Noteworthy News Articles on Mental Health Topics, November 23-31, 2000

High Court Overturns Child-Sex Conviction
Janan Hanna, Chicago Tribune- 11/23/2000

In a ruling that seeks to balance the protection of child victims with the rights of a defendant, the Illinois Supreme Court on Wednesday overturned the conviction of an alleged sex offender, ruling that the unusual steps taken by the trial judge to shield the young accuser from seeing the defendant violated his constitutional rights. The unanimous ruling from the seven justices marks the first time that the Illinois Supreme Court has addressed the issue of a defendant's right to face his accuser in the context of a child sex crime case, the lawyers in the case said.
    The decision of the justices centered on a ruling by a trial judge in Kane County who ordered the placement of 4-foot-high lecterns behind the chair from which a 6-year-old girl testified so that she would not have to see the defendant. The high court said that the use of the lecterns violated the defendant's constitutional right to see his accuser. In ordering a new trial for Anthony Lofton, the high court noted that the trial judge should have relied on the method typically used by judges in child sex crime cases that would protect both the victim and the defendant--taking testimony from the victim on videotape.
    Lofton, 43, of Elgin, was accused of sexually assaulting a then 5-year-old girl referred to in court proceedings as M.H. To settle a dispute between prosecutors and Lofton's lawyers about whether the girl should be permitted to testify via closed-circuit television--a procedure permitted under the 1995 Illinois Child Shield Act--the trial judge attempted to craft a compromise. Prosecutors presented testimony from the girl's mother and a counselor who said the young victim had suffered emotional harm after she was sexually abused, but had recovered. However, when she learned that she would have to testify, the girl relapsed into a state of emotional distress, according to prosecution testimony. Kane County Judge Philip DiMarzio ruled that the girl could suffer harm if she had to see the defendant, but he said he believed the girl was emotionally stable enough to face the jury and lawyers in the courtroom, according to the Supreme Court opinion.
    Lofton's lawyer did not approve of the compromise, telling the judge he believed the arrangement would prejudice his client.  "I think that this is very peculiar," said Thomas McCulloch. "From where we sit, we cannot see the witness. I'm not suggesting that the Chinese wall approach is what we sought, nor do we think it's appropriate." A defendant's right to confront his accuser is a fundamental of criminal law. But it can be abrogated if a judge finds that the victim will suffer serious harm if made to testify in open court. However, the Supreme Court said the proper method to accommodate a child in such cases is to allow the victim to testify via closed-circuit TV, thereby protecting the child from trauma, but allowing the accused to watch and evaluate her testimony in order to help defend himself. "If someone is aware that their accuser is watching them, they'd be less likely to lie," said Darren Miller, an assistant appellate defender who successfully represented Lofton before the high court. "In a lot of these sex cases in particular, the parties know each other. A defendant would be able to tell his attorney `she tends to lie when she tilts her head that way.' When you take the defendant's ability to perceive the witness, you lose that." The Illinois Supreme Court agreed with Miller. "Here, the defendant's inability to observe the manner of the witness while testifying could have prejudiced him by limiting his ability to suggest lines of examination to his attorney that might have been indispensable to effective cross-examination," the court said in an opinion written by Chief Justice Moses Harrison. Representatives of the Kane County state's attorney could not be reached for comment.
    Though the justices did not, and have not to date, evaluated the constitutionality of Illinois' Child Shield Act, the justices relied heavily in its their analysis of the Lofton case on two U.S. Supreme Court rulings regarding closed-circuit testimony. In a 1988 ruling of a case originating in Iowa, the U.S. Supreme Court vacated a conviction in which two witnesses testified against the accused defendant from behind a screen, giving the defendant only a shadow view of the witnesses. The Supreme Court ruled that the arrangement violated the defendant's 6th Amendment right to confront his accuser. But in a 1990 case from Maryland, the court upheld the conviction of a defendant in which children testified by means of one-way closed-circuit television. Lofton has remained in state prison, where he is serving an 18 year-sentence.

Sex Offender Charged in Slaying Won Early Release
David Snyder and Katherine Shaver, Washington Post- 11/23/2000

Marcie Wogan, a former prosecutor in Carroll County, Md., who specialized in child abusers, was trawling the Internet for news this week when she saw the headline about a 9-year-old boy found dead in a baseball dugout in Frederick. As soon as she saw the age of the boy, Wogan said, she knew who did it. "I said, 'Oh my God, it's Elmer Spencer,' " Wogan said yesterday. It had been more than 18 years since Wogan helped convict Elmer Spencer Jr., now 44, of paying an 11-year-old boy $20 to drink liquor, forcing the boy to undress, raping him and then trying to strangle him with a shoelace. The child was able to escape, and Spencer was sentenced to 22 years in prison. But he didn't stay there.
    Spencer, who is mentally retarded, was arrested in the slaying of Christopher Lee Ausherman, 9, on Monday, five days after his release from the Maryland Correctional Training Center in Hagerstown, where he was sent for a 1996 assault on a Frederick woman. That conviction came on the heels of at least two other convictions and three arrests in connection with assaults. How Spencer was freed after compiling such a lengthy and violent record has prompted debate about whether convicted pedophiles should benefit from early release, and whether serving out a sentence means they are safe to return to society. "I don't know if he received any therapy while he was incarcerated, but I do know he'd been evaluated for sentencing in my case," Wogan said. The evaluation found that "when he was released, he would engage in the same actions again, that he was not able to change. He was a fixated pedophile," she said.
    Police said yesterday that a preliminary report from the state medical examiner indicates that Ausherman was beaten, strangled and sexually assaulted. Frederick County State's Attorney Scott Rolle said yesterday that he will seek the death penalty if the medical examiner's final report shows evidence to pursue a charge of first-degree sexual assault. "We don't have enough information yet to know what kind of [sexual] offense we're talking about," he said The Maryland Public Information Act prohibits officials from revealing inmates' psychiatric records, so it was unclear whether Spencer received treatment while in prison, said Leonard Sipes, a spokesman for the state Department of Public Safety and Correctional Services. But Spencer twice stayed at the Patuxent Institution, the state's treatment center for mentally ill inmates--for three months in 1978 and six months in 1984, Sipes said. When he was released earlier this month, Spencer had served 3 1/2 years of a 10-year sentence for first-degree assault.
    Like many Maryland inmates, Spencer was freed under the "mandatory release" system, whereby inmates accumulate "credits" for good behavior. After a certain number of credits, the inmate must be allowed leave. Unlike parole, mandatory release is automatic and not at the discretion of the state's parole commission. In most cases, credits from an already served sentence can be applied to subsequent sentences, Sipes said. On average, an inmate in Maryland serves 70 percent of the sentence before mandatory release, Sipes said. Spencer served about 40 percent, in part because he had accumulated credits during his previous stays in prison.
    Since Spencer's arrest, Rolle and others have railed against the mandatory-release system, saying Spencer exemplifies why some offenders should not be allowed out for behaving well. Others say longer sentences won't help some sex offenders' tendencies toward violent sex crimes and that without follow-up treatment they may only defer subsequent abuses. "No matter what you do in prison with someone like this, you're going to need to continue to have support and supervision once they're out," said Fred S. Berlin, founder of the Johns Hopkins Sexual Disorders Clinic. "This is not only a criminal justice matter, but a mental health and public health matter." Spencer was ordered to receive sex-offense counseling after his release. The terms of Spencer's three-year probation, which was to be served after he left prison last week, also stipulated that he submit to drug and alcohol counseling and random drug tests, Sipes said. As ordered, Spencer reported to the Frederick probation office the very day he was released. Five days later, police say, he killed Ausherman.
    Spencer was ordered held without bail yesterday by Frederick County Circuit Court Judge W. Milnor Roberts. Spencer, visible in the courtroom on a television monitor connected to a camera in the county's detaining facility, sat handcuffed, his head down, throughout the three-minute hearing. He spoke audibly only once, acknowledging that he could hear the judge. Spencer's public defender did not request that bond be set. He would not comment after the proceeding. Several telephone calls to numbers believed to belong to Spencer's relatives were not returned. Family friends have said his aunt, who raised him, lives in Mount Airy and that Spencer's parents died when he was a child.
    Spencer's first dealing with Frederick County prosecutors came in September 1996, when the state dropped a child sexual assault charge filed against him. A 7-year-old girl said Spencer had fondled her, but prosecutors did not pursue the charge because of insufficient evidence and conflicting accounts by one witness, Rolle said. Spencer was arrested in 1995 in Baltimore County on charges of battery and assault with intent to murder, according to court records. The age of the alleged victim in that case was not available yesterday. Court records show the charges were dismissed about three weeks after Spencer's arrest. Howard Merker, deputy state's attorney for Baltimore County, said prosecutors did not remember why those charges were dismissed. The court file has been ordered out of storage for a review but will not be available until next week, Merker said. Sipes said Spencer served three years of a five-year sentence for a 1977 assault and battery charge in Carroll County. Within one year of his release, however, Spencer raped and attempted to strangle the 11-year-old boy behind a Safeway supermarket in Mount Airy, Md., Wogan said. She recalled Spencer, then 26, as being small and slight, fitting in easily with children. She said Spencer's attorney told the judge that Spencer had been abused as a child and that mental evaluations found he "did not have a good prognosis for improvement."
    Wogan said Spencer was "sweet and docile" with adults, enabling him to gain an early release through good behavior in prison. "He looked like a child himself then," Wogan said. "He could easily pass as a 12- or 13-year-old boy back then. He made friends with kids and would lure them places." When the 11-year-old boy got "a little woozy" from the liquor behind the Safeway, Wogan said, Spencer hit him in the face, forced him to undress, then raped and strangled him. Spencer left the boy unconscious, Wogan said, and after he walked off to smoke a cigarette, the boy came to and ran away.

