Noteworthy News Articles on Mental Health Topics, April 23-29, 2001I

 

Jury Deliberates in Case of Man Who Hopes to Show He Was Insane
Theo Emery, Associated Press, 4/23/2001

BOSTON (AP) A jury in Suffolk Superior Court began deliberations Monday in the case of a paranoid schizophrenic man accused of two separate shootings in Boston's South End during an alleged psychotic episode.  During the three-week trial, the attorney for former hospital worker Eric Brown, 32, showed a videotape of his behavior without medications in an effort to prove Brown was incompetent at the time of the 1996 murders.   In closing arguments, Assistant District Attorney David Walker asked the jury to find Brown criminally responsible for the double shooting and convict him of first degree murder. ''Just because Eric Brown left behind three spent shells, just because he left behind DNA evidence, just because he left behind a fingerprint does not mean that he is a person who lacks criminal responsibility,'' Meier told the jury.
    Brown's attorney, Bernard Grossberg said there's no way of telling whether the insanity defense will convince the jury even with the videotape of his unmedicated behavior as evidence. ''It was clear that he had a mental illness, the Commonwealth did not prove that he did not have a mental illness, and the crucial question is did he have a mental illness on the day of the incident,'' Grossberg said. According to the American Psychiatric Association, the insanity defense is used in less than 1 percent of cases. Only about a quarter of those are argued successfully.
    In June 1996, Brown allegedly gunned down Athos Oliveira, 30, of Somerville, and Thomas Meyer, 38, of San Francisco, in Boston's South End neighborhood. The two men were shot separately on Appleton Street the same night. Brown was arrested two weeks later after a routine traffic stop. Soon afterward, he tried to commit suicide and was transferred from the Nashua Street Jail to Bridgewater State Hospital, where he has been since.
    In the summer of 1998, doctors gave Brown a new set of drugs that brought him closer to normalcy. Later that year, a mental health supervisor at the hospital filed a report saying Brown was capable of standing trial. In late 1998, Brown's attorney argued to a judge that Brown should be videotaped when he was not taking the medication that controlled his delusional episodes, and the videotape was showed as evidence at trial. Judge Peter Lauriat ruled in late 1998 that Brown could go off his medication anytime he wanted. Brown did so, but after his psychoses re-emerged, Bridgewater State Hospital officials got a court order to put him back on. Early last year, Lauriat again ruled that Brown could go off his medications, which he did for several months. At the very end of that period, Grossberg made the videotape, which he showed to the jury during the trial. ''Hopefully, the jury will look it during the deliberations,'' Grossberg said.

 

New Program Offers Hope for Maine County Drug Addicts
Associated Press, 4/23/2001

MACHIAS, Maine (AP) The substitution of an aggressive program of court-supervised drug treatment for lengthy prison terms is seen as a way to help ease Washington County's burgeoning drug abuse problem. Maine's easternmost county has an estimated 600 addicts who snort or inject OxyContin and other powerful painkillers.  Adult Drug Treatment Courts, which begin operating this spring in Machias and Calais, offer convicted drug defendants a chance to avoid prison by subjecting themselves to weekly drug tests, meetings with substance abuse counselors and other forms of intense supervision.
    District Court Judge John Romei said the judge delays sentencing while the person is in drug court; success in the drug court program will affect the final sentence. There are 20 openings for drug court in Machias and 20 for drug court in Calais, he said. ''I think we will save some lives,'' Romei said. ''It's just a question of how many.'' Maine's drug courts are being funded with $750,000 from the state's tobacco settlement money. Other drug court locations include Portland, Bangor, Lewiston-Rumford and York-Biddeford.
    Romei said those who participate in the Washington County program will be under close scrutiny. ''Drug court is the most invasive supervision other than confinement,'' Romei said. ''We're monitoring their whole lives and they have no place to hide.'' Sharing Romei's hopes for the program is Tari Murphy, a substance abuse counselor for the Regional Medical Center in Lubec, who has worked with more than 100 opiate addicts over the past four years.  Drug court participants will appear before Romei every Friday, submit to weekly drug tests, meet up to three times a week with Murphy or her colleagues, and regularly attend meetings of Narcotics Anonymous or Alcoholics Anonymous.
    Romei said Washington County's problem with opiate addiction is the worst in the state, and completely out of proportion to its small population. ''It is just overwhelming and I don't think we've even peaked yet,'' Romei said.  The judge quoted law enforcement officials as saying that addicts read the community columns in weekly newspapers to see when people are getting out of the hospital. ''The addicts go in and steal the drugs these people need to recover from their surgery,'' the judge said. The 32-bed Washington County jail, which was usually half-full just nine years ago, has been operating 20 percent over capacity for several years and has been 40 percent over capacity for the last few months. Practically all of that increase is the result of narcotics, Romei said.
    ''Literally, we've had no success with people who are addicted to prescription narcotics,'' he said. ''The only drug addicts who aren't using are in jail.'' Romei said it didn't take much to persuade Maine Chief Justice Daniel Wathen that Washington County should be selected as one of the sites for the new drug court. The chief justice sat in Machias District Court two years ago and was shocked at the number of people arraigned on prescription drug cases, Romei recalled. ''He told me it was something he'd expect to see in places like Camden, New Jersey, Newark or Detroit,'' Romei said.

