Noteworthy News Articles on Mental Health Topics, June 18-20, 2000

Diet Supplement Marketers Target Kids
Guy Gugliotta, Washington Post- 6/18/2000

Dietary supplement companies have begun aggressively targeting children and parents as consumers of their products, among them powerful chemicals designed to help kids gain strength, lose weight or treat illnesses ranging from colds and flu to depression and even attention deficit disorder. As a result, increasing numbers of children are swallowing supplements, often with the knowledge, urging and even insistence of parents in search of "natural" remedies or "healthy" alternatives for youngsters who eat too many cupcakes or drink too much soda. One survey recently found that almost 20 percent of parents were giving their children supplements. In Vancouver, Wash., Nutrition Now Inc., for example, created a cuddly rhinoceros cartoon character to promote its line of dietary supplements for children, including Rhino Pops containing the herb echinacea, a cold treatment. "100% natural, Moms love the soothing support, kids love the all-natural taste, vegetarian approved," reads the legend on the box. From Saco, Maine, Fresh Samantha Inc. ships to supermarket shelves nationwide "body zoomer" fruit smoothies that carry cartoon pictures of children to catch the eye. A 16-ounce bottle of "Oh, Happy Day" contains 100 milligrams of the herb St. John's wort "to lift the spirits." Many adults in search of an alternative to antidepressants such as Prozac take a 300-milligram tablet of St. John's wort three times a day.
    Although some products may be helpful, the surge in supplement use by children and adolescents is causing rising alarm among pediatricians, children's health advocates and federal and state medical officials. At the least, many of the products may be useless. At the worst, some may be dangerous, they say. Supplements are largely untested and unregulated. The full short- and long-term impact of these substances on young bodies is virtually unknown. And in some cases, there's evidence they may be harmful. "Physicians use medications that have been tried and tested, with known side effects," said Rossanne Philen, chief of environmental hazard epidemiology at the Centers for Disease Control and Prevention in Atlanta. "When children are given herbal preparations, they are at the mercy of the adult who is experimenting on them."
    Companies offer discounts and rebates in some states to high school coaches who supply creatine, a powerful body-building nutrient, to their athletes. In Fairfax County, coaches are forbidden to promote creatine, but that doesn't stop it from being popular. "I did a report on creatine in journalism class when I was a freshman, and I did some research on different Web sites," said Sean Curry, 16, a running back on the Chantilly High School football team who noted that he has told his parents he is using creatine. "I started taking it last year, and I'm taking it now." Curry said he has gained 31 pounds over two years. "It's definitely been valuable." Some products even include the stimulant ephedra, which is still recommended for children by some supplement salespeople for attention deficit disorder even though it has been linked to serious illness and even death by the Food and Drug Administration. Much of the industry warns youngsters under 18 away from it.
    Because there's no central source of information about adverse reactions to supplements, it is difficult to get an accurate accounting of whether they are causing widespread problems. But almost all supplements can produce some unpleasant side effects, and their overall safety remains far from clear. The reason for this is that dietary supplements, as defined by the 1994 Dietary Supplement Health and Education Act, may be sold without pre-market clearance by the FDA or a detailed scientific evaluation of their safety and effectiveness. Also, unlike prescription drugs, the FDA must prove a supplement is dangerous before removing it from the market. As a result, thousands of products are sold over the counter to anyone who wants them--including children--with far less scrutiny than prescription drugs.
    Mark Blumenthal, executive director of the American Botanical Council, an herb advocacy group, acknowledged that no one has done a "formal risk-benefit review" of dietary supplements, including those designed specifically for children. But he noted that many herbal remedies have been used for hundreds or even thousands of years and are well known outside the United States."With only a few exceptions, most of these herbs are some of the best-researched in the world," Blumenthal said. "In Europe, where they are sold in pharmacies, they have a stellar record of safety."

Unreported Toll
Unlike pharmaceutical firms, supplement companies are not required by law to report serious product problems to the government. Agencies rely on sporadic voluntary reports that frequently come from inexpert sources. The American Association of Poison Control Centers, which collects data from 65 locations in all but a few states, in 1998 listed 704 reports of bad experiences with dietary supplements involving youngsters ages 6 to 18. The association's list of supplements does not include ephedra, used primarily by adults to boost energy or lose weight and the subject of a virulent controversy between the herbal industry and the federal and state agencies seeking to regulate it. In a report earlier this year, the FDA documented 134 cases linking serious illness--including insomnia, nervousness, seizure, hypertension, stroke and death--to ephedra during a 33-month period ending in March 1999. Ten of the reports involved children younger than 18. In one case, a 15-year-old girl was hospitalized with severe chest pain after taking six ephedra tablets and drinking a pair of "double-shot (coffee) lattes," the FDA report said. The labeled dosage was two tablets, three times daily to lose weight, but the 125-pound victim decided to take all six pills at once. The FDA has also documented cases of adverse effects from other supplements. Echinacea and ginseng produce minor and infrequent problems. The same is true of St. John's wort. A substance known as DMAE, included in products marketed as alternatives to Ritalin for the treatment of attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), can cause side effects similar to Ritalin's: insomnia, hives, headache, drowsiness and involuntary muscle movement.
    Creatine, taken to enhance the body's ability to deliver energy to muscles, also causes muscles to accumulate water, which can lead to weight gain, cramping, muscle strains, dehydration, diarrhea and gastrointestinal pain. The University of Tennessee recently banned creatine after 14 of its football players had cramping episodes during one game. Many of creatine's bad effects can be avoided by cautious use, but this is not a talent generally ascribed to the young. "High school kids don't have a clue about how to take it," said sports nutritionist Ruth Carey, a registered dietitian in Portland, Ore. "I don't find a whole lot of awareness on the part of parents, either. They don't realize it's an unstudied drug." At the same time, there has been little research on creatine's long-term effects, and virtually none regarding its effects on young bodies.
    Finally, studies have shown that the potency of many herbal supplements--including St. John's wort, ginseng and ephedra--often does not match the potency advertised on the bottle. A survey of 20 ephedra products conducted by the University of Arkansas in May found that the potency of half of them was either much greater or much less than what was indicated by the dosage listed on the bottle. "Support for this type of thing [supplements] is simply not there. We don't know proven effectiveness. We don't know contaminants, or the concentration bottle-for-bottle," said Susan S. Baker, chairman of the American Academy of Pediatrics' committee on nutrition. "It's pretty serious. It's like taking a vial of water and not knowing whether it comes through a filter or from the sewer--and then drinking it."