Abuse Seen to Rights of Mentally Ill
Alice Dembner, Boston Globe- 11/24/2000

Massachusetts is violating the civil rights of mentally ill adults by holding them in psychiatric hospitals long after they should be discharged, lawyers have asserted in a letter to state health officials demanding more group homes and other community-based residential programs. The lawyers say they are prepared to file a class action suit representing more than 1,500 state residents who they say have been wrongly hospitalized, improperly discharged, or left in the community without proper residential care.
    The letter, a copy of which was obtained by the Globe, arrived at state offices just days after Governor Paul Cellucci agreed to pump $85 million into residential care for mentally retarded adults to settle a separate class action suit. Tuesday, a spokesman for William O'Leary, state secretary of health and human services, said attorneys for the state would meet early next month with the lawyers from the Center for Public Representation, Mental Health Legal Advisors Committee, and the law firm of Foley, Hoag & Eliot. ''They've raised some concerns that we're willing to discuss,'' said O'Leary's spokesman, Rich Copp. ''We'll be sitting down over the next couple of weeks.''
    By the state's own count, between 75 and 100 adults who are ready for discharge are being held each day in locked state psychiatric facilities because there is no appropriate group home or assisted living arrangement available. Another 3,200 mentally ill adults being served by outpatient counselors are on a waiting list for group homes or rental assistance. These totals do not include hundreds of children who face the same plight. ''The entire system is clogged,'' said Tobias Fisher, executive director of the Massachusetts chapter of the Alliance for the Mentally Ill, which supports but is not a party to the demand letter. ''People can wait for months to get any type of residential services. We think some positive action is long overdue.''
    ''Steve,'' who was held at Worcester State Hospital at least six months longer than medically necessary, couldn't agree more. The 32-year-old, who suffers from psychosis and paranoia when not on his medication, finally left the hospital this fall for a state-supported apartment where he gets help with handling daily activities. He attends a work and social rehabilitation program daily. ''I had been waiting and waiting and waiting,'' said Steve, who asked that his real name not be used. ''I was ready for discharge, but they couldn't find a place. It made me depressed. They were holding me back.''
    Kurt Wallin of Jamaica Plain worries about finding a residential placement for his son, John, who is being treated for schizophrenia and bipolar disorder. At 75, Wallin is not sure how long he will be able to continue caring for John, who at 51 still lives with him. John gets psychiatric services through the state, but Wallin knows housing aid is much more difficult to come by.
    The state Department of Mental Health acknowledges that the waiting list for residential services has been growing because demand has been outstripping the available funding and facilities. The department provides residential services for about 6,000 clients, up from 2,100 in 1988, according to spokesman John Widdison. ''The department has been moving in the right direction over the past three fiscal years,'' said Widdison. ''It has received a total of $5 million from the Legislature to address waiting list issues and provided residential support for an additional 175 people.''
    But advocates say the state must do more. Frank Laski, executive director of the Mental Health Legal Advisors Committee, said his organization believes the need for services is much greater than is captured by the state's waiting list. The demand letter covers three groups of people who the lawyers say are being discriminated against: institutionalized adults who could be living in the community with appropriate services, formerly hospitalized adults discharged inappropriately to nursing homes, and adults at risk of being hospitalized because they aren't getting needed services.
    The legal argument is based on the state constitutional amendment barring discrimination on the basis of disability, the federal Medicaid statute, and the Americans with Disabilities Act. The letter cites a US Supreme Court decision last year in a Georgia case that found that the ADA provides a right to community-based services for people with mental disabilities. The letter seeks a comprehensive plan to significantly reduce the wait for community services over a period of three years. ''We're hoping that this can be resolved without the need for litigation,'' said Robert Fleischner, an attorney with the Center for Public Representation. The center was also a party to the lawsuit, argued on different legal grounds, that won an expansion of residential services for mentally retarded adults.

Abuse Cases Rise During Holidays
Brian Ballou, Detroit Free Press- 11/24/2000

The holiday season often inspires joy. But across metro Detroit, the days from Thanksgiving through New Year's can also spark fear.  Domestic-violence counselors say they receive more crisis calls during the holiday season than during any other time of the year, a trend that national experts say results from higher stress and people spending more time together. "The tension gets so high. We know that stress and alcohol don't create an abuser, but when you have those conditions present with a person who may have a tendency towards domestic violence, they are more likely to act out," said Norma Tucker, executive director of My Sister's Place, a 62-bed shelter in Wayne County.   Tucker said her organization receives more crisis calls and does more counseling in early January than at any other time of the year.
    In the past five years, the 24-hour crisis line for HAVEN, the only domestic-violence shelter in Oakland County, has received 15 percent to 20 percent more calls from November to January. Most of those calls come in the days following Thanksgiving and Christmas, after visiting family members have left and a sense of normalcy returns, said Hedy Nuriel, the shelter's director. At Turning Point, a 48-bed shelter in Macomb County, the highest number of monthly calls to the 24-hour crisis line occurs in January and February. Volunteer coordinator Carey Goryl said most of those calls are about incidents that happened during the holiday season.  "During the holidays, many women choose to stay in the situation because they don't want to deprive the children of the holiday," Goryl said.
    Experts offer these tips for dealing with domestic violence:
*Couples with a violent history should seek counseling before a round of abuse starts. Many local shelters provide counseling services. For immediate help, victims should call 911 or a 24-hour crisis line.
*Be aware that police don't have to witness a domestic assault and don't need a warrant to arrest. If you have been injured, go to an emergency room because medical records are important for civil and criminal cases.
*HAVEN's 24-hour crisis line is 248-334-1274. The 24-hour crisis line for My Sister's Place is 313-371-3900. Turning Point's 24-hour crisis line is 810-463-6990.

Attention Disorder a Medical Minefield
Ronald Kotulak, Chicago Tribune- 11/26/2000