 

Ex-Maxey Worker Cleared in Sex Case
Jack Kresnak, Detroit Free Press- 4/24/2001

When he signed on to work in a sex offender unit at the W.J. Maxey Boys Training School in 1990, James Cotter was told to be careful -- many youths were cunning manipulators who could cost him his job. "I didn't really worry about it," Cotter said Monday, minutes after being found not guilty of any crime stemming from a sexual allegation made by a former resident of the 480-bed facility in Green Oak Township. "The administration at Maxey always said they'd stand behind us" if a youth pressed a false allegation, said Cotter, a 49-year-old father of five from South Lyon.
    Cotter received significant support from Maxey staff members during his two-week trial in Livingston County Circuit Court on a criminal sexual conduct charge. But the Family Independence Agency, which runs the facility, suspended Cotter without pay from his post as a youth specialist in March 2000 after he was accused of sexually assaulting a 15-year-old boy. The youth had been convicted of molesting a 6-year-old relative.
    The jury, which deliberated about two days before finding Cotter not guilty on Monday afternoon, rejected the claims of Cotter's accuser, now an 18-year-old who testified that he works part-time as a stripper in a gay bar. The teenager, whose name is being withheld because the Free Press generally does not identify victims of alleged sexual assaults, testified that he seduced Cotter so he could blackmail him for favors. The youth also had accused four other staff members of various sexually inappropriate acts, but only Cotter was charged with a crime. "There's nobody who plays victim better than a sexual offender," Cotter said. The 18-year-old, who was not in court Monday, could not be reached for comment.  Livingston County Assistant Prosecutor Pamela Maas said she was disappointed with the verdict but the jury obviously had trouble believing the teen. "We can't call central casting for victims of crime," Maas said. "We have to use who we get."  Cotter said that, at Maxey, "people do their job and the public can trust that there are well-educated, skillful people in abundance working there and doing the best they can in a very professional manner."
    A 24-year veteran at Maxey, Cotter's record was clean except for two reprimands for dispensing medication without proper authorization. His attorney, Timothy Hensick, said the other staff members were not charged because the youth's accusations against them were provably false. Cotter's case boiled down to whom the jury would believe, Hensick said. "They owe Mr. Cotter a lot of back pay," Hensick said. "He's ready, willing and able to go back to work." FIA spokeswoman Maureen Sorbet said the department had not yet been notified of Cotter's acquittal. She said a decision on reinstatement would come quickly.

 

'Masters' Show How to Get High on Life Without Abusing Alcohol
Jane E. Brody, New York Times- 4/24/2001

As with almost all troublesome behaviors that need changing--be it losing weight, stopping smoking or starting to exercise--the trick in overcoming alcohol abuse is not so much in the start-up as in the continuation. It sometimes takes years and many failed attempts before a problem drinker can finally achieve lasting sobriety. But the process can be greatly aided and often shortened by tips on coping with life's challenges without resorting to alcohol from people who have overcome serious drinking problems. In her newly published book, "Sober for Good" (Houghton-Mifflin, $25), Anne M. Fletcher describes what many of the 222 former abusive drinkers she calls "masters" have learned about dealing with the sturm and drang of life without using alcohol to smooth the way.  Many admitted that early into sobriety, their greatest difficulty was the absence of alcohol to help "escape, hide or get momentary relief from painful situations, troubles and feelings," Ms. Fletcher wrote. "If someone stops drinking and doesn't fill the void left by alcohol's absence, the result is that he or she will likely start drinking again."

What Works
The masters' first task was learning to separate alcohol from feelings and problems. As Frank L. put it, "Drinking will not make any problem easier to solve nor any outcome better than it is." Instead of masking emotions with alcohol, the masters learned to recognize what they were feeling--whether it was fear, sadness, anger or happiness--and to allow themselves to experience it, express it and deal with it in a healthier way, for example, by talking or writing about it or going off by themselves and yelling or crying. They also learned that few feelings are long lasting--wait a bit and they go away--and that it is all right to be in a bad mood for a while.
    Quite a few of the masters found that when alcohol no longer served as an emotional mask, they needed professional treatment for depression, anxiety or relationship issues that might have fed their drinking problems. Two-thirds of the masters indicated that they had benefited from counseling or therapy in addition to participating in recovery groups. Anger was a particularly troublesome emotion for the former drinkers, many of whom had to learn to deal with their anger more directly and effectively, for example, by speaking up to the appropriate person and by handling anger before it built to explosive levels. Others use indirect techniques like punching pillows, taking brisk walks or hot baths, writing about the problems or even lying down and letting the anger wash over them and then taking naps.
    The many known stress-reduction methods--like meditation, exercise, prayer and deep breathing--also helped many. Some found that changing a stressful job situation--getting a new one or changing an old one--was important in maintaining sobriety. Celebrations and happy feelings can also be problems for people trying to enjoy them without drinking. Clare J. said she reminded herself that "the quickest way to spoil the moment is to take a drink." Others do rewarding activities like buying flowers, books or records; getting massages; singing and jumping for joy; trying new restaurants, or doing nice things for others.
    Even more difficult are social situations where alcohol is an integral part. Ms. Fletcher wrote, "The masters' No. 1 answer for how they now handle parties, weddings, business dinners and traveling is to drink some sort of nonalcoholic beverage." One of my friends goes to parties with her own nonalcoholic beer. Another requests a soft drink. A third drinks water. A few simply decline invitations to cocktail parties and other events where consuming alcohol is the featured event. Duane L. said: "I get something nonalcoholic and keep it full. If all else fails, I tell people I'm driving." Or nondrinkers can say that they are taking medicine that does not mix with alcohol or that they are allergic to alcohol. Perhaps the simplest response to a drink pusher is "no thanks" or "thanks, but I don't drink." About a quarter of the masters decided they had to abandon drinking buddies or find new friends who did not abuse alcohol.
    In dealing with alcohol at home, Ms. Fletcher believes that when sobriety is new, it is easier for most people if their live-in companions do not drink, give up alcohol for a while or drink only in the sober person's absence. But almost half the masters keep alcohol in their homes for housemates or guests, and 40 percent said they lived with one or more persons who drank.

Joy Without Alcohol
Ms. Fletcher found that the masters she interviewed "seem joyful about the richness and fullness of their sober lives: they get high on life without abusing alcohol and seek fulfillment and pleasure in its absence." As their stories unfolded, most masters revealed that they had built lives that had no room for alcohol. They have filled their lives with new sources of gratification and meaningful endeavors, among them reading, pursuing hobbies and the arts, traveling, enjoying nature and the outdoors, eating well and engaging in fitness activities.
    For example, Heather F. now exercises at the time of day that she used to start drinking. Marisa S. said she "learned to revel in small pleasures each day" like gardening, having brunch with friends, taking walks, enjoying sunsets, admiring flowers, reading or being silly with her husband. Becky H. said she wove "a tapestry of sobriety: I notice things, positive things, and revel in them--a raindrop sliding down a leaf, my baby's giggle, the cat's paws twitching in her sleep, the smell of the gardenia."
    A favorite pleasure-enhancing activity of the masters is helping others through volunteer work, community service or involvement in civic organizations. Some have switched careers to ones that help others. Dorothy W., for example, gave up a law practice and became a clinical social worker and pastoral counselor. Two-thirds of the masters said they sought greater career satisfaction by improving their job situations or furthering their education.
    Then, there is the matter of improving and enjoying relationships. More than 90 percent of the masters said their relationships with others improved after they stopped drinking; they became more open, more honest, deeper and more trusting. More than half the masters listed enjoying or appreciating family or friends as one of the top three ways of seeking pleasure. Repairing family relationships that were seriously hurt by alcohol abuse can often be challenging, and Ms. Fletcher said, "It is not uncommon for marriages and families to break up within the first year or two of sobriety." But counseling, communication classes, personal improvement seminars and recovery meetings together have proved helpful to many.