Aggressive Marketing
Despite these misgivings, supplement companies are actively marketing a range of products for children using a variety of techniques. Some strategies are obvious. Considerable science has shown that creatine increases power in short bursts in sports that require it, such as weight lifting, football and sprints. MLO Products Co. of Fairfield, Calif., has forged a relationship with football powerhouse Mater Dei High School of Santa Ana, Calif. "How Would You Like to Increase Lean Weight By 11 lbs. In 3 Months?" read a promotion on MLO's Web site. "The Mater Dei High School football team has been consistently ranked among the top 10 teams in the country." The company originally provided creatine to Mater Dei in order to use its athletes in a study and then publish the results, said Ryan Snyder, a sales manager. "We've just continued sponsoring Mater Dei," Snyder said. "We just want to be associated with a high-quality football program." In Irvine, Calif., Met-Rx Engineered Nutrition has gone a step further. It has 200 high school "Mentor" programs in "almost every state," according to marketing directing Charlie Wright. Met-Rx supplies creatine and other supplements to athletes at 60 percent of the retail cost and sends 10 percent of the purchase price to the school's athletic programs. Coaches and parents must approve each athlete's participation, thus opening "a communications link" about nutrition, Wright said. "Here's a way for them to get information [on supplements], save some money and create some new revenues for strengthening athletic departments." Other marketing strategies simply developed from consumer demand.
    At Gaia Herbs, based in Brevard, N.C., herbalist Mary Bove designed a set of 20 products for children to respond to "physicians all over the states . . . calling me about giving kids herbs." Gaia's list, one of the country's most extensive, includes products ranging from "Skin Cream for Baby Bottoms" to "Melissa Supreme for Children," an herbal treatment recommended in company literature for ADD and "impulsiveness." Melissa, also known as lemon balm, is a medicinal tea herb and mild tranquilizer used as a sleep aid or to calm an upset stomach. Gaia's literature suggests combining Melissa Supreme with a second supplement containing St. John's wort for "hyperactivity, mood swings and tantrums."
    Concern about ADD and ADHD, combined with parental misgivings about Ritalin, the most popular pharmaceutical treatment for these conditions, has spawned a brisk competition among companies searching for alternatives. "Attention Focus," made by Nature's Way of Springville, Utah, uses essential fatty acids to encourage "proper transmission of brain and nerve signals," the label says. Herbs Etc., a Santa Fe, N.M., company, sells a melissa product called "Kid-A-Lin." The Scotts Valley, Calif., company Source Naturals hit pay dirt in 1999 with "Focus Child," developed by Cathleen Rapp to find "something to appeal to people who don't want to use Ritalin." Focus Child's key ingredient, dimethylaminoethanol bitartrate or DMAE, was developed by Riker Laboratories in the 1950s and sold by prescription for nearly 30 years as "Deaner," a treatment for children's learning disabilities. But in 1983, the FDA forced DMAE's removal from the market after determining that it wasn't effective. Nevertheless, there are several DMAE child supplements today, including chewable tablets and fruit and chocolate bars. Natural Organics of Long Island, N.Y., makes a DMAE product called "Pedi-Active A.D.D."--an "advanced diet delivery" system, according to the legend on the label. At least one company, the Utah-based Enrich International, has promoted ephedra in the past as a substitute for Ritalin to treat ADD and ADHD among young children, and at least some of the company's affiliated salespeople still recommend it. And Mary Lou Wilson, who buys Enrich products and resells them as an independent Enrich distributor based in Granbury, Tex., continues to recommend ephedra six years after she prescribed it for her grandson, Woody, then 10 and suffering from ADHD. "He used it for three months and never had to use it again," she said. "It makes such a difference."
    Ephedra is a close cousin of methamphetamine, and in the past enjoyed a certain status among many young people as "legal speed" because of the kick it could give, especially when combined with other stimulants, such as caffeine. Most large ephedra companies stopped promoting ephedra as a source of a natural high and in recent years have put labels on their products warning against the use of ephedra for any reason by anyone under 18. But the companies' position remains ambiguous. The industry opposes a proposed New York ordinance to prohibit ephedra sales to youngsters under 18, believing "it would be more effective as a labeling issue," said Wes Siegner, counsel to the ephedra committee of the American Herbal Products Association. "You don't want to cause trouble for salesclerks." And despite the warning labels, ephedra still enjoys considerable popularity among teenagers trying to lose weight. Ephedra's checkered reputation makes some retailers nervous. "I won't sell the tablets to kids," said Damien Gray, branch manager for a General Nutrition Centers store a few blocks from Suitland High School in Prince George's County. "They'll take one, and it won't have any effect, so they'll take more. Who knows what's going to happen?" But the brightly colored energy-boosting ephedra drinks, many of which also carry warning labels, are a different story. "At least I know how much they're getting," he said.

Eager Consumers
Once a promotional strategy is in place, many companies are finding instant success with an eager public. The San Diego-based Nutrition Business Journal, which tracks the industry, reported 1999 sales of $120 million in herbal and nutritional supplements for children. In 1999, a study conducted by National Public Radio, the Kaiser Foundation and the Kennedy School of Government found that 18 percent of parents were giving their children dietary supplements that were not vitamins or minerals. "A lot of parents are finding that natural herbal remedies are working very effectively on their kids, and it's taking a lot of pressure off of running to the doctor every time you get a runny nose," said Amy Zanger, manager of the Crossroads Health Hut in Glendale, Ariz., near Phoenix. "People are taking charge of their own health, and the pendulum is swinging natural." Supplement-containing "body zoomers" are "one of our top selling categories," said Fresh Samantha public relations manager Kim Mayone, who acknowledged that "Oh, Happy Day" contains "a mood-enhancing herb," but not enough for it "to be a medicine."
    In less than a year, Source Nutritionals' "Focus Child" became a top-10 bestseller for a company that sells more than 400 items. For health food store manager Zanger, it was a godsend. "We're not into drugging our kids," said Zanger, worried because her son, 8, couldn't concentrate in school. "So we decided to go natural." They chose Focus Child. "I just got his progress report card, and I almost cried; it was so much better," she added. Zanger also gives Focus Child to her 2 1/2-year-old son "before we go out to eat or to the movies" to keep him quiet. "It seems to be fine for him."
    Creatine, because it works, because it's legal and because it does not appear to have any unmanageable side effects, is in a class by itself as the most popular sports nutrient on the planet, with sales of $400 million worldwide. In a 1999 Blue Cross-Blue Shield Association survey, 27 percent of children ages 12 to 18 said they knew someone who used performance-enhancing substances, and more than half of those knew someone who used creatine. A survey by New York's Mount Sinai Hospital Sports Medicine Center found that children of both sexes as young as 12 were using creatine and that usage rose to 44 percent among high school seniors. "I took it for a month to get stronger for the football season. My bench press increased 30 pounds, and my curls and squats increased 50 pounds," said Tommy McDonald, a 190-pound senior offensive guard at Jesuit High School in Portland, Ore. "All of a sudden, everything shot up very quickly. I made all-league." But sometimes, marketing strategies go awry. In 1998, the ESPN sports network apologized for running a General Nutrition Centers ad for creatine during the Little League World Series.
    In May, Boston's Efamol Nutraceuticals Inc. ran afoul of the Federal Trade Commission and agreed to stop advertising its products Efalex and Efalex Focus as cures for the effects of ADD and ADHD in the absence of scientific proof. J&R Research Inc. of Massena, Iowa, entered into a similar agreement for its product Pycnogenol. Efamol was using fatty acids as key supplement components, promoting them with a slogan that said "Long Term Side Effects May Include: Hugging your Mom." J&R Research's Pycnogenol is a substance dismissed in most scientific research as showing little evidence of either safety or effectiveness. And sometimes the bloom simply starts to fade. In recent years, there have been signs that creatine is losing favor among those who used to be its strongest promoters--some coaches are starting to question its use. "Hell, it's not illegal, and if you want your son on it, that's your business," said Dick Adams, head football coach at Annandale High School in Fairfax County. "But I don't promote it. I tell them, 'It's a drug. Don't be frustrated with what God gave you.' "
    Last year, the Texas legislature easily passed a law prohibiting public school employees from selling or promoting "performance-enhancing products" on school time after Ann Torrez complained that coaches at Hays High School outside Austin were offering to sell creatine to her son Lyndsey, then 15, to help him bulk up for the season. "Where are they [coaches] going to be 15 or 20 years from now if this should turn out to have damaging effects?" Torrez asked at a Texas House of Representatives committee hearing. "Are they going to be there to pick up the pieces from our children? I don't think so." That's the sentiment of Maryland health consultant Patricia Mann, the former team nutritionist for the Washington Capitals. "It's going to be years before we know what we've been doing to ourselves," Mann said. "We're not a toxic waste dump, and I don't know why people think they can put things in their body and not have bad events. You wouldn't treat your car that way."

Mixing Business, Advocacy
Guy Gugliotta, Washington Post- 6/18/2000

In the beginning, Debra Jones was simply trying to do a favor for a friend, but today she is a leader in the cause of finding natural remedies for the childhood maladies known as attention deficit disorder and attention deficit hyperactivity disorder. It is a fertile and growing field. Her organization, Parents Against Ritalin, is a rallying point for opposition to the leading prescription treatment for ADD and ADHD, and interest is "like never before," she said. Parents Against Ritalin, as its Web site attests, advocates "natural alternatives" for treating ADD and ADHD, including herbal and dietary supplements. "Our organization does not endorse or recommend any product, company, service or physician," Jones said. "We're not hooked up with a company." But Jones is. Since about the time she founded Parents Against Ritalin in Claremore, Okla., in 1995, Jones has served as an independent distributor for the Utah-based supplement company Enrich International. Jones said she is "very protective of there not being a conflict of interest," but in the murky world of health advocacy, disinterest may be a hard argument to make.
    Jones said she founded Parents Against Ritalin in response to a plea from a friend who had earned the ire of her son's North Carolina school district for refusing to put him on Ritalin. Her friend "had the resources" to win the battle, but others did not, Jones said. On Aug. 23, 1996, Jones appeared on behalf of the organization at a hearing in Austin, before the Texas Department of Health, to speak against a proposal to regulate the sales of products containing the herb ephedra, also known as ma huang. Enrich had a half-dozen speakers at the hearing, for while it makes only three products for children--a nutritional drink mix, an echinacea product and a tranquilizer using the sleep aid valerian--it produces a full line of adult supplements, including ephedra, usually marketed as a fat-burner or energy-booster. And in 1996, Enrich was actively promoting ephedra as a remedy for children's ADHD. Its in-house magazine at the end of that year included testimonials from parents who had successfully treated their children with Enrich products, among them "Spark"--each capsule of which contains 204 milligrams of ephedra. Ephedra is the most controversial supplement in the industry, linked by the Food and Drug Administration to 685 cases of serious illness and 39 deaths in six years, and is the subject of an ongoing battle between the supplement industry and would-be regulators in the federal and state governments.
    Jones discounts ephedra's reputation for serious side effects, including insomnia, nervousness, hypertension, seizures, stroke and death. "Often, when you investigate the details, you find that use of ephedra was only one of many contributing elements," she said. And in Austin, Jones made the case for ephedra as a Ritalin substitute: "It saddens me to think that we would live in a society today that would prefer to . . . drug our children than allow them to have the freedom to grow and to flourish naturally with herbal supplementation." Jones had no science to support her statement. Instead, she said, she relied on the endorsements of her members: "Parents have gotten in touch with us, and say they have gotten great results." Later that day, Jones and some anti-Ritalin parents joined ephedra company lobbyists in a meeting with Ron Lindsey, Gov. George W. Bush's health adviser. "They made the most impressive case I ever heard," said North Carolina-based health consultant Clinton Ray Miller, who represented Enrich and other companies at the meeting.
    Enrich, now a subsidiary of the Dutch nutritional giant Royal Numico, makes no claims regarding ephedra's use as a treatment for ADD or ADHD. Chief Operating Officer David Mastroiani, who joined Enrich in 1999, said he is "much more conservative with children and herbs." He noted that company lawyers are supposed to approve all promotional literature used by distributors. Three times--in 1996, 1998 and 1999--the Texas Board of Health proposed a rule making ephedra products available by prescription only; three times, in the face of fierce industry opposition, the board allowed the effort to die. Jones did not return to Texas's fight over ephedra after 1996, but her support for ephedra as an ADD and ADHD treatment remains unshaken. "You wouldn't think you would give an ADHD child a stimulant such as Ritalin (or ephedra) to calm them down and/or increase their focus, but in many children that's exactly the effect that is produced," Parents Against Ritalin's literature states.