At 12 years old, Tony couldn't sleep through the night. Groggy and tired, he was restless in school, unable to pay attention or think clearly. His doctor decided Tony had attention deficit hyperactivity disorder. The doctor prescribed Ritalin. But Tony's real problem was something entirely different. He has restless legs, medically known as periodic leg movement disorder. Twitching uncontrollably at night, his legs constantly awakened him. Taken off Ritalin and placed on a drug that calms fidgety muscles, the Urbana preteen slept soundly and his classroom behavior improved dramatically.
    Tony doesn't have ADHD, and neither do tens of thousands of other children who have been diagnosed with one of the most talked-about and most-studied mental disorders of all time. ADHD is not only widespread--the most commonly diagnosed mental health condition in American children--it is controversial, complex and confusing. Children like Tony are diagnosed with ADHD when they actually have other problems that mimic its symptoms. Some rambunctious children get the label when their parents think Ritalin will make them behave. And yet more children, especially among black and Hispanic populations, are in danger because their ADHD goes unrecognized and they do not receive help.
    Underdiagnosed and misdiagnosed, overtreated and undertreated, attention deficit hyperactivity disorder has become a national medical nightmare. It is reaching epidemic proportions among children in the United States and shows no signs of slowing down. More than 2 million kids now take Ritalin or a similar drug. And although overuse of such drugs is a real fear, untreated or improperly treated children with ADHD are also at high risk. Many will drop out of school and, ultimately, fail to function in society.
    Faced with multiple dangers and conflicting reports from researchers, many parents might be forgiven for throwing up their hands.  "There's a lot of bad information out there," said Dr. Steven Hyman, director of the National Institute of Mental Health, or NIMH. "It's become sort of cultish. There are wars over Ritalin, which distracts people from asking the question of, `What, if anything, is wrong with my child, and what would be the best approach to helping him?' "Underdiagnosis is a disaster. Overdiagnosis is a disaster. We really have to focus on taking care of each child properly."
    The National Institute for Child Health and Human Development estimates that 3 percent to 5 percent of school-age children have ADHD, based on criteria in the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders. The characteristic symptoms of the condition are an inability to sustain attention and concentration, developmentally inappropriate levels of activity, and distractibility and impulsivity. But most primary-care doctors and pediatricians, who diagnose most cases, don't follow those criteria strictly. As a result, an estimated 6.6 percent to 9.5 percent of children have been labeled ADHD, according to the institute. That would translate to up to 5 million U.S. children. Every classroom, on average, would have three pupils with ADHD.
    The sharpest increases in ADHD diagnoses and Ritalin use are occurring among white boys from middle- and upper middle-class suburban families. The most recent studies show that up to 40 percent of white male 5th graders in some school districts are being treated with Ritalin for ADHD. Even more alarming is the rising number of preschool children who are diagnosed with the disorder. Children as young as 1 are being treated, some with several different psychotropic drugs.
    At the same time, ADHD is severely underdiagnosed among black and Hispanic children. These children who truly have the disorder and are not being treated are in danger of spinning out of control in a self-destructive whirl of antisocial behavior and criminal activity. The problem is so severe that the U.S. Department of Justice's Office of Juvenile Justice and Delinquency Prevention is funding NIMH studies on the disorder. "Their hope is to get kids treated before they end up being incarcerated or on a pathway toward a criminal career," Hyman said.
    "What the public really needs to know," he said, "is this enormous differential application of the ADHD diagnosis, from pretty close to zero percent in some school systems to as high as 40 percent of boys in other school systems. That can't be right." What has stunned many observers is the great increase in the number of children diagnosed with ADHD since 1990. The number of prescriptions for Ritalin, the most frequently prescribed stimulant for treating the disorder, increased sixfold in the last 10 years, accounting for about 4 percent of all physician office visits.
    Such dramatic changes raise serious questions: Is ADHD increasing because bad things are happening to some children, such as poor child care that warps the formative years, a lack of time with parents or insufficient discipline? Or does our performance-oriented society expect so much from children that what might once have been considered normal childhood behavior is now unacceptable?  Some have called ADHD treatment an unprecedented psychosocial experiment in which drugs are being used to control children. One disquieting new trend is that because Ritalin and other stimulants can make even normal children more alert and focused, some parents and teachers are beginning to regard stimulants as a teaching aid to enhance school performance.
    Ritalin is also often used incorrectly as a diagnostic tool. "Let's put him on Ritalin and see what happens," a doctor typically tells parents. An improvement in the child's behavior is then wrongly interpreted as evidence of ADHD. "Even for a boy who is within the range of normal, stimulant medications may make him easier to handle behaviorally in school. But that is not a reason to medicate somebody," Hyman said. "That is not medically appropriate."
    At least four major trends seem to be driving the enormous increase in ADHD diagnoses:
- Disorders that have symptoms very much like ADHD, such as depression, anxiety, schizophrenia and learning problems, often are misdiagnosed as the attention deficit disorder.
"A lot of harm can be done in either keeping a child from what they need for anxiety or depression, or, even worse, occasionally giving stimulants to a child who has schizophrenia," said Benjamin B. Lahey, professor of psychiatry and chief of psychology at the University of Chicago.
- Relatively normal, rambunctious behavior has been redefined by some as abnormal. Diagnosing ADHD in children as young as 1 and treating them with stimulants to modify their behavior is of particular concern. "Every symptom of ADHD describes every child," Lahey said. "What matters is does the child have a high level of each of the symptoms, and does he have a lot of symptoms?"
- School systems across the country have established mandatory learning standards in the last five years, frustrating and alienating students who have trouble measuring up. At the same time, the federal Individuals with Disabilities Education Act required schools to identify and help children with psychological problems. In the past, schools didn't worry much about children with ADHD, mild disabilities and other disorders, such as dyslexia, because they simply dropped out. "Now you're dealing with a bunch of kids that the system never was designed to take care of," said Willard Daggett, director of the International Center for Leadership in Education, based in New York.
- Under managed health care, insurance companies save money on psychiatric evaluations by relying on primary-care doctors to diagnose ADHD and prescribe Ritalin--even though the child may have a different problem altogether.
    Dr. Mark Stein, a specialist in ADHD, has seen all of these trends in his practice at the National Children's Hospital in Washington. "My experience is that about 40 percent of the kids who are referred to me for ADHD don't have ADHD. They have something else," he said. "But the more important statistic is that about 80 percent of those children who have ADHD also have something else. "If you just do a brief, superficial evaluation, or just focus on the symptoms, you're more likely to misdiagnose ADHD, or to miss the [additional] conditions. Both of those contribute to a poor prognosis overall." The twitchy legs that earned Tony his ADHD diagnosis are an example of a common medical mimic. Chronic lack of sleep, which can make children cranky and inattentive, is another. Asthma and hectic schedules can also prevent sufficient sleep.
    Dr. Daniel Picchietti of the University of Illinois at Urbana-Champaign and Dr. Arthur S. Walters of the Robert Wood Johnson Medical School in New Jersey found that among 85 children referred for an ADHD evaluation by pediatricians or teachers, 25 percent to 50 percent had Tony's problem, periodic limb movement. "We were amazed," said Picchietti. "These kids were referred for ADHD. They were not referred for sleep problems. But they were getting fewer hours of sleep, which was brushed off as nothing since these kids were hyperactive and didn't need as much sleep."
    Even when ADHD is correctly diagnosed, most physicians do not prescribe enough stimulant medication to be effective, they do not individualize treatment, and there is inadequate follow-up, said Peter Jensen, director of Columbia University's Center for the Advancement of Children's Mental Health. A large-scale study headed by Jensen has found that children with ADHD were most helped by a combination of drug therapy and instruction in appropriate coping skills.
    The 1990s saw other changes that conspired to increase the rate of diagnoses. Criteria in the DSM IV were changed so that either inattention or hyperactivity qualified as ADHD, for example. And scientific research demonstrated the role of neurotransmitters in many mental disorders. "We've become the Prozac generation," said Julie Magno Zito, a psychiatric pharmacoepidemiologist at the University of Maryland. "There's a greater comfort level in society about giving psychoactive drugs to children, much more so than just a decade ago." Stein, from the National Children's Hospital, said he gets especially concerned when children under 4 are diagnosed with ADHD. "It's scary, but it happens a lot," he said. "The problem is that most 4-year-olds display symptoms of ADHD. But we don't say that's ADHD. That's part of being 4 years old."
    According to the DSM IV criteria, a child must display six of nine symptoms of inattention--such as doesn't listen, doesn't follow instructions, doesn't do homework, is easily distracted and forgetful--for at least six months to fit the profile of ADHD. The diagnosis is also valid when a child has six of nine symptoms of hyperactivity--such as fidgets, leaves seat, talks excessively, interrupts conversations--also for a minimum of six months. "Nobody is saying that the dividing line between being very active but normal and being just barely ADHD is clear cut," Lahey said. "It's a very gray area, and you just have to make a decision as to where you're going to draw the line."
    Although environmental influences play a role, scientists believe ADHD is 60 percent to 80 percent inherited. A half-dozen genes have been linked to the disorder, many of them pointing to a lackluster dopamine system that has trouble performing a variety of important jobs in the brain, such as control of emotions and muscle movement. Ritalin, a stimulant developed in the 1930s and used in World War II to make troops more alert, appears to work by increasing dopamine levels in the brain. Brain images provide another clue to causation, suggesting that areas of the brain responsible for executive functions are somewhat smaller in ADHD children.  The findings make sense because the affected areas--prefrontal cortex, basal ganglia, caudate nucleus and globus pallidus--regulate attention.
    Using both the genetic and brain-imaging data, Russell A. Barkley, a neuropsychologist at the University of Massachusetts, Worcester, has developed a theory that biological changes prevent the full development of a child's powers to inhibit impulses.  Basically, ADHD children have less self-control. "An ADHD child is going to be more under the control of external events than internal events," Barkley said. "He's going to be more under the control of others around him than self-control. He's going to be more under the control of the moment instead of under the control of the future. And he's going to be more governed by immediate gratification, like a reward-seeking missile." For Lahey, the risks of not treating a child with such problems outweigh the risks of treatment. "Otherwise, I wouldn't do it," he said. "I'd say these are just exuberant, active kids; leave them alone. But then you say, `Yeah, but if I leave them alone, they're going to be miserable and some of them are going to be hurt and killed.'"

