Barbara Burke in the new JAMA reviews Bipolar Children: Cutting Edge Controversy, Insights, and Research, Edited by Sharna Olfman. Unfortunately, it's subscription only, but I'll give you a fair-use quote:

IN EUROPE AND ACROSS THE GLOBE, MANIC DEPRESSION IS rarely diagnosed in the pediatric population. In the United States, on the other hand, the American Academy of Child and Adolescent Psychiatry (AACAP) suggests that it may exist in up to 13% of children.1 Prescriptions of sedating drugs (anticonvulsants, -agonists, and atypical antipsychotics) have increased up to 3-fold in the last decade.2 Both of these anomalous trends, poorly substantiated by quality research, have occurred during a time of dramatic economic change in the health care industry. Meanwhile, US children appear to be getting less mentally healthy, not more, with diagnoses of “mood disorders” and “pediatric bipolar” (PBD) topping the list. This is clearly crazy, but where does the madness lie? In the children, the prescribers, or society as a whole?

It has often been said that the family is the most violent institution in society. That probably is not true -- the prison system probably wins that competition -- but there is no doubt that the most likely assailant of a woman or child is a family member. Statistics on this point are not very reliable -- family violence happens in private, usually in secret, and usually does not come to the attention of the authorities. Advocacy groups have been known to exaggerate, but This fact sheet seems to offer a level-headed overview.

One can frame this problem in terms of gender role norms. Women are certainly capable of assaulting their spouses and children, but men are more likely to do so. (I'm steering clear of quantification here because it's not reliable.) We now understand that the phenomenon commonly called battering is not really about anger; it's a pattern of coercive control. Batterers are extremely possessive, jealous, and need to monopolize power in their intimate relationships. It's no surprise that they typically victimize children in their households as well as their spouses or partners.

I'm at a meeting of grantees of a federal initiative called the National Child Traumatic Stress Network. This program, administered by the Center for Mental Health Services, aims at strengthening capacity within the U.S. to provide treatment to children who have suffered psychological trauma -- and no, it's not principally about drugs, but about evidence based counseling.

The CDC has asked a colleague of mine to participate in a consultative group on HIV prevention for Latinos, and she asked me to contribute my thoughts on the four big questions they are asking. My pleasure, I do happen to have some opinions.

Based on your knowledge of HIV/AIDS among Hispanics in the United States;

1. Identify at least two community and two societal-level factors that place Hispanics/Latinos at disproportionate risk for acquiring HIV. How should CDC
address these factors?

Much of the disproportionate risk for HIV among Latinos in the northeast is related to injection drug use. While primary prevention is certainly what we would most want to achieve, unfortunately the evidence base for primary prevention is limited. (See below.) We do know that treatment can be effective, and furthermore, as IDU must be transmitted from users to non-users, treatment of current users does constitute a form of primary prevention as well. (Think of it as analagous to infectious disease control. Current users are infectious; get them into recovery, and you stop transmission.)

Yesterday a few thousand demonstrators marched in DC on the anniversary of the Roe v. Wade decision, proclaiming the "right to life," which in their view applies to blastocysts and fetuses.

It does not, however, apply to children. On the same day, UNICEF released its annual report on the state of the world's children. It seems that almost ten million children under the age of five died last year from readily preventable causes - malaria, malnutrition, diarrhea. For the cost of a bus ticket to DC, each of the demonstrators could have saved a dozen of them.

I essentially agree with Mr. G that Provigil doesn't really increase intelligence, it's actually a lot like the amphetamines that students take during exam week -- it creates a temporary state of hyperarousal which allows for intense concentration. But what if there was a treatment that could be given to children which would, in fact, cause them to have permanently enhanced mental capabilities?

Notice I didn't say, "make them more intelligent," because we already know that there isn't a single quality that's synonymous with intelligence. There are various capacities that don't necessarily go together. I would guess that John Coltrane had a reasonably high IQ but I really don't care. And Daniel Goleman's book Emotional Intelligence was very helpful to me in explicating the very different realms of intellectual and social competence.

I'm not a clinician, I'm here as a project evaluator with the intention of getting sense of the what the field of mental health care for traumatized children is like these days -- at least for those community based agencies and academic experts who are fortunate enough to have support from SAMHSA as part of the National Child Traumatic Stress Network.