The Little Professor Syndrome
Lawrence Osborne, The New York Times Magazine- 6/18/2000

They talk like adults and often have sky-high I.Q.'s, but their social skills are nonexistent. Can kids with Asperger's syndrome, a recently diagnosed form of autism, harvest their strange talents in adulthood? Around a circular classroom table, five 6-year-old boys are drawing pictures of blue whales with crayons. Mozart's "Requiem" pipes away on a nearby cassette player; by the window, a group of sunlit bean-bag chairs looks inviting. One of the children, Asa, is turning out a waxy masterpiece with the meticulous care of a jeweler. The fins and tail of Asa's whale, who is jumping out of the water, have been drawn with striking precision; a dialogue bubble percolates from its mouth. "Wow!" the whale is shouting. "Look at him--he's psyched," the bespectacled Asa says in a curiously expressionless voice. "He's so happy to be out of the water and turning double somersaults that he can't stop talking." The teacher, Lauren Cacciabaudo, asks each boy how he has managed his day. "How was your sitting, Henry? She says to one boy. "Three," little Henry says, giving himself a grade from 1 to 3. "Nice sitting, Henry! How about focusing, Jean Paul?" "Three." "Nice focusing, Jean Paul. What about looking in the eye, Asa?" "Three." "Nice eye contact, Asa!"
    Glued onto the surface of the classroom table are pairs of cut-out handprints. Frequently, Cacciabaudo asks the boys to put their hands on these prints and keep them still. For there is a flitting energy of restless birds about these boys, even though not one of them looks up to inspect the stranger sitting in their midst. Instead, they fixate on a colorful pencil I have just bought at the Guggenhemim gift shop. Bright green, it sports an elephant's head with felt ears on a mountable spring. The boys are mesmerized. "Where did you get that?" "How old is that elephant?" They bounce the elephant's head back and forth, sticking their fingers into its grasping mouth. "It's prehensile!" Asa coos.
    At first glance, this brightly decorated room is no different from that of any other elementary school. Shelves are filled with storybooks; on the chalkboard, a vertical line of words reads "prudence," "pretzel," "prairie." "purple." But the nervous agitation of the boys' hands, punctuated by occasional odd flapping gestures, betrays the fact that something is off kilter. There is also a curious poster on one of the walls with a circle of human faces annotated with words like "sad," "proud" and "lonely." When I ask Cacciabaudo about it, she explains that her students do not know how to read the basic expressions of the human face. Instead, they must learn them by rote.
    The boys in this Manhattan classroom, part of a special education school run in association with the New York League for Early Learning, all have a mysterious condition known as Asperger's syndrome--a neurological disorder that disproportionately affects males and is often connected to a striking precocity with language. The Learning Disabilities Association of America defines Asperger's syndrome as "a severe developmental disorder characterized by major difficulties in social interaction and restricted and unusual patterns of interest and behavior." Although sufferers display behaviors associated with autism--monotonic speech, social isolation, a paucity of empathy--they are not mute or incapacitated. Indeed, the outsize vocabularies of children with Asperger's often make them seem less disabled than gifted. In the United States, the syndrome was only made official among psychologists by entry into the DSM-IV.
    The precise relationship between Asberger's and autism remains to be untangled. Dr. Richard Perry, a child psychiatrist at N.Y.U. Medical Center, argues that Asperger's syndrome shares a basic triad of dysfunctions with autism: problems with social interaction, with communication and with play. Both types of children, he says, have perplexing difficulties in "reading" human social signals like facial expressions and dealing with the nuanced to-and-fro of ordinary conversations. "For some reason we don't yet fully understand," he explains, "Asperger's kids cannot decipher basic visual social signals. This leads people to see them as emotionally disturbed."
    Or brilliant. For the flip side of this somber picture is a recognition that Asperger's sufferers may also have extraordinary gifts. Consider Glenn Gould. The eccentric Canadian pianist, who died in 1982 and who retired from the concert circuit at age 31, was notorious for his bizarre behavior; he had a phobia about shaking hands, ate nothing but scrambled eggs and arrowroot biscuits and rocked incessantly at the keyboard. At the same time, Gould's obsessive focus and prodigious memory helped give his legendary renderings of Bach their burning intensity. Might Gould have been an Asperger's sufferer? Timothy Maloney, a musicologist who manages the Gould archives, suggested precisely that at a recent academic conference.
    Other scholars have retroactively applied the Asperger's label to oddball intellectuals ranging from Vladimir Nabakov to Bela Bartok to Ludwig Wittgenstein. Nabokov's hypertrophied vocabulary and obsession with butterflies, some say, may qualify him for the disorder (though an equally focused obsession with nymphs seems somewhat less incriminating). Such claims may be dubious, and probably infuriating to lepidopterists, but the argument is seductive to many: could the very qualities that make Asperger's people so strange lie at the root of their peculiar talents? This sense of potential explains why kids with Asperger's are being grouped together in special-ed classrooms. "If you look at these children, you can see at once that they don't have classical autism," says Jeanne Angus, director of the New York League school, who stops by Cacciabaudo's for a visit. "They're normal in so many ways. They're often very sweet. And they're often amazingly precocious, with sky-high I.Q.'s. But look closer and you'll see cracks. Many of them have had appalling difficulties in the regular school system."
    Those difficulties include temper tantrums and erratic behavior that can unnerve the most strong-willed teacher. Angus nods toward Asa. "When he first came here, he would roll around the floor all the time, just to get a feel for its texture." The boy had no idea that this was inappropriate. "The thing is," she goes on, "everything has to be taught to them--everything. When you ask them at first, 'How do you do?' they will say something like, 'Why do you want to know?' They simply don't understand social games."
    It is an impression of anarchic solitude that is often reinforced by the tendency of Asperger's children to have obsessional interests. Angus tells me that Michael, one of the boys in the class, had a fixation with tornados when he first arrived at the school. "He knew everything about them. The statistics, the G forces, the wind velocities. He was like a videocassette about tornados, which he could rewind and play over and over. He was using technical terms I've never even heard of . And he was 5!" Michael also behaved like a tornado, whirling round the room and tearing everything up.
    Other children have sometimes bizarre fixations. They will memorize entire TV shows and recite them over and over (an ability known as perseverative scripting). Other times, they specialize in memorizing everything there is to know about the oddest things: deep-fat fryers, telephone cable insulating companies, the passengers on the Titanic, exotic species of cicadas, the provincial capitals of Brazil. In one documented case, a child memorized the birthdays of every member of Congress. Needless to say, these obsessions are deeply unsettling to parents. "Just imagine," says Fred Volkmar, a child psychiatrist at the Yale Child Study Center, which is conducting the nation's largest research project on Asperger's syndrome. "You walk into a hamburger joint and your 5-year-old suddenly points at the fryer machine and cries, 'That's a Sigma Model 3000!' What do you say?"
    It is a confusion that is compounded by the linguistic precocity of Asperger's children. "Up to the age of 3," Richard Perry says, "Asperger's syndrome and autism are very similar. But then the former begins to talk. And how!" Unlike the linguistically impaired autistics of the type depicted in the movie "Rain Man," Asperger's children talk like little professors. "They seem brilliant because they have this language," Volkmar says. "But in reality, it's fact-obsessed, fact-oriented. It's rigid and insular. It's not a social brilliance. Usually, their social interactions are a disaster." And according to Perry, this has been precisely the predicament of Asperger's children in the past. "Frequently," he says, "they have been misdiagnosed because they're almost normal. They almost blend in, but not quite. That's their tragedy." "They are," says one parent at the Manhattan school, "perfect counterfeit bills."