Marijuana Use by Teens Declines, Survey Finds
Larry McShane, Associated Press, 11/27/2000

NEW YORK - Teenage marijuana use has dropped for a third straight year, but a jump in the use of the ''club drug'' ecstasy raised new concerns for parents, according to the Partnership for a Drug-Free America's annual report. The nonprofit group's 13th survey, being released today, questioned 7,290 students in seventh through 12th grades nationwide. The margin of error is plus or minus 1.5 percentage points.
    Use of ecstasy, a favorite at dance clubs and all-night raves, has doubled among teens since 1995, the survey found. One in 10 teens has experimented with the drug, it said. The report found the number of teens who have tried ecstasy at least once had increased from 7 percent to 10 percent over the past year. In contrast, the number of teens who said they have tried marijuana dropped slightly last year, from 41 to 40 percent.
    It was the third consecutive drop in teen marijuana use since 1997, when 44 percent of teens said they had used the drug at least once.  ''We appear to be turning a very important corner,'' said Richard D. Bonnette, the partnership's president and chief executive officer. ''But as we turn one corner, troubling developments are coming at us from other directions, specifically with ecstasy.'' The survey found that more teens were turned off than on by marijuana. Fifty-four percent felt smoking pot would make them behave foolishly, up from 51 percent in 1997. And just 21 percent said they had used marijuana in the past month, down from 24 percent in 1997.
    Those statistics are significant because they address attitude changes since the partnership, along with the White House Office of National Drug Control Policy, started a national anti-drug ad campaign in July 1998.  ''This study confirms the trends we've seen over the last three years - a steady decline in the number of teens using drugs,'' said Barry McCaffrey, director of the Office of National Drug Control Policy. ''This is very good news.'' The study found that the number of teens seeing anti-drug advertising on a daily basis has jumped significantly, from 32 percent in 1998 to 49 percent this year.

Confirmed Cases of Child Abuse, Neglect Are Only the Beginning
Jack Kresnak, Detroit Free Press- 11/27/2000

On an average day in Michigan, Children's Protective Services investigators document the abuse and neglect of 67 children. That's about 24,500 children in a year. And those are just the children state officials know about. Last year, CPS workers from the Michigan Family Independence Agency received nearly 128,000 reports of child abuse and neglect. They were able to confirm about 10 percent of those reports, which often involved more than one child.
    About half of abused or neglected children are allowed to remain with their parents with help and supervision from FIA social service programs. But 26 percent are believed to be in so much danger that they are removed from their family's home and sent to live with other relatives or foster parents.  In 21 percent of the cases where abuse or neglect is found, the agency takes no action because the incident is deemed to be isolated or caused by someone other than the parents.
    As Michigan's children's ombudsman from 1995 to 1998, Richard Bearup saw a wide range of abuse and neglect that cut across all socioeconomic classes. "We saw a 4-month-old infant who was plunged into boiling water to keep her from crying," Bearup said. In that case, Bearup said, the FIA declined to ask that her parents' rights be terminated, so the Office of Children's Ombudsman filed the petition that was approved by the judge. The child, now 9, is living with adoptive parents. Bearup said the case both shocked and puzzled him. "I could not imagine how one human being could do this to another human being, let alone a defenseless child," said Bearup, now an executive with Lutheran Child and Family Services of Michigan.
    The first line of defense for children is Children's Protective Services, which has 723 investigators, up from 624 in 1997. Being a CPS investigator is a "tough job from a number of perspectives," said Bearup. "First of all, you are going into the sanctity of someone else's home and asking questions without the benefit of a warrant or a police officer," Bearup said. "You're also talking about secrets that are often very hard to uncover. The child hardly ever runs to the CPS worker and says, 'I've been abused.' " Bearup said children often are reluctant witnesses because they don't want to be taken away from their parents.
    Linda Spears, director of child protection for the Child Welfare League of America, said some researchers estimate that there may be two or three times as many victims of child abuse and neglect nationwide as are confirmed by CPS investigators. Part of the problem is that people know about abuse but are reluctant to call authorities. The welfare league completed a survey a few years ago designed to find out why child abuse is not reported more often. "One thing we found is that people simply don't know how" to report abuse, Spears said. "But there were a significant number of people who feared what would happen if they reported; the child would be removed and it would be their responsibility."

Violence Should be Considered a Disease, Experts Say
Detroit Free Press, 11/27/2000

DETROIT (AP) -- When the U.S. Surgeon General first called smoking a "health hazard of sufficient importance" in 1964, the American Cancer Society showed little interest, because it thought then that smokers risked only their own health. That changed after research showed secondhand smoke might pose a threat to nonsmokers, too. Since 1984, however, when the Surgeon General first identified violence as a public health concern, little progress has been made to control it, according to an eight-month analysis by The Detroit News.
    Though violence ranked as Detroit's fourth-leading cause of death, killing 497 people and injuring untold others in 1998, city health officials spend far more -- $10 million -- on programs involving HIV and AIDS, which killed one-third as many Detroiters. Convincing Americans that the broad population is at risk may be the most critical strategy in social-health movements like an anti-violence campaign, Constance Nathanson, a sociology professor who studies social-health movements at the Johns Hopkins School of Hygiene and Public Health in Baltimore, said in a 1999 Journal of Health, Politics, Policy and Law article.
    Perhaps no example proved more important in the HIV prevention movement than the case of Ryan White, an Indiana boy who was infected with a blood transfusion. He showed that the risk of infection was not limited to homosexuals and drug users. "Sometimes it takes peculiar things," said former Surgeon General C. Everett Koop, who also noted the importance of actor Rock Hudson's death from AIDS. As HIV/AIDS and smoking overcame the specter of being just a homosexual issue or a smokers issue, violence also has hurdles of misconception to overcome. "This societal characterization of violence -- with a 19-year-old black male as the poster child -- helps people deny reality," said Dr. Emanuel Rivers, director of research and emergency medicine at Henry Ford Hospital. "There are white men in ties who are just as mean as some of these 19-year-olds in the city. They just go home and beat their wives."
    In 1989, a group of six doctors from Henry Ford Hospital in Detroit were among the first to push the disease theory of violence. "We accept other risk behaviors as diseases, such as smoking, obesity, drug addiction," said one of the report's authors, Dr. John J. Fath, now at Sparrow Hospital in Lansing. "It is a bit easier to see how a battered woman who goes back to the same man, or picks another partner with the same behavior pattern, will get hurt again. How does that differ from any other psychiatric disease?" Calling violence a disease is no wordplay, Rivers said. "A disease is any process that destroys health and well-being, whether it is cancer, a heart attack, an infection or violence," he told the News for a Monday story. Science is finding biological explanations for impulsive, unplanned violence -- meaning a medical treatment might someday calm or cure the problem.
    Several studies, including one published this year in the journal Science, indicate people who have impulsive bouts of violence might suffer abnormalities in the frontal lobe of the brain, preventing them from controlling their impulses. Other studies suggest that toxins, especially lead and alcohol, might interfere with brain development and activity in the frontal lobe, leading to aggressive behavior. While deciding whether to treat violence as a criminal, moral, social or health issue may seem like a fine point, it actually has broad impact, some health experts maintain, from the amount of money invested in re search and prevention to firearms regulation.
    Most people continue to view violence in stark crime and punishment terms, experts said. Moreover, the gun lobby has disputed violence fits in the realm of public health, calling it a criminal problem alone. In 1998, as the Institute of Medicine studied how to curb violent and accidental injuries in America, National Rifle Association researcher Paul Blackman urged it to "remove criminal violence and intentional injury from its purview." The Michigan Department of Community Health is considered progressive among states for dedicating an entire division to violence prevention. A few violence prevention programs are offered by two of southeast Michigan's five county health departments -- Washtenaw and Wayne -- but not one has a full-time employee or section dedicated to violence prevention.