 

Many Mothers Lie About Alcohol Use During Pregnancy, Study Finds
Erin McClam, Associated Press, 4/24/2001

ATLANTA--So many new mothers lie when asked whether they drank alcohol during pregnancy that some national statistics on birth defects should be thrown out, a government study says. Only about one in 20 women who drink during pregnancy admits it on her child's birth certificate, according to a study presented Tuesday. In most states, women are asked after delivery whether they smoked or drank alcohol during pregnancy. Their answers are listed on birth certificates along with records of birth defects.
    But many new mothers lie about their drinking or answer no because they think they haven't consumed enough alcohol to hurt the child, said Marc Weisskopf, a Centers for Disease Control and Prevention epidemiologist. His study compared what women said for birth certificates and what they said in a telephone survey several years later. Just seven of 278 women admitted alcohol use on the birth certificate; 32 admitted it in the telephone survey.  The study projected the number of women who actually drank during pregnancy was 131 nearly 20 times the number who admitted it on birth certificates.
    The study urged the government to stop using alcohol data from birth certificates until accuracy can be improved. In 1999, 1 percent of women reported consuming alcohol during pregnancy. The National Center for Health Statistics uses birth certificate data to pinpoint nationwide trends on pregnant women's alcohol use. Exposure to alcohol in the womb can stunt growth, harm a baby's memory and contribute to learning problems. ''One would like to be able to look at alcohol use during pregnancy and ask: Is it higher than we'd like?'' Weisskopf said. ''The problem is, can you trust the data?''
    Medical experts have long known that some women, embarrassed by the stigma associated with drinking while pregnant, lie about or underestimate the alcohol they consume. The data have become so flawed that NCHS plans to eliminate the alcohol question from the standard birth certificate it suggests to states. The change is expected to be made by 2003, a spokeswoman said. Weisskopf's study surveyed women in Illinois, Michigan, Indiana, Ohio and Wisconsin between 1989 and 1995. The survey also found birth-certificate data underestimate tobacco use by 20 percent, a figure roughly in line with what other studies have found.
    On the Net:
National Center for Health Statistics: http://www.cdc.gov/nchs
National Organization on Fetal-Alcohol Syndrome: http://www.nofas.org

 

Psychotic Man Found Guilty for Double Murder
Associated Press, 4/24/2001

BOSTON--A jury Tuesday found a paranoid schizophrenic accused of shooting two people during a psychotic episode guilty of two counts of first-degree murder. Eric Brown, 32, is to be sentenced Wednesday in Suffolk Superior Court. He faces a possible life sentence with no possibility for parole, according to Suffolk County District Attorney spokesman Jim Borghesani. Bernard Grossberg, Brown's attorney, told the jury that he was off his medication at the time of the 1996 killings, and therefore was not responsible for his actions.
    ''It was an extreme disappointment,'' Grossberg said Tuesday night of the verdict. ''I sincerely believe he suffered from schizophrenia then and continues to suffer from schizophrenia.'' Grossberg said he expects to appeal the verdict. ''There are a number of appellate issues (including) whether he was even competent to stand trial,'' Grossberg said.
    During the three-week trial, Assistant District Attorney David Meier told the jury to ignore the insanity defense, and to find Brown criminally responsible for the two slayings. Authorities say Brown gunned down Athos Oliveira, 30, of Somerville, and Thomas Meyer, 38, of San Francisco, in Boston's South End neighborhood. The two men were shot on the same street on the same night, but in separate incidents. Brown was arrested two weeks later during a routine traffic stop. He tried to commit suicide soon after, and was moved to Bridgewater State Hospital, where he remains. In 1998, doctors switched him to a new set of drugs that regulated his psychotic episodes. Later that year, a mental health supervisor at the hospital said he was ready to stand trial for the two murders.

 

Childhood Bullying Is Common, Study Finds
Rosie Mestel, Los Angeles Times- 4/25/2001