    This baffling syndrome was originally diagnosed a half-century ago by the Austrian pediatrician Hans Asperger. In 1944, Asperger published his postgraduate thesis, "'Autistic Psychopathy' in Childhood," which described many of the symptoms of the syndrome and ascribed a genetic basis for them. But Asperger refused to label children with a heavy psychiatric hand. Autism, he argued, was not a straightforward fate; the condition could be ameliorated through "pedagogical methods." Working in Nazi Vienna, Asperger was surely aware of the prospect of many autistic children being sent to concentration camps after being labeled mentally retarded. Thus, he ended up creating a more optimistic picture of the disorder than the vision of crippling disability that the psychiatrist Leo Kanner had described in his groundbreaking analyses of classical autism, first published in 1943. Asperger and Kanner mapped out two different ends in the spectrum of autism: the Asperger end was distinctly sunnier, with the possibility that such "high end" autistic children could thrive and even be gifted in their way.
    After World War II, Asperger's subtle contributions were temporarily lost as the center of gravity in child psychology moved from the German-speaking world. Only in the 1970's was Asperger's research revived by a British researcher named Lorna Wing at the Medical Research Council in London. Along with her collaborator, Judith Fould, Wing set out to study autistic children in the London borough of Camberwell. After a few months, Fould and Wing began to realize that the social problems of autism could be manifested in highly divergent ways. "For example," Wing says, "instead of being socially aloof and indifferent, the classic autistic picture, some children made active and social approaches to others, but in a naïve, hopelessly inappropriate way." Instead of having no language or stunted language development, some children had perfect grammar and a huge vocabulary. "Even so," she continues, "they used this to talk on and on in a monotonous way about pet subjects."
    Wing began to see a link between the children she was studying and the symptoms described by Asperger back in 1944. But unlike Asperger, who had believed in a clean distinction between autism and "his" syndrome, Wing saw the two as shading into each other. "We developed the idea of a very wide spectrum of autistic disorders, of which Asperger's was only a part." Wing published her findings in 1981 in the journal Psychological Medicine. At last, Asperger's syndrome, the hyperverbal realm of autistic experience, had entered the realm of official psychiatry. "I felt," Wing recalls, "like Pandora opening the box."
    Currently, the Yale Child Study Center is working with 900 families nationwide to produce the first empirical diagnostic for Asperger's syndrome. One of its directors, Ami Klin, says that it was only seven years ago that Yale researchers began tracking socially isolated children who did not fit the profile for classic autism. "Cognitively, they were quite good," he says. "But socially, they were disabled. They fell between the cracks." Asperger's children, Klin feels, are unique. "Classic autistic people," he says, "are bad at language, good at images; with Asperger's people, it's exactly the opposite." Yet efforts to produce a cast-iron definition of Asperger's has been difficult. Scientists involved in the Yale study are mapping out chemical reactions in the brain as it tries to decode faces and exploring abnormalities in "eye tracking"--the reaction of the human eye to social signals. This research may provide a way of pinpointing Asperger's suffers. "But it will take time," Klim cautions.
    This diagnostic uncertainty makes it extremely hard to know exactly how many people suffer from Asperger's. A 1993 study reported a prevalence of 36 per 10,000 children, while a 1999 paper reported a rate between 2 and 5 per 10,000. (The male to female ratio is at least 5 to 1) Since Asperger's entered the DSM-IV, the number of students in U.S. elementary schools found to have some form of autism has soared by 154 percent to around 35,000, an increase attributable in part to Asperger's awareness. Indeed, Asperger's advocates tout figures as high as 1 per 250 or the general population, though this is most likely an exaggeration. Yet because Asperger's sufferers usually manage to get by in the world, it is indeed possible that someone we know--someone previously dismissed as a bookish outcast--might suffer from it.
    Slightly built, with closely cropped black hair, glasses and jittery manner, Phillip Snyder is a 36-year-old aspiring actor who grew up in Berkeley, California. Only recently told by doctors that he suffers from Asperger's, Snyder has spent his entire life in a state of bemused non-communication with the rest of the world. "I studied acting at Harvard," he says resignedly, "but they threw me out because I was so rude to the other students. Of course, I had no idea that I was being rude. I thought I was actually being nice. But that's the story of my life: one long non sequitur." Phil is the father of Asa, the boy who admired my elephant pencil. We are sitting in Starbucks on East 87th Street with Asa and Phil's wife, Lise, from whom he is separated. Asa and Phil are telling each other about their nightmares. "I saw my room collapsing," Phil says. "That's cool," says Asa. "Were you scared?" "Very." "Do you have a lot of nightmares?" I ask Asa. "I can't sleep much," he replies. "My mind doesn't stop."
    Phil met Lise while they were both waiting on tables at the Vienna Café in Los Angeles. "I always knew he was a little odd." Lise laughs. "But I was drawn to that very quality." Their relationship soon grew troubled, however, and she left him while pregnant with Asa. "Phil and Asa," she adds affectionately, "are very similar. They can tell you how to get to the moon, but not to their own rooms. I think Phil would agree with that." "Oh, yes," Phil sighs. "It's pretty bad." With his round-frame glasses and high voice, Asa is adorable enough to draw attention from doting granny-types around us. "I like Mary Poppins and Roger Rabbit!" he cries to one of our neighbors. "I'm going to be a director and a dentist." And what do you like about Mary Poppins?" she says. "Supercalifragelisticexpialidocious," comes the reply. "Ah."
    Asa was always verbally adroit, his parents recall; he spoke his first words at 7 months. At the same time, however, potty training and learning to get dressed were arduous chores. Asa also suffered from a common Asperger's affliction known as auditory hyperactivity, meaning an inability to tolerate noise; he used to sit through entire movies with his hands over his ears. Asa also suffered from irrational fears, scared even by the popping of soap bubbles. "Almost from the beginning," Lise admits, "I knew that Asa was different. My conversations with him aren't like normal adult-child ones. Instead, Asa fires off research questions. He never goes in for small talk of any kind. There's no reciprocity or bantering trivia. He's too focused. With him, talking is not really a conversation. Asa was always rather philosophical, too, Phil adds. "during his second birthday party, he came up to me and said, 'I'll never be 2 again.' It reminded me so much of myself. Sometimes he would say simply, 'I feel so alone.'" Tellingly, Phil identifies closely with Glenn Gould. He listens to his recordings constantly. I wonder, indeed, if Gould has not become something of a hero among Asperger's sufferers, proof that the diagnosis is a blessing as much as a burden. Phil sees much of Gould in Asa, as well. Asa has also taken a shine to Gould and his music, although he oddly insists on referring to the pianist as "Mr. Ratburn" (a cartoon character on one of Asa's favorite TV shows).
    Asa also has an imaginary friend called Ehe, who is a brilliant inventor. Ehe, in short, shares Asa's consuming interest in all things scientific. Ehe "shows" Asa how to draw diagrams of atoms so precise that they include neutron clusters and orbiting electrons. Asa's own insights are sometimes worthy of Ehe: the previous night, says Phil, his son calmly informed him that written numbers were fast, whereas spoken ones were slow. Asa is similarly fascinated with black holes and likes to say that a human entering one would be "stretched like spaghetti." Inspired by the example of Gould, Phil clearly regards Asa as having his one Asperger's intellectual vector, one that should be respected. "If you ride a wild elephant," he is fond of saying, "you go where the wild elephant goes." Indeed, he feels that the ability of an Asperger's person to synthesize information in novel ways will eventually work to Asa's advantage. "Society," he says hyperbolically, "will actually become more and more dependent on people with Asperger's to usher it through the difficulties ahead."