Heroin Addicts Losing Their Link to Treatment in Flint
Detroit Free Press, 11/28/2000

FLINT, Mich. (AP) -- About 140 heroine and morphine addicts who have come to rely on the New Era Alternative Treatment Center for doses of methadone could be forced to seek help outside of Genesee County. New Era, the only clinic that dispenses the treatment here, is facing sanctions because of admitted Medicaid fraud. And it could be ousted from the medical reimbursement program, Richard Koenigsknecht of the state attorney general's office told The Flint Journal.
    The charges were related to New Era's primary office in Highland Park but will send shock waves throughout New Era's system. Those kind of shock waves would be particularly jarring for populous Flint, which has no other methadone source. To cope with the loss of its only methadone provider, the Genesee County Board of Commissioners could enter into a contract with a provider in Madison Heights -- a Detroit suburb 50 miles south of Flint. People who work with addicts say they're worried about what will happen if the nearest methadone provider is so far away. "If folks had to travel to Oakland county or Detroit, it would certainly pose a hardship," said Ronald S. Brown, executive director of Flint Odyssey House. The house, which is not affiliated with New Era, provides outpatient substance abuse treatment. The more the hardship grows, the harder it will become to stick to the treatment regime, he said.
    Methadone is a synthetic narcotic used to treat heroine and morphine addicts. It is more potent than morphine, has longer effects and more gradual withdrawal symptoms. Methadone has long been the subject of controversy. Its critics have called it little more than legalized heroine, but its advocates say it has helped introduce addicts to various social services and has helped curb the spread of AIDS.
    "We have to have a backup plan for these clients," said Kristie R. Schmiege, a division director for the county Health Department.  Meantime, county patients will be seen at New Era under terms of an extended contract that is due to expire on Jan. 31. Schmiege told county commissioners that the clinic threatened to stop seeing Health Department patients a few weeks ago because its contract had not been extended beyond January. Dr. Joseph Pitts, New Era's executive medical director, declined comment when contacted by the Journal.

Guardian's Ethics Questioned
Carol D. Leonnig, Washington Post- 11/28/2000

In Benjamin Land Jr.'s little corner of Northeast Washington, many people are interested in his life, because he is a daily presence in theirs. At the soul food restaurant, where he asks for free coffee and corn bread, the 6-foot-4, 220-pound Land is known as "Big Man."  Every day he sweeps the sidewalk outside the Woodridge office of a dentist, a family friend who gives him pocket change and keeps tabs on him. Land's mother died nine years ago expecting to leave her home and life savings to her only son, 43, who is schizophrenic and has spent much of his adult life on the streets. In May, Land's court-appointed guardian, Deborah Boddie, sold the four-bedroom house to her own mother and stepfather for $36,000, records show. Renovation of the house in the 2000 block of Jackson Street NE had begun months before, and in July the couple sold the property for $137,000.
    Legal experts question the propriety of the transaction because Boddie sold to her family without putting the house on the market. Because Boddie did not seek competing bids, there is no way to know whether another buyer would have paid more for the house and whether Land--rather than Boddie's parents--could have benefited. Advocates for people with mental illness, who call Boddie's sale a classic case of conflict of interest, say the circumstances call attention to a bigger problem: that D.C. Superior Court is not adequately monitoring dozens of private lawyers it appoints to handle the finances and care of thousands of people with mental illness. "This is awful," said Andrew Sperling, director of public policy for the National Alliance for the Mentally Ill. "Nothing like this should happen. I would hope there are court rules that prohibit this kind of 'self-dealing' and self-interest."
    Boddie said the sale price was fair because the semi-attached colonial was boarded up and needed a full renovation. She noted that an appraisal done by a business colleague valued the property at $34,000. Boddie said she didn't hire a real estate agent to market the home because she wanted to save Land the $2,000 in real estate commissions. "It absolutely doesn't look strange," Boddie said. "The property was sold at market value, so there's no prohibition on that. . . . Even as conservator, I could have bought it." For her legal work in protecting Land's assets and overseeing his care since March 1997, Boddie has reported about 170 hours of work and billed Land $17,000. She spent $11,600 to settle a tax bill, giving Land a net gain of $7,400 from the sale. Boddie said she sees nothing questionable about her relatives benefiting from their work and later sale of the property. "What they put in and what they sold it for is a function of their ingenuity," Boddie said. "As long as it's sold at market value--that's the primary concern."
    But the home's market value and the appropriateness of Boddie selling to her family without competition are in dispute. Two local real estate agents who reviewed the property for The Washington Post say a house of comparable size in shabby condition would typically sell for $80,000 to $100,000 in the neighborhood. An uninhabitable house in the same area could fetch $50,000 to $80,000. Two local real estate appraisers who reviewed the appraisal noted that the land alone was valued at $32,000, suggesting the house was nearly worthless. "That would be a deal at $34,000," Peter Vidi, former president of the National Association of Independent Fee Appraisers and president of Vidi Appraisal Service Inc. in Washington, said after reviewing the transaction.
    Some legal experts see Boddie's actions as a potential breach of her fiduciary duty to Ben Land, and one expert said the transaction could be voided under D.C. law. Robert Tuttle, a professor of legal ethics and estate law at George Washington University Law School, said lawyers should never sell a client's property to themselves or people close to them unless they can prove beyond any doubt that there is no other possible market for the property. "Unless she has some very good reason, that should be grounds for disbarment," Tuttle said. "We're skeptical that you can have an arm's-length transaction with your family members. . . . I would think after this comes out, it will be referred to the D.C. Bar Association."
    D.C. law protects mentally ill wards by allowing the voiding of a sale if a conservator had a personal stake in selling a ward's property. Courts can approve such sales, but only after a formal hearing. The court record does not indicate that Superior Court Judge Cheryl M. Long, who appointed Boddie as Land's limited guardian and conservator of his finances, knew the house was sold to Boddie's family. Long declined, through her staff, to comment on the case. Boddie said "it's not necessary" to notify the court about the purchasers' identities. Several lawyers said a conservator should notify the court of any transaction that presents a possible conflict of interest.
    A court official said the court record "on its face does not reveal improprieties" because there's no indication in the file that Boddie is related to the purchasers. The attorney's conduct could be the subject of future court scrutiny and action if an interested party filed a written complaint, the official said. Boddie's involvement with Land dates to 1997, when Long appointed her as Land's guardian for the primary task of rescuing the  house from a tax sale. In February 1999, Boddie reported to the court success in stopping the sale from going through. Within several weeks, Boddie's stepfather, Wayman Lundy, said he began fixing up the property. Lundy said the house was a "mess" but began work there after reaching an agreement with Boddie to buy it. He said he was "pretty sure I could make money on it." Lundy said he put in parquet floors in the living and dining rooms and an all-new kitchen, bathroom, roof and windows. Two neighbors--businessman Ralph Queen, who had taken Land into his group home, and Ruth Goodwin--helped Land petition the court to remove Boddie as his conservator. They said they were suspicious after Boddie refused to pay Queen $400 a month to provide Land with room and board. Judge Long rejected the request, ruling that Queen was interested in finding a tenant. "Between Boddie and Queen, Boddie is the more credible person," the judge wrote in her July 1999 order. "She has previously given outstanding service to incapacitated people, and she is utterly honest in her accountings and in her dealings with the Court. She has no motive to misrepresent anything that occurred in this situation." Boddie said Land is a loner who chooses to remain homeless. She said she is happy to find him housing but was not appointed by the court to monitor his care. Land said he likes living in the neighborhood and doesn't want to live in other parts of the city suggested by Boddie.
    For advocates of the mentally ill, Land's case raises questions about the court's diligence. A review of about a dozen cases shows that some conservators, who for months and even years failed to file court-ordered reports, faced no fine or punishment for being delinquent. "If those of us with mental illness can't get justice from the justice system, then where can we get it?" asked Nancy Lee Head, board member of the D.C. Mental Health Consumers' League. "The justice system is supposed to oversee these conservators, and that apparently is not happening." Kelly Bagby, of the advocacy group University Legal Services, said she is concerned about several cases in which conservators are delinquent in their duties. When advocates plead for action, she said, the court supports the lawyer rather than the client. "The court needs to be more aware of the implications of its decisions in cases where vulnerable people are involved," Bagby said. "They can't turn their back when a vulnerable person is asking for their attention." Tuttle, the ethics and estate law professor, said that in Land's case, the court should at least have some record of the identity of the purchasers and the conflict of interest. "This may be a story of how easy it is for something like this to slip through the cracks, because there's nobody around to care," Tuttle said.
    In a recent interview at the restaurant, Land wore two dirty, loose-fitting down coats and a brown wool cap. He talked about not sleeping well since his mother died and how he has "one eye always open." He said he appreciated Boddie trying to help him, when the two met in 1997. Land said he knows his mother left him more money than most other homeless people have, but he's not sure how much he is entitled to. "I haven't tried to be picky," Land said of his relationship with Boddie. "I'm okay getting $40 or $50 at a time, she says."