There's plenty of good news here -- then I'll give you the bad news.

Good news bulletin #1: I have heard scarcely a word about psych meds. The only way pills have come up is as a peripheral note that somebody who is part of a case scenario had been prescribed something. The NCTSN is not about drugging kids.

Bulletin #2: The DSM-IV is equally conspicuous by its absence. There is absolutely no interest in classifying kids' problems as diseases, tossing around disease categories, or using diagnostic labels to guide treatment.

Stars: **1/2

Willie’s Dad is a picture book for children who have parents in Prison. Willie is a five year old boy whose father has been in prison almost his whole life and who will be there until he’s a grown man. Willie and his Mother don’t visit his Father very often and when they do, they go with Duane, who is growing attached to Willie’s mom. His father makes a selfless decision and tells Duane to go ahead and marry the mother because Willie needs a dad and he’s a good man.

The story is pretty good and it’s nice to see a book for children on a subject not often seen. Unfortunately there are quite a few children who have a parent in prison and who could use this book.

I picked this morning's NY Daily News and I read a story about some guy who is on the reality show "Big Brother" who made an incredibly lame and offensive comment on the show about autistic children.

Apparently, Adam Jasinski, who allegedly works with autistic children, said, "I want to open a hair salon for kids with special needs so the retards can get it together and get their hair done." When one of his "housemates" rightly called him out on such a remark, this jackass defended it by saying, "Disabled kids, I can call them whatever I want, okay? I work with them all day. I'm not saying anything offensive...I bust my ass to help these special needs children!"

I just thank God the overwhelming majority of people who really do work with autistic children don't have this asshole's attitude.

As many of you know, I have two nephews who have been touched by autism. I can't begin to say how offended I am by this cretin's crap. Autistic children are not "retards." An Autism advocacy group has demanded this show be cancelled because of this remark, but CBS won't do that, because the show makes money for them. They distanced themselves from what this moron said, but it rightly has many people angry.

The Randomized Controlled Trial (RCT) is the so-called gold standard for determining what is and is not evidenced based therapy. When we talk about the clinical trials submitted to the FDA in new drug applications, that's what we're talking about. When people call for Evidence Based Medicine, they mostly want doctors to use interventions that have been "proven" through RCTs.

So it was refreshing to day to hear Malcolm Gordon, who is an official of the Center for Mental Health Services, tell us about many of the reasons why RCTs don't necessarily tell us what does and does not work when it comes to mental health services. For example, they are very expensive to do, so they seldom go on long enough or have large enough sample sizes to support adequate subgroup analysis. An intervention that works for some people might not work for others, but we just don't get the information we need from RCTs to understand that. Attrition is a big problem in trials, particularly of mental health treatments, and it can seriously mess up the statistics. A truly major problem is that interventions are developed, implemented and tested in highly specialized settings and circumstances that just don't correspond to anything that is likely to happen in the real world of the mental health system.

You've probably heard about the study that finds that over 7% of hospitalized children experience an adverse event from drugs, and given that some experience more than one, the total is 11 events per 100 hospitalizations.

That sounds appalling, but fortunately most of these events don't have any lasting consequences. Of course, they should never happen -- people are hospitalized to try to make them well, but hospitals are in fact dangerous places. It's not just the astonishingly high likelihood of being given the wrong medication, or too much of something. Hospitals are full of really nasty, antibiotic resistant germs, and the people in the hospital beds have extra holes in them with tubes going into the holes which help the bugs get in and out, among other unpleasant conditions. But we already know this.

Senator McCain expects to be elected president because he supported The Surge™, and it's been a great success. I guess we all have different ideas of what constitutes success.

While we ponder whether growing violence throughout the country (including continuing deaths and injuries of U.S. troops), political disintegration and now a border war between Turkey and Kurdistan constitute success, I want to draw your attention to another surge in Iraq, specifically an outbreak of measles in Anbar province -- you know, the place where we have already won, although oddly a Marine was killed there yesterday in combat? UNICEF today reported a measles outbreak there.