    Nevertheless, Asa has had his share of problems in the regular school system. He started out at P.S. 198 on the Upper East Side, until those problems became too much. "At first," Lise confesses, "I didn't want to admit to myself that he might be ill." One telltale difficulty was Asa's refusal to do the school fire drill. "He simply could not grasp the concept behind it, that you had to pretend there was a fire when there wasn't one. He'd say, 'Is there a fire or isn't there?'" Asa's stubborn refusal to follow the imaginary logic of fire drills earned him time out. "It was a blow he never got over," Lise says. Perplexed, school officials suggested that he needed therapy. But what kind? Since Asa had not received a diagnosis of any official disorder and because he was not obviously abnormal. The school simply allocated him a posse of specialists: a communication therapist, a socialization therapist, a physical therapist and a speech coach. The quartet followed Asa around during his school day. "Needless to say," Phil says, "they made him feel 10 times more abnormal than he had before." Asa himself called them "the shadows." Eventually, Phil and Lise rebelled; they argued that Asa was gifted, a special case rather than a problem child. The school disagreed. "We were told," Lise says, "that he couldn't get into the program for gifted children because he was 'quiet.' Quiet? Since when is a kid singled out for being introspective?"
    Only at the private New York League school, Lise adds, has Asa really flourished. The school's STAR program (Social-Emotional-Training and Academic Readiness) aims not to drum every Asperger's characteristic out of the children's heads but simply to help them control the more outwardly disadvantageous ones, enabling them to survive in the social jungle. Jeanne Angus explains that in the regular school system the emphasis is on "inclusion"--that is, lumping Asperger's children with everyone else and hoping for the best. "It doesn't work," she says. "We feel that we need to get to the Asperger's children as early as possible in order to get through to them." They are, she goes on, usually unhappy and isolated in normal school, whereas in the tiny classes provided by a specialty school like hers, they are among peers who share their problems. "When we teach them the facial expression charts here, they are all learning the same thing," she says. "When we make them focus and maintain eye contact, they all have to do it. It doesn't make them feel abnormal." The schools recognizes that, with patience, Asperger's children can at least learn to imitate social behavior that other kids learn intuitively. We take it slowly, rather than forcing them to conform to what neurotypical children can do," Angus says.
    The school day is broken down into small periods in which socializing is strongly emphasized; even lunch breaks have structured conversations. Angus has seen Asa's progress first-hand. "When he first came to this school," she remembers, "he would clasp his hands together and jump up and down all the time. It's typical self-stimulation that we see in a lot of Asperger's boys. But he's calmed down a lot." Asa's experience is one that most Asperger's parents can easily sympathize with. Echo Fling, the president of the Asperger's Syndrome Coalition of the United States, is also the mother of an Asperger's child. Her new book, "Eating an Artichoke," chronicles the struggles of getting her son Jim's ailment correctly diagnosed and then him eased onto the right pedagogic path. Because it wasn't on the books until 1994, even getting diagnosed was a nightmare," she says. "And Jim always seemed very precocious. But then he'd use memorized dialogue from movies to converse with people, and if you didn't know the movie, you'd find it awfully strange! And he was so stoic, so seemingly emotionless. Give him an umbrella and a cigar, and he'd be a perfect mini-Winston Churchill. He had to be taught what a smile means."
    Recalls Phil: "I was always the cleverest kid in English, but I practically flunked college. I was always inventing personae for myself. One month I'd be Groucho Marx; then I'd be Sherlock Holmes. I was trying to find a character who people would like, but it never worked. Eventually they called me Mr. Peabody, that pedantic little talking dog!" "What about Mr. Ratburn?" Asa pipes up, eyes twinkling behind his rather professorial wire frames. "Yes, he's a great character, isn't he?" "Personally, I'd rather be Roger Rabbit," Asa says matter-of-factly. "Roger Rabbit can dance."
    Curious about the kind of adults that Asperger's children eventually become, I decide one night to drop in on the monthly Asperger's parent' meeting held in a social services center on West 65th Street. Although most of the people here are frustrated parents of children who cannot find affordable targeted schooling, there is also a smattering of Asperger's adults who show up to offer solidarity or to meet one another. I am not sure, however, quite what to expect. I recall a haunting passage I have read recently in the American Journal of Psychiatry in which an 11-year-old Ausperger's boy tries to describe himself. He writes: "I am an intelligent, unsociable but adaptable person. I would like to dispel any untrue rumors about me. I am not edible. I cannot fly. I cannot use telekinesis. My brain is not large enough to destroy the entire world when unfolded. I did not teach my long-haired guinea pig, Chronos, to eat everything in sight (that is the nature of the long-haired guinea pig)." With this unnerving prospect in mind, I fall in with the Asperger's adult group, which is sitting somewhat to one side by itself. One of them is Mark Romoser, a Yale graduate in his mid-30's. Unlike Phil, Mark has a more pronounced aversion to eye contact and seems to observe any interlocutor slightly sideways. Now a research assistant at Columbia University, he once hoped to enter graduate school in psychology but "had trouble obtaining recommendations from professors." Mark is dry and droll, with a seductive, slightly effeminate drawl; after telling me that many Asperger's people are huge Monty Python fans because it conforms to their actual rather absurd experience of the world, he asks me point-blank if I find him normal. "Perfectly," I say. "Mahalo nui loa," he fires back. "Excuse me?" He leans forward and says quietly: "Hawaiian. I must tell you, I hate living on the mainland."
    The "mainland" for Mark seems to be the realm of a suspect normality filled with what Asperger's people often call "typicals"-- those who are neurotypical or, to use the outlawed word, normal. Instead, he calls himself an "ex-pat waiting to happen" who has made Hawaii the object of his impassioned interest. Indeed, the full-time Manhattan resident now writes a regular column for an online magazine called enewshawaii.com. But why, I ask, Hawaii? "My mother thought it would be a good idea for me to swim with dolphins. So I found a woman in west Oahu who takes autistic people out for swims. She calls us 'unique beings.' That was that. I was hooked. After all, we're supposed to be gripped by obsessions, aren't we?" He winks. I ask him about romantic relationships, and he shakes his head. He hasn't had a girlfriend in years. "That's a tough one. I'd say the only place I could be considered popular on the mainland was college. But girlfriends…" He shrugs. "You know, I was a big Deadhead at college. But I must have been the only one ever to leave a Dead concert completely alone."
    This inability to form close sexual bonds is widespread (though, as Phil shows, it is by no means universal). Fred Volkmar, the Yale professor, shared with me the example of one 18-year-old Asperger's patient who simply stared at girls in his college cafeteria. When the unlucky object of this attention came up to him and asked him what he wanted, he would simply blurt out the carnal truth. Needless to say, the police were called on several occasions. "When I was in school," Mark says, "I was doing too well to be called mentally retarded. So they called me 'emotionally disturbed' instead. That was the trendy label at the time. I've often wondered if it was accurate. I wouldn't say disturbed, though. Dislocated more like." Then he adds, "Except when I'm in Hawaii, of course."
    Says Judy Rivkin, the executive vice president of the Asperger's Syndrome Coalition: "People forget that autistic and Asperger's children grow up. They don't just vanish into thin air. But we have to remember that you can often get by masking a disability, passing for something that you're not. Many Asperger's people seem normal and gifted, and maybe they are in some regards. But that doesn’t mean that they don't have to face profound problems." In the end, perhaps Asperger's sufferers perpetually swing between brilliance and isolation, between originality and awkwardness. Lise, for her part, recognizes that Asa alternates between wildly differing psychological states. "When I walk him from home to school," she says "I see him stepping from one state into the other. He puts on his 'school face' and goes from being lively and relaxed to being locked into a kind of monotone. It's a startling transformation. But then, that's the Asperger's world in a nutshell."

