wrong, or whether my patients are playing a joke on me. But no, as far as I can tell, I’m doing things right: I prescribe appropriately, I use proper doses, and I wait long enough to see a response. My training is up-to-date; I’ve even been invited to lecture at national conferences about psychiatric meds. I can’t be that bad at psychiatry, can I?
The entire blog post is here.
Tuesday, February 12, 2013
Heart risk link to SSRI antidepressants confirmed
BBC Health News
Originally posted January 30, 2013
Some but not all antidepressant drugs known as SSRIs pose a very small but serious heart risk, say researchers.
Citalopram and escitalopram, which fall into this drug group, can trigger a heart rhythm disturbance, a new study in the British Medical Journal shows.
UK and US regulators have already warned doctors to be extra careful about which patients they prescribe these medicines to.
And they have lowered the maximum recommended dose.
The UK's Medicines and Healthcare products Regulatory Agency (MHRA) says people with pre-existing heart conditions should have a heart trace before going on these drugs, to check for a rhythm disturbance known as long QT interval.
Experts reassure that complications are very rare and that in most cases the benefits for the patient taking the drug will outweigh the risks.
The entire story is here.
Thanks to Tom Fink for this story.
Originally posted January 30, 2013
Some but not all antidepressant drugs known as SSRIs pose a very small but serious heart risk, say researchers.
Citalopram and escitalopram, which fall into this drug group, can trigger a heart rhythm disturbance, a new study in the British Medical Journal shows.
UK and US regulators have already warned doctors to be extra careful about which patients they prescribe these medicines to.
And they have lowered the maximum recommended dose.
The UK's Medicines and Healthcare products Regulatory Agency (MHRA) says people with pre-existing heart conditions should have a heart trace before going on these drugs, to check for a rhythm disturbance known as long QT interval.
Experts reassure that complications are very rare and that in most cases the benefits for the patient taking the drug will outweigh the risks.
The entire story is here.
Thanks to Tom Fink for this story.
Measure would strengthen mental health-care system
By ,
The bill would put in place standards for about 2,000 “federally qualified” community behavioral health centers, requiring them to provide such services as substance abuse treatment and 24-hour crisis care.
In return, facilities meeting criteria would be able to bill Medicaid for their services — a change intended to open the door to treatment for many more people and one that is estimated to cost about $1 billion over the next decade.
“There is an important gap here,” said Sen. Debbie Stabenow (D-Mich.), one of the bill’s main sponsors. She warned that too many people receive inadequate or no treatment and are at risk of their problems becoming more dangerous.
Sen. Roy Blunt (Mo.), the lead GOP sponsor of the measure, cited his state’s work in providing community health centers but also said that the recent shootings in Newtown, Conn., spotlighted shortcomings in mental health care that demand attention.
“We have a moment that works, and we have a model that works,” he said.
Additional Republican co-sponsors include Sens. Marco Rubio (Fla.) and Susan Collins (Maine). Other Democrats backing the legislation include Sens. Jack Reed (R.I.), Patrick J. Leahy (Vt.) and Barbara Boxer (Calif.).
The entire article is here.
The bill would put in place standards for about 2,000 “federally qualified” community behavioral health centers, requiring them to provide such services as substance abuse treatment and 24-hour crisis care.
In return, facilities meeting criteria would be able to bill Medicaid for their services — a change intended to open the door to treatment for many more people and one that is estimated to cost about $1 billion over the next decade.
“There is an important gap here,” said Sen. Debbie Stabenow (D-Mich.), one of the bill’s main sponsors. She warned that too many people receive inadequate or no treatment and are at risk of their problems becoming more dangerous.
Sen. Roy Blunt (Mo.), the lead GOP sponsor of the measure, cited his state’s work in providing community health centers but also said that the recent shootings in Newtown, Conn., spotlighted shortcomings in mental health care that demand attention.
“We have a moment that works, and we have a model that works,” he said.
Additional Republican co-sponsors include Sens. Marco Rubio (Fla.) and Susan Collins (Maine). Other Democrats backing the legislation include Sens. Jack Reed (R.I.), Patrick J. Leahy (Vt.) and Barbara Boxer (Calif.).
The entire article is here.
Drowned in a Stream of Prescriptions
By ALAN SCHWARZ
The New York Times
Published: February 2, 2013
Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.
It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”
It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.
The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.
Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.
Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.
The entire story is here.
The New York Times
Published: February 2, 2013
Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.
It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”
It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.
The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.
Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.
Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.
The entire story is here.
Monday, February 11, 2013
Vignette 22: A Duty to Report?
Dr. Tell worked with a woman for several months on issues related to depression, anxiety, and relationship issues. During one session, the patient indicated that her boyfriend has lost interest in sex and became more involved with online pornography. While discussing these issues, the patient suddenly stopped talking. Dr. Tell allowed several moments to pass before asking the patient what was happening.
Dr. Tell explained that the alleged perpetrator was several times removed from their sessions and she did not believe that she had the obligation to report it. The client then asked if she could invite her boyfriend to the next session so that they could all discuss the information and the best way to handle the situation.
Dr. Tell focused the client on her dilemma as well as the relationship issues with her boyfriend. Dr. Tell agreed to contact someone to discuss whether Dr. Tell had to report this information to the police or Child Protective Services. And, Dr. Tell agreed to determine whether or not reporting this information would put her client’s confidentiality at risk. She also agreed to think about the need to bring in the boyfriend, because inviting him to therapy will not necessarily help the situation.
Dr. Tell contacts you with the above scenario.
1. How would you feel if you were Dr. Tell?
2. How would you feel if you were the consultant?
3. Is Dr. Tell a mandated reporter in this situation?
3. Is Dr. Tell a mandated reporter in this situation?
4. As a mandated reporter, would Dr. Tell report place her client's confidentiality be at risk?
5. If Dr. Tell is not a mandated reporter, should Dr. Tell bring in the boyfriend gather more facts so that Dr. Tell can report the alleged crime?