Researchers Discover a Gene Underlying Autism
Associated Press, 11/28/2000

WASHINGTON –– Scientists have long theorized that about 15 different genes play a role in who is born with the severe brain disorder autism — and now they've finally found one of those genes. A study of 57 autism patients found that 40 percent carry a mutated version of the HOXA1 gene, which plays a crucial role in early brain development, University of Rochester scientists reported Monday.
    Children need to inherit just one copy of the mutated gene from one parent to have autism. In fact, scientists found only one patient, a very severe case, who inherited a copy of the bad gene from both parents, suggesting that when that happens the fetus usually dies, said lead researcher Patricia Rodier, who heads the university's National Institutes of Health-funded autism research center. The NIH called the finding a significant step in understanding what predisposes people to developing autism. More than 400,000 Americans have the brain disorder, characterized by profound social withdrawal, repetitive behavior and inability to communicate. Research suggests it's caused when something goes wrong during critical fetal brain development — a theory the gene discovery, in the December issue of the journal Teratology, supports.
    Why don't parents who harbor the defective gene have autism themselves? Some do have very subtle symptoms, suggesting that something else, perhaps some other gene, keeps the autism-related gene in check, Rodier said. HOXA1 is one of a family of genes vital to early embryo development because genes in the group turn on or off other genes. HOXA1's specific role is in brain development. Mice who lack this gene have brainstem damage, malformed ears and other classic signs of autism — one reason Rodier's research team decided to check the gene's role in people. It's not the kind of gene that could ever be fixed with gene therapy. But the discovery may help doctors unravel just how the brain changes when HOXA1 is abnormal, Rodier said. "If you figure out the brain changes, you're on your way, we hope, to finding better treatments," she said.

Low Re-Arrest Rate Among Graduates of Drug Treatment Court
Associated Press, 11/30/2000

ROCHESTER, N.Y.--Drug offenders who pass through the city's drug court are required to undergo up to two years of treatment and must either get a job or return to school. There is now compelling evidence that this nationally popular alternative system, begun here in 1995, is far more effective than the traditional court system in keeping people out of trouble. Only about 11 percent of the 385 people who have completed regimens laid down by Rochester's Drug Treatment Court have been re-arrested, an independent study found. In contrast, about 70 percent of drug offenders arrested in the city who didn't go through the drug court have been re-arrested over the same period, researchers at the Maryland-based Pacific Institute for Research and Evaluation found.  ''Obviously, the community benefits more as (drug court) graduates remain free from chemical dependency and criminal behavior over longer periods of time,'' said the study, which was commissioned by the court as part of a $400,000 federal grant it received in 1996.
    Drug treatment courts are becoming increasingly popular around the country as a way to combat drug-related crimes. There were just 12 drug treatment courts in 1994. Now, there are more than 500, including 25 either operating or soon to open in New York state.  Rochester's court, the first of its kind in New York, requires offenders to undergo closely monitored hospital or outpatient treatment for up to two years, depending on the severity of their addiction. Participants are must complete their high school education or, in many cases, attend college or take a job. ''The program is not just aimed at people being clean all the time,'' the court's judge, Joseph Valentino, said in Thursday's Rochester Democrat and Chronicle. ''It's also important that they have an education and ... have a job.'' About 21 percent of drug defendants referred to the court ultimately complete the program.
    When the court opened, political opponents maintained that its approach would be ''soft on crime'' by setting aside criminal charges in place of treatment. But those who fail to complete the program can be tossed back in jail or face sentencing for their crimes.  ''On the street many people don't even want to go to drug court because it's harder,'' one graduate, Beth Coombs, 37, who has been drug-free for five years, told the newspaper. ''You're talking about responsibility. ... You're talking about growing up.'' Its low recidivism rate lines up with findings from other drug courts, said Allan Cohen, who helped organize the study. The drug court in the New York borough of Brooklyn found that just 12 percent of its graduates were re-arrested within a year, Cohen said.

Video Conferencing to Link Rural Mental Health Providers
Detroit Free Press, 11/30/2000

CADILLAC, Mich. (AP) -- Psychiatrists and social workers are scarce in many rural areas. But in northern Michigan, a high-tech referral network is being developed that could help fill some gaps. The network will use the Internet and video conferencing to link family doctors and patients in rural areas with mental health specialists. Creation of the network will be funded with a $760,000 grant from the U.S. Department of Health and Human Services -- one of three grants awarded nationwide for such programs. The others are in New York and Maryland. The Behavioral Health and Wellness Network of Northwest Michigan will receive the money over three years. The first payment arrived in October. The program will serve 10 counties: Crawford, Kalkaska, Lake, Mecosta, Missaukee, Montcalm, Newaygo, Osceola, Roscommon and Wexford.
    "I see an overwhelming need of having consultations and having resources made available to the public closer to where they live and work," said Mark Kane, a Big Rapids psychologist and member of the network. He said there are probably fewer than a dozen psychiatrists in the 10 counties outside the publicly funded Community Mental Health system, which also is hampered by a shortage of providers. Cadillac Mercy Hospital closed its inpatient behavioral health program in August. Studies have found that primary care providers often wind up providing behavioral health care in rural areas, said Patrick McFarlane, interim director of the Behavioral Health and Wellness Network. Problems like mental illness and depression often are "outside their comfort zone," McFarlane said.
    In some cases, family doctors or other primary providers might use the network to consult with a specialist, he said. In others, the specialist might speak directly with the patient. The network also will advise doctors on how to organize care and work together in rural areas without running afoul of antitrust laws, the Traverse City Record-Eagle reported Thursday. Creation of the program is in the early stages, McFarlane said. At this point, the priority is lining up providers to take part.

Child Protective Service Caseworkers Asked to be 'God' Panel Says
Chris Grygiel, Seattle Post-Intelligencer- 11/30/2000

Zy-Nyia Nobles, the 3-year-old girl killed after the state reunited her with an abusive mother, fell victim to a system that asks overwhelmed caseworkers to "be God," members of an independent review panel said yesterday. "The job that a caseworker is given to do is humanly impossible," said state Sen. Val Stevens, R-Snohomish County and a member of the 13-person Fatality Review Committee that looked into Zy-Nyia's case. The committee concluded that the state doesn't give caseworkers the tools to do their jobs.  Zy-Nyia was beaten to death on May 27 while in her mother Aretha Sconiers' care. Sconiers has pleaded not guilty to a charge of homicide by abuse and is awaiting trial. The social worker overseeing Zy-Nyia was handling 24 other cases -- higher than the national average of 17 -- and was too busy to visit the month before the toddler's death.
    The independent team of community specialists that released its report yesterday said the caseload of Zy-Nyia's social worker was typical of many Child Protective Services staffers. The state should create "case-management teams" for individual children, so responsibility for them is shared by several professionals instead of one person, the panel said. Also, the panel recommended that individual case workers handle a standard of 20 cases each. "We ask these caseworkers to be God, and then we tie their hands behind their back and don't give them the resources," said Dr. Willa Fisher, a pediatrician and co-chair of the committee. Committee members said "consistency and continuity" in case management, through the formation of teams, would help better protect children from abuse.  The panel's observations and recommendations are similar to those made by others, including state-paid consultants who earlier this year said caseworkers were overworked and confused as to what they should be doing -- protecting children or reuniting families.
    Child Protective Services and the Department of Social and Health Services were widely criticized after Zy-Nia's death. The girl died less than four months after DSHS returned her and her 7-year-old brother to live with Sconiers. The consultants report recommended sweeping changes in CPS, saying caseworkers who look after abused and neglected children have dangerously high turnover rates.  Earlier this year, a Seattle Post-Intelligencer examination of documents related to the Zy-Nyia case found that warning signs were overlooked by the social workers and others. The social worker found evidence that Zy-Nyia's brother had been abused about a year before she was beaten to death, but the social worker did not report that to CPS. Sconiers, who had a chronic history of drug abuse and violence, lost custody of Zy-Nyia at birth after the newborn tested positive for drugs. After that, Sconiers was sent to prison on drug-related offenses. However the state, in an attempt to give Sconiers a chance to redeem herself, repeatedly delayed plans to end her parental rights. The report released yesterday by the Fatality Review Committee also noted that important trial dates to determine whether to terminate Sconiers' parental rights were set and continued at least five times, and that the case was heard by numerous commissioners and judges. Zy-Nyia also had five individual social workers in her brief life. "There were times when nobody was in charge of her case," Fisher said.
    Rosalyn Oreskovich, assistant secretary of the DSHS Children's Administration, said the panel's report provided good perspective but contained no surprises. It will take the department about a month to review and respond to the report, she said. "We are carefully considering the recommendations and will make serious efforts to implement them as much as financial and staff resources allow," she said in a statement. Committee member Rep. Ruth Kagi, D-Lake Forest Park, said the group realized the recommendations will be costly and could be a tough sell in Olympia; budget constraints are expected to force lawmakers to make cuts to many state programs during the next legislative session. "We are definitely facing a very challenging budget," said Kagi, who added that she hoped the high-profile Zy-Nyia case would help focus attention on the needs of vulnerable children.