The Changing Profile of Smokers
Benedict Carey, Los Angeles Times- 6/19/2000

The number of people who light up 'only for social reasons' is growing quickly, especially among the young. The trend has experts pondering the impact on people's health. Some are posers who simply want an accessory with their designer gin, something to flick and flourish for public consumption. Others are weekend bingers who can't resist mooching a few whenever there's talk and drink around. And some are true heavyweights, cutting down, choosing their moments, trying to get clean. Together they form the fastest-growing category of tobacco users of the modern smoke-free era: social, or occasional, smokers, who light up regularly but not daily. In 1990, about 18% of California smokers said they fit this description. By 1998, the most recent year for which data are available, the rate among California smokers had climbed to almost 30%. And although numbers on so-called occasionals are still sketchy, national trends appear headed in the same direction, even as overall consumption decreases. "When we first reported on the size of this group a few years ago," says John Pierce, a cancer prevention specialist at UC San Diego, "no one believed us. We were all accustomed to thinking of smokers as people who smoked a pack a day or more. Now researchers everywhere are finding rates of 18% and higher. We are witnessing an enormous change in smoking behavior."
    Public health researchers attribute the change in part to stricter anti-smoking laws, particularly workplace bans, which California began enforcing in 1994. But at least as important, they say, are the restraints that many smokers are placing on themselves, such as married people who have volunteered to take their smoking outside in consideration of their spouse or children. "The result," Pierce says, "is that there's no place left to smoke, except maybe the car or the garden." In effect, public and private restrictions are stripping the habit of its most traditional, most intimate connections: the coffee break, the pre- and post-lunch treat, the emergency stress-reducer, even the after-sex smoke. This smoke-free environment shapes the habits of younger smokers most of all, public health researchers say. Many younger than 25 who are experimenting with cigarettes haven't really had the chance to string together a pack's worth of smokes through a day, to establish a daily routine. They're not allowed to do so, at least if they work in an office. Almost half of California smokers in this age group are social users, Pierce says. The downside, addiction specialists say, is that rates of smoking are on the rise among younger people, and many who start in their late teens and early 20s seem to consider cigarettes a strictly social, and therefore mostly harmless, pleasure.
    "The only time I smoke is when I'm out, drinking beer," says Gerardo Guzman, 26, a Cal State Northridge student who works for a public advocacy organization in San Fernando. Guzman goes out with friends about once a month, typically burning three or four butts each time. "That's about it. I can't smoke at work, I can't smoke at home. My environment doesn't really allow me to be a regular smoker. And thankfully, my beer habit isn't very large." He's been smoking in this way, off and on, for nine years. Gretchen Harrington, 32, an administrative secretary at a drug and alcohol counseling center in Los Angeles, is a former everyday smoker who's down to about five cigarettes a week. "One or two at parties, on the weekends," she says, "and sometimes I'll have one during the week, when I see co-workers smoking outside the building." A once-in-a-while smoker for four years now, Harrington isn't worried about falling back into bad habits. "I'm too busy most of the time," she says, "to be leaving the building to smoke."
    Certainly, part-timers like these are no longer a curiosity; they are challenging the conventional understanding of smoking itself. These are cigarettes, after all: butts, twigs, coffin nails, cancer sticks; by any name, as habit-forming as it gets. Most rehabilitation specialists and drug users rate nicotine as the most addictive drug of all, ahead of alcohol, rock cocaine and powder, even heroin. Yet many strongly addicted smokers appear to be maintaining social habits. "Some of these people are not only cutting down," says Saul Shiffman, a University of Pittsburgh psychologist who has made a specialty of studying occasional smokers. "They seem to be changing the reasons they smoke. They're lighting up more for reward, as a treat, than to reduce stress or to satisfy cravings."
    In a 1994 study among heavy smokers and lifelong occasional users, or "chippers," Shiffman found precisely that pattern: occasionals smoking for pleasure, as a rule, and full-timers lighting up to fend off discomfort. Some former heavy smokers probably "are being converted to chippers," Shiffman says. "And we know from other cultures that this kind of light smoking can be sustained." In some Latin American countries, for instance, regular smokers average fewer than 10 cigarettes a day, Shiffman says. The same goes for many Latino men and women in the United States. "Certainly we find that social, occasional smoking is very common in these communities," Pierce says. "It's simply the way a lot of Latinos smoke."
    As hooked as many smokers are, in short, they still exercise considerable control over their habits. When the price of cigarettes goes up, they tend to smoke less. When anti-tobacco advertising is in full force, say public policy researchers, many smokers cut down. Even the decision to buy smokes by the pack instead of by the carton is an act of self-restraint. And now, for the first time, social pressures are forcing large numbers of smokers to control themselves every day. The danger of more modest smoking, doctors hasten to say, is that smokers don't think of it as a bad habit. "I hear this all the time," says Dr. Vanessa Tatum, a spokeswoman for the American Lung Assn. who has a practice in Inglewood. "When I ask females between the ages of 21 and 30 whether they smoke, I'd say about 75% of them say, 'No, not really.' They don't think of themselves as smokers, and some of them are smoking a pack or more every weekend." Tatum is afraid that many of these younger smokers may be fooling themselves, as well as setting themselves up for a lifelong habit that will be as hard to break as any old-fashioned, pack-a-day jones. By telling themselves they're just being social, she says, they avoid confronting the very real health risks of even light smoking.
    To be sure, most occasionals run nowhere near the health risks that heavy smokers do. The relationship between smoking and disease is what doctors call dose-response: the more you smoke, the higher your risk of getting sick. A pack a month is much easier on the body than a pack a day, for example, which roughly quadruples your risk of developing heart disease or cancer, compared with a nonsmoker. But tobacco is still strong poison, in virtually any dose. Unlike alcohol, which in moderate doses may actually impart cardiovascular benefits, tobacco is all bad.  "For the guy who smokes a single cigarette every New Year's Eve, there's probably no increased disease risk at all," says David Burns, an authority on tobacco health risk at UC San Diego. "But the risk levels go up very quickly as soon as you start smoking weekly or even monthly." On average, Burns says, a social smoker who has five or 10 cigarettes a week probably hikes his or her lifetime risk of lung cancer by two times and of heart disease by one and half times. But because of genetic differences and individual quirks, some people are either far less--or far more--susceptible to tobacco's effects. As one pulmonologist put it: "That's why George Burns could smoke 10 cigars a day and live to be 100, and Mary down the street smoked for only a few years, but she's got cancer at age 40."   Since there's no way to distinguish the Georges from the Marys, doctors see social smoking as a kind of Russian roulette, especially for those with a family history of cancer or heart disease. In short order, doctors should understand these risks a lot better--for occasionals soon may be as common as the everyday variety. "The social costs of smoking keep going up," Pierce says. "It's becoming more like marijuana or heroin use. You can't use those drugs habitually, during the day, because it's just not acceptable. . . . "Not long ago, everyone knew a three-pack-a-day smoker. Now no one does. Those kind of smokers barely exist anymore."

High Heroin, Cocaine Use Rates in Detroit Area
Associated Press, 6/20/2000

Metropolitan Detroit has one of the nation's higher rates of cocaine and heroin abuse, according to a survey of large urban areas. The U.S. Department of Health and Human Services says the Detroit area ranks seventh out of 21 metropolitan areas in the rate of hospital visits for cocaine and heroin abuse. The city and its suburbs had 861 hospital visits per 100,000 residents in 1996-98 for cocaine or heroin, according to the report by the department's Drug Abuse Warning Network. That ranked behind metropolitan Baltimore (1,849); Newark, N.J. (1,497); Chicago (1,115); New York (1,102); Philadelphia (981); and San Francisco (919). Others in the Top 10 were Seattle (800), New Orleans (707) and Buffalo, N.Y. (685), the study found. Experts told The Detroit News in Tuesday's editions that the Detroit area's large international airport, closeness to the Canadian border, large college-age population and pockets of poverty contribute to its drug problem.
    The U.S. Drug Enforcement Administration reports heroin's purity in metropolitan Detroit climbed from 27 percent in 1996 to 48 percent last year. By comparison, metropolitan Chicago's heroin fell to 23 percent pure. The price of heroin in the Detroit area dropped from $1.31 per milligram in 1996 to 62 cents last year. The same drug fetches 67 cents per milligram in Chicago, the DEA said. ''We've had some people pulling in some heroin at 75 to 80 percent pure, which is a nearly lethal dose even for experienced users,'' said Phil LaCourse, a psychologist in the substance abuse division of the Oakland County Health Department.

Attacks on Workers Brings Staff Changes at NJ Mental Hospital
Associated Press, 6/20/2000

WINSLOW, N.J. After a series of patient attacks, staffing at Ancora Psychiatric Hospital has been rearranged at the facility. The eight attacks, most against women employees, occurred between April 16 and June 6, officials said. The attacks all occurred during the 7 a.m. to 3:30 p.m. shift, prompting administrators to transfer ten male workers to that shift two weeks ago. ''We believe (the inmates) are less likely to act out if there are more male staff members,'' Gregory Roberts, the hospital's chief executive officer, told the Courier-Post of Cherry Hill for Tuesday's editions.
    In the attacks, six workers were punched in the face, one was bitten in the arm and another was knocked down and kicked, Roberts said. He also said two of the victims lost consciousness and the one who was knocked down was treated for fractured cheek bones at Kessler Memorial Hospital in Hammonton. Roberts wouldn't identify the assailants except to say two were criminally insane. ''It was very unpredictable,'' said LaTanya Wood El, an administrator who said she was attacked June 5. ''I was standing in the hallway, talking with an employee. There was a group of patients returning from the cafeteria. As soon as he saw me, he assaulted me. The patient punched me several times. It has never happened. I was shocked.'' Priscillano Parilla, a doctor, said he was attacked May 15. Parilla said she had just ended a meeting with the patient when ''out of nowhere he gave me a hook to my left eye. My glasses flew off. I thought he was going to keep attacking me.'' Parilla, 61, is on leave and has problems seeing because of the incident.
    'We've been getting different types of patients younger, chronic males with forensic history and substance abuse that equates to a population difficult to treat,'' said Cheron Quashie, hospital administrator. Quashie said ''forensic patients'' are those patients with obvious psychoses, major mental disorders in which contact with reality is impaired.   Roberts said the increase in assaults was ''noticeable,'' although comparative data weren't immediately available. Roberts also said the hospital last year hired 30 more nurses and increased security patrols on the grounds, but not the number of security personnel. The hospital houses 675 patients and employs 1,160 full-time and 55 part-time staff members.