Nearly one-third of U.S. schoolchildren in the sixth through the 10th grades have bullied other children or been bullied, according to the first study of its kind, published today in the Journal of the American Medical Assn. The study, based on a poll of 15,000 schoolchildren, found that bullies and their victims are more likely to have psychological or behavioral difficulties--a finding that underscores the need for schools and society to take action, said the study's authors. The study was the first on this subject to survey U.S. schoolchildren from a nationally representative cross-section of ethnic groups and urban and rural populations. "Bullying is something we need to take seriously as a nation," said Tonja Nansel, a researcher with the National Institute of Child Health and Human Development in Bethesda, Md., and lead author of the study. "We need to not treat it as a normal part of growing up, but as a public health problem."
    The study found that bullying is more common in grades six through eight than in grades nine and 10; that boys are more often involved in bullying than girls; that boys are more likely than girls to bully using physical force and girls more inclined to use taunts and spread rumors. The study finds no difference, though, among rural, suburban and inner-city schools and no striking differences among ethnic groups.
    Such a study is long overdue, said Dr. Howard Spivak of the New England Medical Center and Tufts University School of Medicine, who co-authored a commentary accompanying the study. Bullying, he said, is a sign that a child is troubled. It may be linked to a pattern of later violence. Given the problems of violence in the United States, he said, "it is a sad irony that this issue has not been looked at very much in this country."
    But researchers said the study has limitations. It relies on the children's own assessments, which may not be wholly accurate. "The merits of the study are obvious: the size of the study and the fact that it's a representative sample covering both middle and high school," said Jaana Juvonen, a behavioral scientist at Rand Corp. in Santa Monica. "But it's important to recognize that this study is all based on self-report."
    In the study, 15,686 sixth- through 10th-graders in public and private schools nationwide completed an anonymous questionnaire in class. It included 102 questions about a range of psychological health issues. The children first read a description of bullying: "We say a student is being bullied when another student, or a group of students, say or do nasty and unpleasant things to him or her. It is also bullying when a student is teased repeatedly in a way he or she doesn't like. But it is not bullying when two students of about the same strength quarrel or fight."
    Overall, 29.9% of the children reported that they had been involved in bullying "sometimes," once a week or more often during that school term. Of those, 13% reported that they had bullied other children while 10.6% said that they had been bullied. And 6.3% of the children reported that they had, at different times, been bully and victim. The researchers found that children involved in bullying were more likely to get into fights. Those who said they had been bullied also were more likely to report problems making friends, feelings of loneliness or poor relationships. Children who were bullies and victims had it the worst. They were lonely and confessed to unsatisfactory relations with classmates. They were poor academic achievers and tended to smoke.
    Fred Frankel, director of the UCLA Children's Friendship Program, criticized the JAMA study for several reasons. For instance, he faulted the scientists' definition of bullying. "They're making a common mistake, lumping together different forms of aggression," he said. "Teasing is not bullying." But Nansel and Juvonen counter that teasing can definitely be bullying if it is done repeatedly and by a person in a stronger position.

 

Doctors Find Early-Warning Indicator for Autism
Will Dunham, Reuters News Service- 4/25/2001

WASHINGTON -- Elevated levels of proteins in the blood at birth appear to foreshadow the development of autism and mental retardation later in childhood, researchers said on Wednesday in a finding that could lead to earlier diagnosis and better treatment. Researchers studied archived neonatal blood samples from children born in four northern California counties from 1983 to 1985 who later developed autism, mental retardation, cerebral palsy or developed normally. They found that concentrations of proteins in the blood called neural growth factors were significantly elevated in children who later developed autism or mental retardation, but not in the other children. The findings appear in the journal Annals of Neurology.
    Dr. Karin Nelson, who led the study, said the discovery of this early-warning indicator for the development of autism and mental retardation before the onset of symptoms could help doctors make earlier and more definitive diagnoses. Nelson, who works at the National Institute of Neurological Disorders and Stroke, part of the U.S. government's National Institutes of Health, said the research could point the way for developing drugs that could be used in children showing these early-warning signs to better treat and perhaps prevent the development of autism.  Nelson said despite the similarities in these early biological markers for autism and childhood mental retardation, there is no reason to think they are the same disorder.
    Autism, a developmental disorder, affects up to one in 500 children. Diagnosis generally is not made until after symptoms surface at about age 2. The children show unresponsiveness to human contact, poor language development and bizarre behavior such as uncontrollable head banging and screaming fits. "The basic biology (of autism) has been fundamentally not understood," Nelson said in an interview. "These kids look normal, most of them, and they move normally. For a long time it was thought that this was a psychological disorder caused by defective parenting. Now it is pretty clear this is an organic disease of the brain."
    The study found that children who later developed autism or mental retardation had, on average, three times as much of certain brain growth factors in their blood as the other kids. The finding that these major regulators of brain development differ in autistic children in the first days of life helps in the understanding of the malady's biological basis, she said. "Things are happening after birth that make one hopeful that there may be ways found to intervene," Nelson said. "Many people think that the earlier you start treatment, the more favorable the outcome."
    Neural growth factors are important to the formation of the central nervous system during embryonic development. Previous research found that many of these proteins are crucial in the production of new brain cells and the organization of those cells into distinct networks. The researchers said the abnormal abundance of these proteins in the autistic and retarded children may disrupt the normal process of cell migration, differentiation and programmed death during early nervous system development. Animal studies have shown that an early shortage of one of these proteins leads to microcephaly (a brain defect marked by a small head and mental retardation) and other developmental problems.
    Nelson said "gorgeous foresight" by the California Department of Health Services to save blood specimens from the state's newborn screening program made the findings possible. The department's Judith Grether, a co-author of the study, said the archive provides "a tremendously valuable resource for scientific study of a wide range of developmental disabilities and birth defects."

 

Drug Found to Curb Kids' Debilitating Social Anxiety
Shankar Vedantam, Washington Post-4/26/2001