Zy-Nyia Nobles timeline:
Nov. 15, 1996: Zy-Nyia Nobles is born to 22-year-old Aretha Sconiers; both test positive for drugs.
January 1997: Sconiers sentenced to 30 months at Purdy Correctional Center on cocaine-related drug conviction; Zy-Nyia and her 4-year-old brother in temporary foster care.
Feb. 9, 2000: Both children returned to Sconiers; family-support workers visit weekly and Sconiers is to attend counseling.
March 2000: Sconiers tells support workers she doesn't need the service.
April 11, 2000: Sconiers tells social worker Zy-Nyia burned her foot in bath after brother ran water too hot.
May 27, 2000: Zy-Nyia is beaten to death while at home with Sconiers.
June 5: Sconiers pleads not guilty to homicide-by-abuse in Pierce County Superior Court.

Etched Threats: Mass. Court Deciding Whether a Student's Drawings Merit Punishment
Amanda Onion, ABC News- 11/30/2000

Normally children’s drawings are considered cute, not feared. But in a Massachusetts middle school, the doodles of a 12-year-old were determined to be so threatening the student was arrested and slapped with criminal charges. The drawings, which a student presented to his teacher after being expelled from a class for talking, depict a boy pointing an oversized gun at a teacher. Tears drip from the teacher’s face and the words "Please don’t kill me" are written in a bubble from her mouth.  Two years ago, a lower court ruled the drawings constitute a serious threat and sentenced the boy to more than five years probation.
    Free speech advocates say the Worcester, Mass., case, which is now being reviewed by the Supreme Judicial Court, the state’s highest court, is emblematic of a trend by teachers and school officials to overreact to harmless adolescent expressions for fear that students might lash out for real.  But, in the wake of seven deadly school shootings in the past three years, including a rampage at Columbine High School in Colorado that left 15 dead, school officials argue they have no choice. "It’s impossible now to simply dismiss out of hand, crazy comments about weapons and violence," says Wayne Ogden, principal of Duxbury High School in Massachusetts. "Every threat has to be scrutinized for the sake of safety of the students."

Deciding When to Act
Ogden speaks from experience. Last month a student at his high school threatened to shoot classmates and teachers. Ogden says the student’s threats became so hostile that the matter was becoming a disruption at the school. "It comes down to the right of every individual student to have access to their education vs. the right of the remaining students to exist in a physically and emotionally secure environment." he says. "And it’s a tough one." In the end, Ogden felt obligated to act. The student was arrested and charged and has been suspended from the school.
    Across the country, school officials have taken similar initiatives to try and nip school violence in the bud. According to John Roberts, director of the Massachusetts American Civil Liberties Union, a student at Methuen High School was suspended recently after writing in the margin of his math test "Trench Coat Mafia." The name refers to a club at Columbine High School that purportedly included shooters Dylan Klebold and Eric Harris. In Illinois, two elementary school students were suspended in 1999 after carrying nail clippers with knife-like attachments. In Virginia, a 12-year-old boy was expelled for waving a stapler as if it were a gun on a school bus. And in southeastern Massachusetts, a student at Boston Latin Academy was suspended after writing a short story in which a teacher has her hands cut off and is killed. Roberts claims many more cases go unreported. "We get calls from parents who feel their children’s rights have been violated," he says. "But they don’t want to go on record for fear of being exposed within the school. It’s really become a ‘One strike you’re out’ policy."

Fear Despite Dropping Crime
   The rigid atmosphere that Roberts claims exists in schools today coincides with a relatively mild period of violence in American schools, according to a recent federal study. The study, released in October, shows the percentage of children who reported they were victims of crime at school dropped from 10 percent in 1995 to 8 percent in 1999. Despite such encouraging data, a string school shootings in the past few years remain fresh in public memory. In response, candidates in the 2000 presidential election made school safety a priority in their campaigns. And a Secret Service study released last month recommended that teachers listen to their students and look for possible patterns.   "Some of these behaviors may not lead to actual attacks," says Randy Borum, a forensic psychologist and mental health law expert who worked as a consultant for the Secret Service report. "But there are patterns of behavior that should raise an index of concern."
    Roberts and others claim the Worcester case, where the student was punished for his violent drawing, represents an especially egregious violation of the student’s freedom of expression. Kathleen Kelly, the boy’s lawyer, argued in court that a picture alone can’t be considered a threat. "If a picture communicates a thousand words, why does one need a thousand words?" Chief Justice Margaret Marshall asked during the hearing of the case earlier this month at the Supreme Judicial Court. "Because if it’s a picture alone, there’s no intent within that picture to communicate the threat," Kelly replied. By punishing a young person like the Worcester student, some argue schools are needlessly jeopardizing their students’ futures. "There is a stigma attached for a kid being sentenced to anything," says Jason Ziedenberg, a senior policy analyst at the Justice Policy Institute. "Now we’ve criminalized this kid and made him at risk for falling even deeper into the criminal justice system — all for drawing a picture."

Drawing as a Tool
Claudia Ronaldson, acting director of Expressive Therapies at the University of Louisville Allied Health Science Department in Kentucky, uses drawing to help counsel troubled children and teens. While she believes schools should be sensitive to signs of violence, she is also uncomfortable with the idea of limiting students’ freedom to express themselves through drawing — no matter how violent the drawings may be. "If we limit students’ freedom to draw, we eliminate one of the few, nonverbal vehicles they have to express themselves," she says.
    The Massachusetts high court is expected to rule on the Worcester case this month. In the meantime, the student who drew the pictures has entered counseling. And that, says Charles Patrick Ewing, a child and forensic psychologist at the University at Buffalo State University of New York, is a positive result of acting early. "Kids who make threats are kids who are often troubled and are asking for help," he says. "Getting them that assistance is good — as is teaching them that school is no place for threats."

Family on the Brink: Inside One Household- Rage, Violence, Fear & Despair
ABC News, 11/30/2000

When Jonathan and Joseph Foster were 12, they seemed out of control — even they feared they were headed for a violent end. That was three years ago, when ABCNews first got to know them. In the wake of several school shootings, we decided to look into the problem of ungovernable kids and what sets them off. The Foster twins’ mother, Lisa, said she was on the brink of despair and asked us to document the struggle she was having with her sons by placing cameras in her home with her sons’ knowledge. After witnessing the boys’ anger, including Jonathan’s fascination with knives and threats of suicide, Summit Quest Academy, a residential facility in Pennsylvania, offered free, long-term treatment for the boys. The boys spent nine months in the program beginning in 1998, where they received schooling, counseling and medical attention for what was diagnosed as attention deficit disorder and obsessive compulsive disorders, among other conditions. One day before their 14th birthday, the twins were allowed to return home because of their rapid progress. Two counselors from the academy accompanied them to monitor the boys and brief their mother about her roles, such as setting up consistent rules and talking out problems.
    Once again — this time, presumably, to show the world the boys’ astounding progress — Lisa Foster invited PrimeTime into her home, with the boys’ approval. Several cameras were placed in the home, again with her sons’ knowledge. Periodically, she would send us tapes. We ended up with 303 — approximately 1500 hours of raw footage — in all. For the first week, Jonathan and Joseph seemed to be trying to hold on to the habits they had learned in their months at the treatment center. They willingly did their chores and played together without violence. And Lisa and her boyfriend, Joe, were affectionate toward the boys, praising and rewarding them. We were expecting to find a happy ending. But after the first week, the tapes showed a change. The boys’ behavior once again erupted into wild rages, threats, torment and despair.