For those of us in the wealthy countries, measles is pretty much history, due to widespread vaccination. When I was a child, it was generally nothing more than a nuisance. But it can occasionally cause permanent disability or death, and children who are malnourished are at much higher risk. Well, while we've been busy sending over tens of thousands more troops and winning the war:

That was the headline I saw on a fellow traveler's newspaper on the subway this morning. I can only say, it would probably be an improvement over the present administration down there. It got me to thinking I should weigh in here on politics. Lately I've been leaving it to others who specialize in that sort of thing, and I still need to deal with the Man and Superman thing, the rest of Stem Cell Century, and current public health news. However, this will be the most critical election for public health in my lifetime, so it requires attention.

I haven't ranted very much lately about the democratization of science, and mea culpa. So the theme for today is that we can't have a more democratic scientific institution if most people lack the basic knowledge they need to participate.

This is the story of my professional life, actually. My day job is with a community based public health agency, and my academic half is concerned with people's control -- or usually lack thereof -- over their own health and health care. (As I often say, I am a community-academic partnership.) My work concerns all sorts of issues -- mental health, addiction, environmental justice, diabetes, heart disease, you name it -- but HIV is a particularly big piece of it, in part because it has paradigmatic qualities that make it particularly instructive for many of the principal concerns of medical sociology.

StrikeSwag.com - the non-profit site which donates all profits to the Writers Guild Foundation Industry Support Fund to assist non-WGA members of the industry who are in financial distress as a direct result of the strike - is out with its January 2008 line which Fashion Week boldly called "the black and white shield tee." This 100% cotton shirt a variant of the official WGA West strike shirt.

C. Corax is curious about my response to this study which suggests there may be a genetic component to religiosity. Unfortunately, I don't have on-line access to the Journal of Personality so I can only comment on this reporter's summary. Nevertheless, this is a good opportunity to make some general observations about, uh, observational studies in general, and twin studies in particular.

This is not a review. I have not read the book but just wish to pass along the information.

Pub Date: April 3, 2008
Binding: Trade Hardback
Pages: 170
US: $12.99
ISBN-10: 0981504906
ISBN-13: 978-0981504902

LEAVING A LEGACY OF LEADERSHIP:
‘Handoff’ Summons Baby Boomers to ‘Pass the Baton’ to Youth

DAYTON, Tenn., May 20, 2008 – A straight-forward new book emphasizes that the most important thing in life is to be intentional and strategic about influencing the next generation, for the sake of preserving civilization, morality and not repeating the mistakes of history.

I saw this at CJ Hill's Blog and had to do this!

What Be Your Nerd Type? Your Result: Literature Nerd 

Does sitting by a nice cozy fire, with a cup of hot tea/chocolate, and a book you can read for hours even when your eyes grow red and dry and you look sort of scary sitting there with your insomniac appearance? Then you fit this category perfectly! You love the power of the written word and it's eloquence; and you may like to read/write poetry or novels. You contribute to the smart people of today's society, however you can probably be overly-critical of works.

It's okay. I understand.

My thanks to the commenters on my post about my father -- and thank you particularly for sharing some of your own stories. I try to let my personal life intrude minimally here, but as a disciple of the late Irving Kenneth Zola I take very much to heart his insistence that sociology can only be called objective when we disclose ourselves. It may seem paradoxical but only if you haven't thought about it very hard. Obviously, I have a personal stake in the issues I write about here. You should only conisder me credible to the extent I reveal it.

One of the few benefits of getting older is gaining perspective from the passage of time. What strikes me most about the large scale changes that have taken place in the course of my adult life are not those related to terrorism or torture or the conservative grip on the Supreme Court, but rather the shift in the economic structure of the country. We’ve all heard about the increasing disparity between rich and poor, which is a part of this shift, but it goes beyond that, as Joshua Holland details in this report:

Fewer than 1 percent of Americans are millionaires, but almost one in three believe they'll end up among that group at some point.

Roger Clemens is desperately trying to save his honored place in baseball history by denying that he ever used anabolic steroids or human growth hormone in order to improve his athletic performance. He isn't looking very credible right now, and it's a sin to tell a lie, but it is far from obvious to me why underlying allegations are so despicable.