'Moderate Drinking' Author Had Decided to Abstain
Anne Koch, Seattle Times- 6/20/2000

The founder of a national movement that says many problem drinkers can drink in moderation determined she needed to abstain from alcohol altogether more than two months before she was involved in a deadly alcohol-related crash. Audrey Kishline, 43, of Woodinville joined Alcoholics Anonymous (AA) and posted a note on her Moderation Management Web site in late January saying she was choosing abstinence, say several people who read the statement and her attorney.
    Kishline, author of the 1994 book "Moderate Drinking," had a blood-alcohol content of 0.26 percent, more than three times the legal limit in Washington, when the pickup she was driving the wrong way on Interstate 90 near Cle Elum, Kittitas County, smashed head-on into a car, authorities said. Killed in the March 25 accident were Richard Davis of Grandview, Yakima County, and his 12-year-old daughter, LaSchell. Kishline has been charged in Kittitas County with two counts of vehicular homicide and hit-and-run driving for allegedly forcing another vehicle off the freeway before the crash. A trial is scheduled for September.  Her Seattle lawyer, John Crowley, said Kishline has been extremely affected by the crash and shown great remorse.  She encountered anger and resistance from her followers after she told them she was choosing abstinence and would no longer be the movement's spokeswoman, Crowley said yesterday. Before the crash, she was both struggling to abstain from alcohol and struggling to build a new identity for herself, Crowley said. Kishline is receiving intensive in-patient alcohol treatment in an undisclosed treatment facility in Oregon.
    Her book, subtitled "The Moderation Management Guide for People Who Want to Reduce Their Drinking," is not for alcoholics but for problem drinkers who have experienced mild to moderate alcohol-related problems, according to a Web site associated with it. The book says it is the official handbook of the nonprofit, national self-help program, Moderation Management. The movement itself acknowledges that about 30 percent of Moderation Management members go on to abstinence-based programs such as AA.

Child Molester Gets 18-Year Term for Third Attack
Neely Tucker, Washington Post 6/20/2000

A child rapist was sentenced yesterday in D.C. Superior Court to at least 18 years in prison for his third assault on a young girl in the past 25 years. Leon A. Fields's oldest victim is now in her late twenties. The youngest, who testified against him by writing in crayon during a trial in January, is 7. She sat quietly in court with her parents yesterday, watching her attacker be sentenced. "The finding in this case suggests that whatever one means when saying 'child molester,' that's what we have here," Judge Rufus G. King III said in imposing the sentence.
    The story of Fields and his victims is an unsettling window into the role that family secrets can play where child sexual abuse is concerned, according to court papers and trial testimony. Although Fields's girlfriend and family members knew that he had been convicted in 1976 and 1984 for child sexual assault, no one reported him to parole officers, even as he spent $80 a week to buy the children "shoes, underwear, bras, toys, candy . . . anything they wanted," he later told a parole officer. On March 31, 1999, his girlfriend, Susan Jones, helped him host a slumber party for five girls, ages 7 to 11, in their apartment in the 4900 block of G Street SE. The 7-year-old was raped that night. She went home and told her mother. Too ashamed to speak out loud on the witness stand, she took a crayon when asked by prosecutor Elisa Poteat about what happened that night. "He sexed me," she wrote, holding it up for the jury to see. Fields was convicted by a jury of first- and second-degree sexual abuse. The sentence means that Fields, 45, won't get out of prison until age 63. He will be on probation for the rest of his life after that.
    It was of little comfort to his now-adult victim. "What will become of these little girls' lives? Who will they trust? Who will understand that their problem runs deeper than the eyes can see, deeper than the ears can hear, deeper than the heart can feel?" she wrote in court papers, describing the emotional scars that his two assaults left on her life. The adult victim was first assaulted by Fields when she was 4. He was convicted and released after serving time. When she was 11, he raped her again. Few in the family believed her, she wrote. When Fields raped her sister, the other girl was reluctant to talk, "especially considering the way her sister was treated when she told of abuses," a court summary of the case says. Fields eventually was convicted for the attack on the girl when she was 11.
    "Mr. Fields is a seriously disturbed young man," a psychologist reported. "It is beyond question that [he] functions at a borderline psychotic level." Family members would, after the slumber party rape, finally tell police there might be a reason for that. Fields was sexually abused extensively from the age of 9 to 12 by a neighborhood man known as "Ben," they said. Further, as a child, he had tuberculosis, spending ages 1 to 3 in a sanitarium. His parents divorced soon after he was well enough to come home. Fields never seemed to mature or adjust. His IQ was 97.
    After his release from prison in 1991, probation officers said, his family and girlfriend shielded his behavior from the police. Other parents ignored that background. "Several individuals who knew of the defendant's past indiscretions voluntarily sent their children to the defendant's home," wrote Paul S. Brennan of the Court Services and Offender Supervision Agency, the District body that oversees paroled inmates. "His parole officer was not privy to the defendant's behavior since those close to the defendant essentially covered up for him. . . . Jones knew he was not to be around children, yet she chose to remain silent. . . . [His family] often expressed their displeasure about his consistent and constant interactions with children" but never contacted police. His mother, Marie Fields, disputed that allegation, saying it was not common knowledge in the family that he was often around young girls. The 7-year-old's parents did not know of Fields's history, prosecutors said. She is now receiving mental health counseling through Medicaid.
    Fields's court-appointed attorney, Michelle Bonner, urged the court to take into account the damage Fields suffered as a boy. Bonner said Fields only recently acknowledged the incidents, offering hope for rehabilitation. "This is the beginning of reversing years of denial. . . . He has acknowledged that he needs therapy and treatment," Bonner said. King rejected the plea. "It is hoped that by the time Mr. Fields is eligible for release, that nature will have corrected what the court systems could not," he said.

Wrong in the Head: Brain Scans Increasingly Common in the Courtroom
Geraldine Sealy, ABC News- 6/20/2000

Cary Stayner has confessed to committing shockingly brutal crimes in Yosemite National Park: He allegedly beheaded one woman, killed and burned two others and slit the throat of a fourth. What made him do what he says he did? Stayner’s lawyers hope neuroscience will help them answer that question, and perhaps help spare the former motel handyman’s life in the process. They want to scan their client’s brain to see if a biological defect, or even a traumatic injury, could have contributed to his alleged behavior.
    The scan, called positron emission tomography, or PET, tracks glucose metabolism in the brain. The result is a colorful graphic display of the patient’s brain functioning: Reds usually indicate a high level of activity and blues show areas of inactivity. Although PET scans are used to treat cancer, epilepsy and other illnesses, they are increasingly common in courtrooms across the country. Scientific studies have shown that murderers as a group have poor brain functioning in the prefrontal cortex, the area of the brain that regulates and controls impulse control.
In some cases, defense attorneys have used PET results to convince jurors that their clients were biologically predisposed to committing the crime, and thus should be spared a conviction or death sentence.
    Stayner’s attorneys are arguing against the death penalty, but have not indicated how they would use the scans of their client’s brain at his upcoming trial. Stayner is accused in the slayings of Yosemite naturalist Joie Armstrong last July. He also faces charges in the February 1999 slayings of Carole Sund, 42, her daughter, Juli, 15, and their Argentine friend, Silvina Pelosso, 16.

Predisposed to Violence?
Although finding a biological basis for criminal behavior may seem suspect to some, prominent researchers say the science of the scans is sound. "It’s an outstanding measure of brain functioning," says University of Southern California neuroscientist Adrian Raine, a pioneer in the field. In the early 1990s, Raine worked on a major study using PET technology that showed poor brain functioning in 41 murderers in California. Similar research that followed has confirmed those findings, he said, and along with decades of less sophisticated research, creates a body of work pointing to the same conclusion: "For many decades, we’ve repeatedly found that murderers as a group have brain dysfunction," he said.
    But even if a brain scan can show a predisposition toward violent behavior, can it prove that the defect compelled someone to commit a specific violent act? Not yet, researchers say. "There is no felony murder center in the brain. That is a legal concept," says Monte Buchsbaum, a neuroscience researcher who began using PET scans in testimony at criminal trials in the 1980s. Nonetheless, PET scans can, on occasion, successfully sway juries. Scans conducted by Buchsbaum were instrumental in preventing a death sentence for Barry Wayne McNamara of California, convicted of killing his parents, sister and niece.