'Living in a Pressure Cooker'
Lisa had agreed with the boys and their counselors on a behavior contract, which also outlined what their daily chores would be. But after the counselors left, Lisa started to change the rules and the list of chores grew. Lisa’s praise waned, and she began to subject them to a mounting din of harsh criticism. While the boys did procrastinate at times, they seemed to be trying to remain mannerly and obedient — even in the midst of orders and threats from their mother. Lisa, a former hospital clerk who adopted the boys as infants along with the husband she divorced 10 years ago, said she was provoked by the boys in scenes that took place away from the cameras. She also insisted the boys were displaying exceptionally good behavior for the cameras and that her tender moments were not caught on tape.
    To understand the situation better, PrimeTime convened a panel of experts. Dr. Patrick Tolan, head of the National Research Center on Juvenile Violence, watched excerpts along with five other panelists. In one scene, Jonathan pleaded to talk with his mother but was greeted with "I don’t talk. There is no talking. I always win." "He cannot get any kind of response that allows him to calm down," said Tolan. "That’s how you make people become angry and frustrated and aggressive." Other panel members, having witnessed Lisa’s yelling, extreme emotional outbursts and threats of putting her son in jail as well as Jonathan holding a kitchen knife to his throat and threatening suicide, said Lisa had created a difficult and charged atmosphere for the boys. "The idea of anyone living in a pressure cooker, like these children do, only gives them a limited number of options," said Doug Shine, a family therapist. He, suggested the boys might run away to escape, kill themselves, or shut down completely. "They are being terribly provoked here," said Tolan. "I don’t see a lot of hope," said Shine.

Seeking Treatment
When the situation had calmed down, and the boys got more medication, after missing them for five days, we took our cameras out of their home. But six weeks later, Lisa called and said things were once again spiraling out of control. She said she had to have Joseph arrested for animal cruelty. He pleaded guilty to tying a rope around of one of her dogs and dragging it, and was placed on probation. Lisa asked us to put the cameras back into the house to see how truly dangerous the boys had become. But once again, as we watched the tapes, it seemed to us that they showed the boys tried to be loving, while their mother kept erupting and threatening to send them away. "It’s heartbreaking," said Tracy Prendergast, the boys’ therapist from their time at Summit Quest Academy. "I saw how much love they have to give, how much energy they have, how much excitement they have about the world around them … and I don’t see them getting what they need in this house." Tolan added, "I think the taunting, the threats, the chasing them and both the parents screaming at them, I would consider all those abusive."
    This fall, the state of Florida went to court to have the boys permanently removed from their home. Judge Jack Singbush said, "The court is rarely surprised, but often appalled … and this is one such case." The judge cited emotional abuse of the boys as his primary concern. "At this juncture, the court will not allow the children to return to the home because they would not be safe," he said. Florida’s Department of Children and Families took the twins out of their home and they are now in separate foster homes for children who need special intensive therapy. Lisa was ordered to undergo monitored psychiatric treatment for one year; only if she successfully completes that course of treatment will the boys be allowed to return home. Lisa’s attorney says she plans to appeal the ruling.  Summit Quest Academy, where the twins received free treatment after ABCNews’ first segment aired in 1998, has set up a special fund to help the Foster boys and other children in therapeutic care to obtain items that help build self-esteem and confidence, such as sports equipment and computer software.

Remedies for Violence Elusive
Sarah A. Webster, The Detroit News- 11/29/2000

DETROIT — On Jan. 2, a 17-year-old from the city’s west side was stabbed in the back with an ice pick during a party fight. Paramedics rushed Allen Nickols to Detroit’s Henry Ford Hospital, where doctors did a battery of tests and determined the pick missed his spinal cord by just an inch — an injury that could have resulted in paralysis and taxpayer-supported disability payments. Doctors patched up the wound and sent him home. But three months later, Henry Ford Hospital followed up in a way most hospitals don’t. It sent a letter: We have found that young men who have been injured in a violent way and come to the hospital are more likely than other young men to be injured again. In fact, their chances of being more severely injured or of dying is far greater than other young men... The hospital invited Nickols to a 20-week program it launched this spring — a course that represents a small but growing trend among health care providers and insurers to devise ways to curb violence and the millions of dollars in medical bills it spawns.
    An eight-month Detroit News analysis found that Southeast Michigan hospitals charged an estimated $210 million to treat intentional injuries during the past two years. Those bills were less likely to be paid than other types of medical expenses — meaning the costs are passed along to everyone who buys health care. Health-based anti-violence programs show how much more could be done to curb intentional injuries, but the sophistication of the efforts vary widely. There are few tools to measure their effectiveness, and when a program does work, there has been little communication among health advocates on how to replicate the success. "There hasn’t been a consistent approach," observed Dr. Mark Brautigan, chief of emergency medicine at Sinai-Grace Hospital, Detroit.
    Furthermore, doctors complain there are few follow-up programs or guidelines to help their patients rid their lives of risky, violent behavior, as there are for other preventable health conditions, such as smoking or obesity.  And patient screening for violence is not yet routine, said Dr. Henry Maicki, an obstetrician-gynecologist at Providence Hospital in Southfield. "There is nobody you should not screen," he said.

Trying to diagnose causes of violence
Henry Ford Hospital’s Teen Enrichment Program employs a classic public health approach and sets an example for what can be done sensibly in health care to curb violence. The public health approach is a scientific way of identifying the location and scope of the problem, with data and testing interventions, to collar the problem early, before it escalates.
    With HIV/AIDS, for example, public health experts examined infection cases to determine where and how the disease was transmitted. Then, they developed strategies to block the transmission and flooded problem areas with information on abstinence and safe sex. At Henry Ford, hospital officials used research that showed 44 percent of the violence victims it treated returned with more violent injuries.
    Rick Blakeney, project coordinator for the health system, decided every time a teen-ager came to the hospital with an intentional injury, Henry Ford would try to stop the escalation of violence — which tends to worsen from fights to gun violence — by inviting him or her into this program. The hospital asked Nickols and others like him to attend a weekly, five-month course on self-esteem, life planning and health. It even provided free dinner during the classes, plus $75 over three installments. Nickols, whose own father was paralyzed in a stabbing more than a decade ago, decided to go.
    About 30 kids participated in the first session — a few escorted by their mothers and siblings. They learned how to walk away from fights, drugs and gangs, and how they drained hospital resources. The teens were given an attitude survey before and after the program, to measure whether their beliefs about violence had changed. While those results have not yet been tabulated, the program, so far, seems successful. None of the kids in the Teen Enrichment Program has been back to the emergency room, Blakeney said. Nickols is working on his GED and long-term plans to become a paramedic. "I almost ended up just like my father," the lanky Nickols said, munching on pizza one night at the hospital. "I felt like I had to do (this program). I feel like it’s my last chance."

Little hard proof programs work
While Henry Ford Hospital evaluates its program’s success with hard data, many do not. Some anti-violence programs in Metro Detroit offered anecdotal evidence that they work, but only one out of the four main anti-violence programs offered by city hospitals had hard proof. That program, the Peace Club, is offered through Detroit public school health clinics operated by St. John Health System. Data from McNair Middle School, where the Peace Club was first implemented in 1997, showed fighting dropped by 48 percent, to 61 brawls, in 1998, said Ken Coleman, who oversees St. John’s school-based health centers. Other violence prevention programs, while well-intentioned and even inspirational, offered little hard evidence of success.
    At Sinai-Grace Hospital in Detroit, health workers operate Stop the Violence, a program that brings students — not necessarily victims or perpetrators of violence — into the hospital for an anti-violence lesson. The children visit the morgue, hear stories from people disabled by violence and look at emergency room slides of people brutalized by violence. And while children twist in shock and horror at the site of a knife-slit stomach or bat-crushed skull, Dr. Brautigan has no idea if the half-day program is effective. "We don’t know what kind of impact the project has had, other than word of mouth," he said.
    The same is true for the Pioneers for Peace at the Rehabilitation Institute of Michigan, where hundreds of people have been treated for permanent, violent injuries. The Pioneers, people who have been disabled by violence, tell their stories to youths who are under court order to attend the session. Sometimes, they also visit local classrooms or Sinai-Grace’s Stop the Violence sessions. While exposure like this is seen as important, the Rehab Institute has little more than letters from some touched participants to assess whether the discussions really make a significant difference. Brautigan said he is one of many doctors who feel the response to violence "should be elevated to a more scientific concern."