Children who are so shy or so attached to their parents that they are afraid to go to school or sleep alone do much better when given a psychiatric drug, according to a major study with profound -- and controversial -- ramifications for millions of children. The study of 128 children ages 6 to 17 found that the drug Luvox, widely prescribed for adults with depression, alleviated the debilitating symptoms of social phobia, separation anxiety and generalized anxiety -- psychiatric illnesses that afflict as many as 1 in 10 U.S. children. The effects of the medicine were dramatic, but experts were divided about its appropriateness: The medicine can help children with severe emotional problems, but it might also be abused as a chemical quick fix for normal anxiousness, with lasting effects on growing brains.
    "Although the results seem impressive, they nevertheless raise some very important questions about the use of psychotropic medications in children," said Joseph Coyle, chairman of psychiatry at Harvard Medical School, in an article accompanying the findings in today's New England Journal of Medicine. "Any drug that is effective is not going to be innocuous," he said in an interview. Children and adolescents diagnosed with these disorders should first try a form of therapy known as cognitive behavioral therapy, and turn to medication only if that fails, he said.
    An estimated 575,000 children nationwide were diagnosed with anxiety disorders in the 12 months ending in March, including 136,000 under age 10. Doctors recommended 390,000 children be put on medicines such as Zoloft, Paxil and Prozac. Of these, 89,000 were under age 10, according to IMS Health, a private company that tracks the pharmaceutical industry. Such vast numbers leave critics aghast. Too many children are being put on powerful brain-altering drugs for behaviors that may be merely troublesome, critics say. But other experts point out that many children suffer from distress that, left untreated, can cause impairment well into adulthood. "Researchers found that anxiety was among the most common problems that kids have," said Daniel Pine of the National Institute of Mental Health. He led the study. "When researchers follow children with anxiety over time, sometimes anxiety developed into more chronic problems. It could be the harbinger of problems with depression, panic attacks and all different kinds of problems."
    The study, the first large, well-designed survey to examine the effectiveness of a psychiatric drug for a wide range of anxiety disorders in children, was partly funded by the National Institute of Mental Health and by Solvay Pharmaceuticals, which sells Luvox. The drug, which like Prozac increases levels of the brain chemical serotonin, has been approved for the treatment of obsessive compulsive disorder in children. Luvox sales were more than $2 billion in the United States last year, according to IMS Health. Scientists at Johns Hopkins University, Columbia University, New York University, Duke University and the University of California at Los Angeles studied the drug over eight weeks in children with anxiety disorders.
    An example of a child with severe social phobia would be one who refused to go to school for two weeks, said Mark Riddle of the Johns Hopkins University School of Medicine, one of the study's authors. A milder example, he said, would be a child who went to school and participated in clubs and group events, but with intense discomfort. Extreme separation anxiety disorder, he said, would be displayed in a child who avoided birthday parties and sleepovers. A medium-grade example would be children who refused to sleep in their own rooms and wanted to get into bed with their parents. Generalized anxiety disorder, Riddle said, were "the worrywarts." "A lot of it would be about performance -- getting very preoccupied with a test at school, a lot of fussing about day-to-day things," he said. "We don't want a Prozac nation," he said about the medication of children. "We want to make sure we are not doing anything to harm youngsters. On the other hand, it can be a huge disservice to children to minimize the true significance of psychiatric impairments that do require treatments. It's the latter that can get lost in the very easy and popular position to take, which is 'Don't drug our kids.' "
    Richard Harding, president-elect of the American Psychiatric Association, said clinicians should carefully evaluate anxious children to find out whether their fears are caused by an underlying personality problem -- which would merit psychotherapy or medication -- or by a social problem, such as a bully in school or child abuse at home, in which case medication would be inappropriate. "A good clinician will not commit a child to a life sentence on medicine," said Riddle. "A good clinician will look to stop medication after the youngster has had a chance to regroup. You want to work with a clinician who says we are going to get John off this medication." It is unclear what impact this study will have in clinical practice, where doctors are prescribing children such medicines "off-label" -- meaning they have not been approved for such uses by the Food and Drug Administration.
    "Given our current medical-economic system in practice, I suspect both doctors and parents will be strongly attracted to the quick-fix nature of this intervention," said Lawrence Diller, a behavioral pediatrician in Walnut Creek, Calif., and the author of "Running on Ritalin." "We have highly effective psychosocial interventions for these problems," he said. But "they are more expensive and take longer." He said that helping families come up with parenting strategies could ease children's anxieties. "Children are highly responsive to their environments, and the home is the practice arena to deal with life," he said. "This is not parent-blaming -- children are difficult to raise. But when the parent makes changes, you see very rapid changes in the child." "It doesn't negate the value of the medications," he added. But "with uncertainty on both sides, effective psychosocial treatments -- first do no harm -- take preference."
    More extreme critics, such as Bethesda psychiatrist Peter Breggin, said the study was produced by scientists who are part of an "old boys' network of drug pushers." He said the psychiatric drugs cause harm -- some data have shown that the drugs cause lasting alterations in the brains of young animals. Researchers involved in the new study said the drug was well tolerated and safe.



Survey: Alcohol, Drug Use Increasing Among Students
Juanita Westaby, Grand Rapids Press- 4/26/2001

EAST GRAND RAPIDS -- If the numbers on East Grand Rapids schools' annual drug and alcohol survey aren't getting better, it's because parents aren't improving, school officials say. "The problem is, how do you get the parents to come to the (community) meeting (about drug usage), who allow their children to have parties on the weekend?" asked East Grand Rapids Superintendent James Morse. "That's why this is a community problem." The district's Community Action Council is offering a Your Chance to Ask evening Tuesday and will discuss the results of a survey that shows marijuana and amphetamine usage is rapidly increasing.
    The annual survey of seventh- through 12th-graders shows that East Grand Rapids students are reflecting county, state and national norms when it comes to drug usage: cigarettes are falling out of favor, while alcohol and marijuana remain the drugs of choice, said Wealthy Elementary Principal Mark Tompkins, who presented the survey results. "Thirty-five percent of our eighth-graders have had a drink in the last 30 days," he noted. "It makes you pause." Alcohol use has steadily grown, Tompkins said. Marijuana use also is on the rise, "which is not surprising," he said, noting the arrest last week of a Grand Rapids brother and sister who were charged with selling marijuana at the 7-Eleven in East Grand Rapids. The growing problem of amphetamine usage is an over-the-counter phenomenon, Tompkins said. "This is where we've had the biggest change," he said. "We live in a coffee era. We have kids buying (high caffeine content) Jolt (soda) to stay up all night to write a paper ... There is a problem with these things truck drivers buy."
    Frustrated that they haven't seen drug usage decline despite numerous educational and social efforts, East Grand Rapids High School administrators said lax parenting and societal influences share part of the blame. "Until we can turn off the TV and change the movies kids watch, we can't do much" to improve the statistics, Assistant Principal Sheila Pantlind said. Drug usage is "glorified" in the entertainment industry, she added. "Kids don't get the message to drink and do drugs from the schools," High School Principal Patrick Cwayna said. "I'm always encouraged by the young children we work with. I get discouraged with some of the adults we work with. We need to have the focused energy of adults to help us with the problem."
    While administrators felt some discouragement by the survey's results, a group of city administrators, on hand for another matter at Monday's meeting, said it may just be a perception problem. "We're a step ahead," City Manager Brian Donovan said. "That's the good news here. When we talk about this at (municipal) meetings, they want to know what we're doing. We have a lot of good things. We just need to keep working together." Mayor Judy Frey said both the children they are working with and the drugs being used are "always a moving target. You educate them and they move on. It's constantly changing."