No Cause and Effect
Just because PET scans cannot pinpoint a cause and effect relationship between brain abnormality and criminal behavior doesn’t mean they don’t have a place at trial, researchers argue. Instead, PET scans should be considered just as credible as evidence of child abuse or domestic violence is in describing a defendant’s background and circumstances, they say. "The debate [over PET] is entirely shifting from science to the issue of how juries should use information on the brain in decisions on punishment," Buchsbaum said. "The job of the PET scan is merely to present the latest information on the patient’s brain and mental equipment, it’s up to the jury to decide guilt or incarceration."
    And it’s up to the defense attorneys to convince juries that a brain malfunction or traumatic injury should lessen the degree of guilt in a heinous crime or warrant a lesser sentence. That’s no easy task, says Paul H. Robinson, a former federal prosecutor and Northwestern University law professor. Attorneys must persuade jurors that their client’s brain abnormality is so great society cannot expect him to resist committing such an offense. "A lot of people go through life naturally bad tempered or inclined toward violence, but we don’t say, ‘we are not going to punish you,’" he says. "We say, ‘perhaps there is some greater burden you suffer because of violent tendencies, perhaps you have a greater burden, but that’s a burden we expect you to carry.’"

Not All Juries Buying the Idea
So far, not all juries are buying the idea that murderers should be excused from their actions because of biological defects. In 1989, for example, convicted serial killer Randy Kraft was sentenced to death despite a PET scan that showed brain dysfunction. Until science can directly link a biological defect to a specific violent act — and that day may never come — procedures such as PET may never be anything more than one type of evidence weighed by judges and juries at trial. Meanwhile, researchers continue to probe the inner workings of the brain, seeking explanations for violence. The next frontier, Raine says, is tracking the relationship between brain function and behavior from an early stage of development. "That would be next step in teasing out causality," he said.

Move Over Prozac: A Quarter of New Drugs in R & D are for Depression
Maggie Fox, Reuters- 6/20/2000

WASHINGTON — More than 100 different drugs, including a batch of new products aimed at combating drug and alcohol use, are in the pipeline for mental illness, according to a new analysis by a drug industry group. A quarter of the drugs, 26, target depression alone, the Pharmaceutical Research and Manufacturers of America (PhRMA) said in a report.

Estimated $6 Billion on Drugs
"This year, pharmaceutical companies will spend an estimated $6 billion to discover and develop medicines for diseases of the central nervous system, including mental illnesses," Alan Holmer, president of PhRMA, said in a statement. Researchers agree that drug addiction is a physical illness, not a weakness of will or lack of moral character, and the industry and government researchers are targeting the potential treatment market. Drugs being tested include British-based Cantab Pharmaceutical’s cocaine vaccine, in early safety testing, and five drugs being tested under the auspices of the National Institute on Drug Abuse for use against cocaine dependence — desipramine, disulfiram, GBR 12909, NS 2359, and selegiline, originally developed for use against Parkinson’s disease. NIDA is also testing drugs for opiate addiction, including mecamylamine, lofexidine and buprenorphine.

Depression: a Huge Market
Depression, which affects an estimated 19 million Americans, is another big market. Many of the drugs affect levels of serotonin, an important neurotransmitter, or message-carrying hormone, linked with mood. The success of the selective serotonin reuptake inhibitors (SSRIs) such as Eli Lilly’s Prozac, known generically as fluoxetine, has encouraged companies to continue to develop similar drugs, including Lilly’s duloxetine and Solvay Pharmaceutical’s fluvoxamine. Sanofi-Synthelabo is investigating the potential of a reversible monoamine oxidase inhibitor called befloxatone. Monoamine oxidase breaks down serotonin, so inhibitors of the enzyme make more serotonin available.

Alzheimer’s Drugs In Pipeline, Too
For Alzheimer’s, which affects 4 million Americans and 22 million people worldwide, more than a dozen new drugs are in development, including Sigma-Tau Pharmaceuticals’ ALCAR, or acetyl-l-carnitine, and a vaccine called AN-1792 being developed jointly by American Home Products Corp. and Elan Corp Plc. It targets the amyloid plaques that mark the incurable brain illness. Novartis is in Phase II safety and efficacy trials with NDD 094, which may regrow brain cells that produce acetycholine, a neurotransmitter involved in memory. One group of drugs, the cannabinoid receptor antagonists, are building on research that examined the effects of marijuana on the brain. Sanofi-Synthelabo is testing SR 141716 against Alzheimer’s, obesity and schizophrenia, which affects two million Americans. Research in animals has shown that anandamide, a chemical similar to cannabis, puts the brakes on dopamine, the neurotransmitter associated with schizophrenia. Uncontrolled production of dopamine is blamed for some of the symptoms of schizophrenia. A lack of dopamine is blamed for the shaking and motor hesitation that marks Parkinson’s disease.

Gains in Diagnosing Hyperactivity
Susan Gilbert, New York Times- 6/20/2000

 Diagnosing attention deficit hyperactivity disorder has never been easy. Doctors say that it frequently rests on nothing firmer than judgement calls on difficult questions like these: Does the kindergartner who cannot sit still and pay attention in class have the developmental disorder, or is he just immature? Does the first grader who has trouble concentrating on her homework but no trouble concentrating on a computer game have it, or is she lazy? Does the second grader who is bright but struggling to learn how to read have the disorder, or a reading disability?
    But, armed with new findings on the symptoms of attention deficit hyperactivity disorder and the brain abnormalities that cause them, many leading researchers say they can reduce the guesswork of the diagnostic process and, with it, the number of people who are misdiagnosed. The first step, they say, is for doctors and parents to understand that, despite its name, attention deficit hyperactivity disorder encompasses more symptoms than inattention, hyperactivity or both. "It's not just a disorder of kids who can't pay attention or sit still," said Dr. Thomas E. Brown, associate director of the Yale Clinic for Attention and Related Disorders. "It's more complex than most people think."
    Dr. Brown is the editor of a new book, "Attention-Deficit Disorders and Comorbidities in Children, Adolescents and Adults" (American Psychiatric Press), in which more than two dozen researchers describe findings on the causes and symptoms of attention deficit hyperactivity disorder. The research underscores two major points that Dr. Brown and his authors consider crucial to making more accurate diagnoses and prescribing medication and behavioral therapies more judiciously. One is that people with the disorder are at very high risk of having or developing various other problems like depression, bipolar disorder, anxiety, learning disabilities and , in adolescence, substance abuse.
    In many cases, doctors fail to recognize that a patient has more than one disorder, Dr. Brown said. "The kid is medicated for attention deficit," he said, "but if he still can't get his homework done he's pegged as lazy because no one realizes that he may also have a reading disability." Dr. Brown said that a problem that coexists with the disorder could interfere with Ritalin and the other stimulant medications that are often used to treat it. The second crucial point in Dr. Brown's book is that many people with attention deficit hyperactivity disorder appear to have chronic difficulty with the brain's executive functions. The view of attention deficit hyperactivity disorder as a developmental disorder of executive functions, not merely of attention or impulse control, is gaining ground.
    "There's a strong circumstantial case that some individuals with attention deficit have problems with executive functions," said Dr. F. Xavier Castellanos, who leads the attention deficit hyperactivity disorder research unit at the National Institute of Mental Health, and whose work is cited in Dr. Brown's book. One bit of circumstantial evidence is the way that the symptoms change as a child gets older. "Hyperactivity decreases with age, but symptoms of inattention don't seem to diminish," Dr. Castellanos said. A likely reason, he and other experts say, is that a person's life becomes more demanding and requires a greater use of executive functions. Further evidence comes from the seemingly contradictory symptoms in individual patients. In particular, many people with the disorder have trouble paying attention in some situations--when the teacher is talking, for instance, or when they must finish their homework--but not in others. "Everyone knows people with attention deficit who can concentrate well enough to play computer games for hours," Dr. Castellanos said.
    Mr. Michael Gordon, chief clinical child psychologist at the State University of New York Upstate Medical University in Syracuse, notes that everyone has trouble with executive functions from time to time, especially when they are under stress. "Any one of us is potentially disabled if we get ourselves into a competitive situation where our abilities are outstripped by the demands," Dr. Gordon said. But Dr. Brown thinks that recognizing deficits in executive functions as well as the possibility of coexisting disorders can help doctors make more accurate diagnoses. "Attention deficits are overdiagnosed in some people and underdiagnosed in others," he said, noting evidence that it has been underdiagnosed in girls, as well as in adolescents and adults, because they are less likely than young boys to have the most obvious symptoms, hyperactivity and impulsive behavior.
    Experts say that parents who are concerned that their child might have the disorder should arrange for a comprehensive evaluation by a pediatrician, psychologist or psychiatrist who is experienced with the disorder. "You can't do this in one or two sessions," said Dr. David Fassler, chairman of the Council on Children, Adolescents and Their Families of the American Psychiatric Association. "A comprehensive evaluation means getting a detailed history of the child's early development, medical conditions and problems in school and with friends, as well as meeting with the child and the family."