6. Is the goal of therapy to help the client manage the situation or is the responsibility now on the psychologist to gather more information about the possible crimes committed with children?
7. Can the client contact Child Protective Services anonymously in this case?
8. Can the psychologist contact Child Protective Services anonymously, provided that the client supply the name and address of the uncle?
8. Can the psychologist contact Child Protective Services anonymously, provided that the client supply the name and address of the uncle?
9.What should the psychologist do?
Does an 'A' in Ethics Have Any Value?
B-Schools Step Up Efforts to Tie Moral Principles to Their Business Programs, but Quantifying Those Virtues Is Tough
By MELISSA KORN
The Wall Street Journal
Originally published on February 6, 2013
Business-school professors are making a morality play.
Four years after the scandals of the financial crisis prompted deans and faculty to re-examine how they teach ethics, some academics say they still haven't gotten it right.
Hoping to prevent another Bernard L. Madoff-like scandal or insider-trading debacle, a group of schools, led by University of Colorado's Leeds School of Business in Boulder, is trying to generate support for more ethics teaching in business programs.
"Business schools have been giving students some education in ethics for at least the past 25 or 30 years, and we still have these problems," such as irresponsibly risky bets or manipulation of the London interbank offered rate, says John Delaney, dean of University of Pittsburgh's College of Business Administration and Katz Graduate School of Business.
He joined faculty and administrators from Massachusetts' Babson College, Michigan State University and other schools in Colorado last summer in what he says is an effort to move schools from talk to action. The Colorado consortium is holding conference calls and is exploring another meeting later this year as it exchanges ideas on program design, course content and how to build support among other faculty members.
But some efforts are at risk of stalling at the discussion stage, since teaching business ethics faces roadblocks from faculty and recruiters alike. Some professors see ethics as separate from their own subjects, such as accounting or marketing, and companies have their own training programs for new hires.
The entire story is here.
By MELISSA KORN
The Wall Street Journal
Originally published on February 6, 2013
Business-school professors are making a morality play.
Four years after the scandals of the financial crisis prompted deans and faculty to re-examine how they teach ethics, some academics say they still haven't gotten it right.
Hoping to prevent another Bernard L. Madoff-like scandal or insider-trading debacle, a group of schools, led by University of Colorado's Leeds School of Business in Boulder, is trying to generate support for more ethics teaching in business programs.
"Business schools have been giving students some education in ethics for at least the past 25 or 30 years, and we still have these problems," such as irresponsibly risky bets or manipulation of the London interbank offered rate, says John Delaney, dean of University of Pittsburgh's College of Business Administration and Katz Graduate School of Business.
He joined faculty and administrators from Massachusetts' Babson College, Michigan State University and other schools in Colorado last summer in what he says is an effort to move schools from talk to action. The Colorado consortium is holding conference calls and is exploring another meeting later this year as it exchanges ideas on program design, course content and how to build support among other faculty members.
But some efforts are at risk of stalling at the discussion stage, since teaching business ethics faces roadblocks from faculty and recruiters alike. Some professors see ethics as separate from their own subjects, such as accounting or marketing, and companies have their own training programs for new hires.
The entire story is here.
Sunday, February 10, 2013
Ethical Framework for the Use of Technology in Supervision
By LoriAnn S. Stretch, DeeAnna Nagel and Kate Anthony
Ethical and Statutory Considerations
Supervisors must demonstrate and promote good practice by the supervisee to ensure supervisees acquire the attitudes, skills, and knowledge necessary to protect clients. Supervisors and supervisees must research and abide by all applicable legal, ethical, and customary requirements of the jurisdiction in which the supervisor and supervisee practice. The supervisor and supervisee must document relevant requirements in the respective record(s). Supervisors and supervisees need to review and abide by requirements and restrictions of liability insurance and accrediting bodies as well.
Informed Consent
Supervisors will review the purposes, goals, procedures, limitations, potential risks, and benefits of distance services and techniques. All policies and procedures will be provided in writing and reviewed verbally before or during the initial session. Documentation of understanding by all parties will be maintained in the respective record(s).
Supervisor Qualifications
Supervisors will only provide services for which the supervisor is qualified. The supervisor will provide copies of licensure, credentialing, and training upon request. The supervisor will have a minimum of 15 hours of training in distance clinical supervision as well as an active license and authorization to provide supervision within the jurisdiction for which supervision will be provided. Supervisors providing distance supervision should participate in professional organizations related to distance services and develop a network of professional colleagues for peer and supervisory support.
Supervisee and Client Considerations
Supervisors will screen supervisees for appropriateness to receive services via distance methods. The supervisor will document objective reasons for the supervisee’s appropriateness in the respective record(s). Supervisors will ensure that supervisees screen clients seeking distance services for appropriateness to receive services via distance methods. Supervisors will ensure that the supervisee utilizes objective methods for screening clients and maintains appropriate documentation in the respective record(s).
Supervisors will ensure that supervisees inform clients of the supervisory relationship and that all clients have written information on how to contact the supervisor. Written documentation of the client acknowledging the supervisory relationship and receipt of the supervisor’s contact information should be maintained in the respective record(s). Supervisors will only advise the supervisee to provide services for which the supervisee is qualified to provide.
Clients and supervisees must be informed of potential hazards of distance communications, including warnings about sharing private information when using a public access or computer that is on a shared network. Clients and supervisees should be discouraged, in writing, from saving passwords and user names when prompted by the computer. Clients and supervisees should be encouraged to review employer’s policies regarding using work computers for distance services.
The entire story is here.
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