 

Teen Killers: A Need to Balance Justice, Safety
David Fisher, Seattle Post-Intelligencer- 4/27/2001

EVERETT -- One is an A and B student at Evergreen Middle School. Another is an avid soccer player. A third turned 13 just 25 days ago. Among other things, the four teenagers who sat in juvenile court yesterday are likely no more than "in the beginning stages of coming to the realization of what death means, and what death is," said Karen Schepp, an adolescent and childhood development specialist at the University of Washington. But police and prosecutors say the four -- two 13-year-olds, a 14-year-old and a 15-year-old -- are capable of murder. And the law -- trying to balance the need for justice and safety against the fragility of a child's development -- may make them pay for their crimes as adults.
    The four, along with Barbara Opel, 37, and Jeffrey Grote, 17, are charged with first-degree murder in the savage beating and stabbing death of Jerry Duane Heimann. According to court papers, Opel recruited the teenagers, who then smashed Heimann, 64, in the head with a baseball bat on April 13. Opel, Heimann's caregiver, could face the death penalty -- if prosecutors decide to ask for it. Grote, who has already been charged in adult court, could face life without parole.
    Yesterday, Snohomish County Juvenile Court Judge Charles French set a June 13 hearing date to determine whether the four younger teenagers should be tried in adult court. If convicted in juvenile court, they would be held in a youth detention facility until their 21st birthdays. A conviction in adult court would carry a sentence of 20 years to life.
    The differences, though, go beyond simple time. In the juvenile system, the emphasis is on counseling and rehabilitation, Deputy Prosecutor Chris Dickinson said. In state prison, where juveniles convicted as adults are transferred after age 18, the sole goal is punishment. Judges have broad discretion to determine whether juvenile defendants should be treated as adults, particularly if keeping a case in juvenile court is "in the best interest of either the child or the public."
    Appellate courts, meanwhile, have laid out seven criteria to help guide the decision, including the seriousness or violence of the offense; the strength of the prosecution's case; the sophistication and criminal history of the defendant; the public's need for protection; and the likelihood that juvenile services could accomplish rehabilitation.
    The decision often boils down to a question of whether a child is developmentally impaired from proper decision making, or whether they've reached an age at which they have displayed any kind of independence of thought or action, said Dr. Alan Unis, an associate professor of psychiatry and behavioral sciences in the UW Medical School.
    And that has to be balanced against public protection. "We are skittish about all the violence we have seen perpetrated by youth," Unis said. "I think our level of fear has led us to become increasingly intolerant. "Even though I understand that, I also think we can make decisions that are both thoughtful and compassionate, and scientific and rational, in cases like this." The complications of doing that became apparent yesterday. French granted all four defense attorneys time and money so their clients could undergo psycho-social evaluations. But he doubled bail on each defendant to $100,000.
    The studies will likely delay any hearings until late summer or early fall, French said. As the lawyers haggled, the youngest boy, who turned 13 on April 2, leaned back in his chair, swamped in an oversized jail jumpsuit. While grieving family members wept in the gallery, he looked wide-eyed and a little bewildered, like a kid waiting to see the principal. "I'm not 100 percent convinced he understands what he's doing here today," defense attorney Steve Garvey said. It's logical to argue that most, if not all, 13- and 14-year-old children, lack an adult's ability to fully comprehend the gravity of their actions, Schepp said. They lack fully formed moral and empathetic filters that allow most adults to evaluate the heinousness of criminal acts.
    Opel is accused of recruiting the teenagers, including her own 13-year-old daughter, to kill Heimann for his money.  According to court papers, she paid them with rewards that seemed geared to their maturity levels -- money for clothes and a car for Grote; a $250 check, forged on Heimann's account, for the younger boys; free time at a local skating rink for the 14-year-old girl. Yesterday, as defense attorney Mickey Krom unsuccessfully argued that girl should be released without bail, partly because she has been a good student with deep family ties to the community, one of Heimann's family members choked back sobs in the gallery. "That doesn't matter," she muttered. "That doesn't matter."


Autistic Girl Unsafe At Home, Judge Says
Manuel Perez-Rivas, Washington Post- 4/27/2001

A Montgomery County family yesterday lost its bid to keep an 11-year-old autistic daughter at home after county social workers convinced a judge that the girl would be safer, at least temporarily, in a group home. The case involved no allegations of child abuse or neglect. Rather, it grew out of a years-long struggle between the county school district and Caleb and Ann Chang over the best treatment for their severely disabled child. Social workers said Jessica Chang could injure herself at home and should go, instead, to the live-in facility that the school district wants her to attend.
    But an attorney for the Changs said the school district and the county were overstepping their bounds and infringing on the parents' rights. "Does the county have the right to remove her from the home simply because she's severely autistic?" Lyda Astrove asked outside the courtroom. "Are they making a value judgment that she's so autistic that the parents can't possibly take care of her?"
    Ultimately, Montgomery County District Judge Stanley Klavan said he had to make the "safe choice" and ordered that the girl be temporarily placed at Community Services for Autistic Adults and Children, a residential facility in Rockville. A full hearing has been scheduled for June. "I find that this young girl is very, very ill. I find that she, in a split second, could do something that is irreversible," Klavan said. "My sympathies go out to this family. They are nice people. They've done nothing wrong. Nobody's accusing them of doing anything wrong." Jessica Chang was taken from the courthouse by social workers as tears welled in her mother's eyes. Klavan allowed the parents liberal visitation.
    Jessica, diagnosed with autism and mental retardation at age 3, lives in a constant whirl of motion. She knows few words of English, communicating better in Mandarin, and has little appreciation for danger. A county social worker testified that Jessica has shown multiple signs of self-injurious behavior in previous contacts with county officials, including eating inedible objects, throwing things randomly, climbing onto window sills, and touching herself inappropriately. Claudia Segal, the social worker, said the Changs' North Potomac home -- where the girl has lived most of her life with her parents and three siblings -- did not provide a stable, secure environment to ensure her safety.
    The Changs, both Taiwanese immigrants, acknowledged that Jessica has been hurt at home -- including once when she fell out of a second-floor window at age 4, and was hospitalized with minor injuries -- but they said she is better off with them than in a residential program. Twice they have tried group homes. They say she was poorly cared for in them. In addition, they said, she reacted badly -- injuring herself by rubbing the skin on her face raw, scratching her hands, and tearing her underwear and shoes -- during a recent eight-month stay at the Kennedy Krieger Institute in Baltimore, which runs a hospital for children with neurological problems.
    In court, Segal said Caleb Chang had agreed to place the girl at the Rockville center for the autistic when she was admitted to Kennedy Krieger. When the family did not take her there Monday, child welfare officials stepped in and issued an authorization for emergency shelter care, which led to yesterday's hearing. Caleb Chang said he did not agree to placing his daughter in the 24-hour residential program. In court, he said, years of bad experiences have led him to not trust the county bureaucracy in making good decisions about his daughter. "They want to keep their family together," Astrove told the court. The Changs would like Jessica to attend a private or public school for the disabled and be able to stay home with her family. Ideally, they would like the county to provide her with in-home caretakers.
    Before the hearing, Astrove said the county stands to save money by placing Jessica in the residential facility, rather than paying for a private day school and aides at her home. School officials said the live-in facility was more expensive than the day school, but did not include the cost of at-home aides, which the county provided the Changs for years. Officials said the girl did not show progress with the at-home services and continued to show signs of injurious behavior. The aides were dropped in 1999, and school officials said Jessica's developmental needs would best be met in a residential program so she could receive constant treatment.
    Agnes Leshner, the manager of Montgomery County's Child Welfare Services, declined to comment on the case. But, generally, she said, the agency bases its decisions on whether to pursue out-of-home placements on safety. "Is the child going to be safe in that home? That's the guiding principle," Leshner said. Tom Urban, founder of the Fairfax-based Parents for Autistic Children's Education, said yesterday that such removals are unusual and need to be weighed carefully. "The problem is professionals don't give parents enough credit in knowing what their child needs," said Urban, who has a 7-year-old autistic son. "Too often, judges give way too much deference to professionals and don't really listen enough to parents."