I can think of a few reasons why people condemn the use of performance enhancing drugs. One is that it is held to give the athlete an unfair advantage. But athletes do all sorts of unnatural things to their bodies, and those who are fortunate enough to have more resources devoted to their training have an advantage over those who do not. This begins in childhood, with children of affluent families, who happen to be born in societies that invest more resources into developing athletes, or who just happen to attend the right school and have the right coaches, get advantages over all the other children. Athletic training includes systematic exercise and carefully designed nutritional regimens which produce abnormal muscle mass and endurance. Athletes use all sorts of technologies and tricks to enhance their physical capacities and skills. If you think there is something wrong with using peformance enhancing drugs, you have to explain how they are different from nutritional supplements and training regimens.

Beautiful Children, by Charles Bock

My review on Bock's Beautiful Children is up at Pajiba, so click here to read it.

In a nutshell: A solid debut novel: not perfect, but better than you might think.

Bibliolatry Scale: 4.5 out of 6 stars

This morning we heard from Dr. Kelly Kelleher about how it's a great idea for primary care doctors to screen for alcohol and other drug abuse problems. There are, however, some difficulties.

Every disease advocacy organization in the world wants primary care doctors to be screening -- for asthma, diabetes risk, cancer, depression, domestic violence, you name it. In fact there are something like 700 questions that primary care docs are supposed to be asking their patients. However, they generally see 4 or 5 patients an hour. Since the patients are presumably there for some reason other than to be asked the first 30 or so of 700 questions, it's unlikely we're going to get very far with that.

Stars: *****

I received this book for review. It was also read for the Pub in 08 and In Their Shoes challenge.

I came into London today to talk on a local radio show about my book. It was a very strange thing to do. Not only sitting in a dark booth at BBC studios infront of a console with such a bewildering array of buttons and dials that it looked like we were about to take off, but just the talking about the book at all. Writing it was bad enough. It is definitely not a comfortable thing to publicise. I have been psyching myself up for it for weeks, though I was very glad to get it over and done with today, particulary given the cold I have. But the presenter's reaction was so lovely, and in a way unexpected. I assumed like most people his interest would be in the homelessness bit and how I wrote the blog. He did talk about the shame and secrecy of homelessness, and how it had been for me living in the car for those nine months, but he focussed mostly on the earlier part of the book — on some of the childhood stuff.

This weirdly tropical late October day in Boston would be a good one on which to start taking on our specific crises, but I'm a little too busy for a decently researched post today, and there are still a couple more points I want to make about the fundamentals.

First, regarding the humanity/nature false dichotomy (or maybe not so false, in the view of some commenters) I'm inclined to view this question pragmatically. As long as we're around, we're going to have a big impact on the ecosystems around us. Whether that is for better or for worse is a question that we can only answer, ultimately, from our own point of view. To accuse me of speciesism is feckless, because if we weren't around, some species would be better off and others would be worse off. And I'm not just talking about our companion animals, and cockroaches and rats.

I suspect that most of the people here would agree with me, although it hasn't exactly come up in an overt way: the majority of kids who come to the attention of adults because of their alcohol or drug using behavior don't, fundamentally, have a drug problem. If kids are smoking pot before class, they have a school problem. If they are drinking six beers at a party and then driving home, they might have a social problem and they certainly have a judgment problem, as most adolescents do. Kids in poor neighborhoods who end up involved with criminal drug dealing gangs likely have an economic problem.

But the basic issue is not that there are bad chemicals out there and we need to sit down and talk with them about chemicals. There might be something we need to talk with them about, or really, there might not be a problem at all -- they might just be experimenting because kids like to try new things. The vast majority who do so do not end up getting into any kind of trouble at all, except for the trouble that overreacting adults make for them.

Our good friend Jean, in response to my asking for contributions to President Obama's "to do" list, proposes honest, effective, and comprehensive health education. I think that's an excellent addition. Although I'm afraid it may be too hot to handle for the campaign, it's something we're going to need to address after the dust settles in January.

If we're going to have honest and effective health education, it has to start with honest and effective biology education. And here, we have a problem. Michael Berkman and colleagues in the May PLoS Biology lay the bad news on us. Sixteen percent of U.S. high school biology teachers admit to believing that "God created human beings in their present form at one time within the last 10,000 years," and 47%, while agreeing that humans developed over millions of years, believe that God guided the process, and one in eight say they teach creationism in a positive light.