Illinois Still Struggling to Help Problem Gamblers
Nicole Ziegler Dizon, Associated Press- 4/28/2001

EAST ST. LOUIS, Ill. (AP) A $60 winning streak during a family trip to Las Vegas started Bob Olsen's lifelong battle with gambling. The streak didn't last long, but that didn't stop Olsen's betting. Soon he had gambled away all the money he and his wife had brought on the trip out West with their 3-year-old twins. Olsen got help and hasn't gambled for 25 years. But he sees temptation all around in the nine riverboat casinos that stretch from Chicago's suburbs to southern Illinois.
    The Illinois Gaming Board held a daylong hearing last May to consider ways the state could help compulsive gamblers like Olsen. Now board members are set to draft a rule that would let problem gamblers bar themselves from the floating casinos. Olsen calls the plan a good first step, but wonders why Illinois which has reaped billions of dollars from casino gambling isn't devoting more money to the problem. ''Me being a casino gambler, I used to have to get on a plane,'' Olsen said. ''Now we've opened up the expressways for anyone within a half hour to gamble in Illinois.''
    Illinois has lagged behind its neighbors with riverboat casinos in devoting state funds to compulsive gambling. Last year, Gov. George Ryan ordered the Department of Human Services to find $1 million to address the problem after lawmakers failed to include the money in the state budget. This year, the Department of Human Services has asked for $2 million to expand a campaign that includes public service announcements, signs on riverboats and training for counselors. The riverboats themselves fund a compulsive gambling hot line the state does not.
    The Gaming Board is expected to vote in May on the proposed self-exclusion rule, which would let compulsive gamblers put themselves on a list of those banned from Illinois casinos. But board Chairman Gregory Jones concedes the plan is far from a solution to compulsive gambling. ''That is not necessarily a very big step, but it's a step I believe we can take as the Gaming Board,'' Jones said. ''The next step that we really can't do is funding for treatment.''
    The self-exclusion plan is patterned after a Missouri program that lets problem gamblers ban themselves from that state's casinos for life. A draft of the Illinois rule would let those on the list apply for readmission in five years with a doctor's approval. In Missouri, gamblers who violate the ban are arrested for trespassing. Illinois would simply make the person leave and forfeit any chips, tokens or credits accumulated.
    Susan Gouinlock, executive director for Illinois Casino Gaming Association, said the eight boats she represents all have their own self-exclusion policies. Some bans are irrevocable, while others allow gamblers to reapply for admission after a year or more. Gouinlock said her group supports a policy making it easy for problem gamblers to ban themselves from every boat by filling out one set of forms. Cyndi Moriarity, a board member of the Illinois Council on Problem and Compulsive Gambling, favors the proposed rule but stressed that a ban alone is unlikely to stop compulsive gamblers unless they also get counseling and enter a 12-step program.
    A 1997 Harvard University study found that between 1.1 percent and 1.6 percent of adults in the United States and Canada met the criteria for pathological gamblers. The problem affects about 176,000 Illinoisans, according to estimates from the Department of Human Services. Olsen and another recovering compulsive gambler, Wayne Burdick, say they've seen the number of Gamblers Anonymous meetings in the Chicago area grow from about 10 in 1992 before riverboat casinos came to the area to 54 today. The two work for gambling outreach groups and tell their stories at high schools, nursing homes and wherever else people will listen. Earlier this month they came to a hotel just steps from the Casino Queen in East St. Louis, traveling together to avoid temptation, to talk to members of the Gaming Board who were meeting there. ''The disease, it's never cured. It's always there, waiting to surface,'' Olsen said.
    The Illinois Casino Gaming Association's Help-Line number is 1-800-GAMBLER (1-800-426-2537). The Illinois Council on Problem and Compulsive Gambling's hot line can be reached at 1-800-GAMBLING (1-800-426-2546).
On the Net:
Illinois Gaming Board addiction assistance site: http://www.igb.state.il.us/compulsive/
National Council on Problem Gambling: http://www.ncpgambling.org/
Illinois Council on Problem and Compulsive Gambling: http://members.nbci.com/icpcg/

 

Vermont Anti-DUI Effort May Become National Model
Associated Press, 4/28/2001

KILLINGTON, Vt. (AP) A local program to prevent drunken driving could become a national model. Killington's efforts to reduce drunken driving on Killington Road will be presented by Sgt. Randy Arthur of the Arizona Department of Public Safety at two national conferences of law enforcement officials. Arthur also will file a copy of his report on it with the U.S. Department of Public Safety. And John Cosenza, Northeast consumer awareness and education manager for Anheuser Busch, has presented the idea in Vale, Colo., and in Utah, where the 2002 Olympics are being held.
    Killington's efforts include free rides home for people too drunk to drive; videos and posters in bars that discourage drunk driving and point to alternative transportation; and police officers who introduce themselves at the nightclubs. Arthur heard about the program while working with Vermont State Police on monitoring sobriety checks. He was looking for innovative DUI programs and said Killington's was the most impressive. The program was started cooperatively by Killington Road businesses, the town and police. Bar and restaurants feared that checkpoints and roadblocks, common on Killington Road, were hurting their businesses. The road has one of the highest concentrations of drinking establishments in the state.
    A public meeting was called in the spring of 2000 to talk about the concerns and to figure out a solution. A task force was created that included business owners, police and town officials. ''Everyone realized the importance of tourism,'' Killington Resort President Allen Wilson said. ''We didn't want word getting out that Killington was a police state.'' Pickle Barrel owner Chris Karr started a free van service in December for drivers who drank too much at the bar. The van took people home and did not penalize them for leaving their cars in the parking lot overnight.
    Next ski season, taxi vouchers will be added, giving patrons a ride back to their cars the next day. Each voucher is worth a return trip to a Killington bar or restaurant. For places farther away, the voucher works as a $10 discount. Anheuser Busch is paying for the vouchers and other program materials. The program cost $5,000 this year, which could triple to $15,000 next season with the addition of the taxi vouchers. Wilson said it was a small price to pay, considering that around 1.3 million visitors were being educated each ski season.

 

Vermont Lawmakers to Pass Confidential-Address Program for Abuse Victims
Associated Press, 4/28/2001

MONTPELIER, Vt. (AP) The Vermont Senate is expected next week to approve a measure that would help victims of domestic abuse hide from their attackers. Under the plan passed by the House, victims of domestic violence and stalking would be able to list a state government address on public documents rather than their street addresses. They would also be able to route their first-class mail through this government address. As a result, abusers would not be able to locate their victims through public records and not-so-private lists.
    ''We know from the homicides in this state that batterers pursue their victims,'' said Jeri Martinez, public policy advocate for the Vermont Network Against Domestic Violence and Sexual Assault. ''This is one loophole that we could help close for victims.'' ''It's not going to do everything'' to keep them safe, she said. ''This is part of a safety plan, one element in it.'' Advocates for crime victims estimate 30 to 40 people will sign up in the first year. Karen McGauley, who was hired by the secretary of state to coordinate the confidential address program, already has received inquiries on behalf of 10 victims.
    Lawmakers passed a bill last year that would have launched the program in January, but Secretary of State Deborah Markowitz said the law was flawed. The program was delayed until the Legislature could correct the legal problems this year. The bill before the Senate would clarify when law enforcement officials could gain access to a participant's address. As soon as the governor signs the bill, Markowitz said, ''we're ready to go.'' She expects people could start signing up for the Safe at Home program in June.  Vermont modeled its program on one that has been running in Washington for 10 years, McGauley said. New Hampshire, Rhode Island, New Jersey, Florida, Nevada and California also have confidential address programs.
    Each participant will receive an authorization card they will show clerks when they register their cars, apply for driver's licenses or fill out other applications on which addresses are required. McGauley said this should smooth the way for victims to list the Montpelier address instead of their home addresses. The program also sets up a process so participants may vote without going to the polls or having their names and addresses on local voter rolls, McGauley said. Participants will request absentee ballots, which will be mailed to them through the Montpelier post office box. The best candidates for the program, McGauley said, will be people who have just moved to an address unknown to their abuser.
    Antje Ricken, coordinator of Women Helping Battered Women in Burlington, applauded lawmakers for their strong commitment to protecting abuse victims. She noted that the need is great. Last year, her agency served more than 100 people at its shelter, helped 525 obtain protection-from-abuse orders and fielded about 5,000 calls on its hot line. ''I can tell you that protecting themselves after they leave a battering situation is one of the foremost concerns that people we work with have,'' Ricken said. ''After women leave, that is when they are in the most danger. That is when the violence escalates.''

 

Michigan County Officials Battle Domestic Violence
Associated Press, 4/29/2001

BAD AXE, Mich. (AP) -- Communities in Michigan's thumb area are gaining tools to combat domestic violence and sexual assaults, thanks to a grant from the U.S. Justice Department. The Huron County Sheriff's Department and the Bad Axe Police Department are using the STOP (Services, Training, Officers, Prosecutors) grant to purchase two Polaroid cameras, a digital camera, a laptop computer and other equipment to help victims of domestic violence. Officials first won the grant in 1996 and have kept it going. "Now that this has been in place since 1996, we've serviced over 900 victims of sexual assault and domestic violence in this office," said Gayle B. Alexander, the Huron County Prosecutor's office advocate for domestic violence victims.
    "With the Polaroid cameras, you instantly know if the picture turned out or not, because there is nothing worse than having to go back out and get more pictures from the victim. We need to get the evidence right away."  The STOP program benefits Huron, Sanilac and Tuscola counties. Huron County Prosecutor Mark J. Gaertner said he's pleased with the quality of the cameras, which are Michigan State Police approved. "It not only protects the victim but also will protect against any false claim," he said. "It will help get to the fairness." The new equipment also helps speed up the initial investigation process, Alexander said. "The whole idea behind this grant was to have someone to serve as the go-between, between the victim and the prosecutor's office and the victim and law enforcement officers," she said.
    One hundred women in Michigan died in 1999 because of domestic violence. That's according to Lt. Gov. Dick Posthumus, who last week released a report of 40 recommendations compiled by the Domestic Violence Homicide Prevention Task Force. The task force met around the state for months to gather testimony from victims. Among its recommendations were the need to increase public awareness and education of domestic violence; create a statewide Web site that would offer resources for victims; put domestic violence cases on a fast track in the court system; and create uniform standards for reporting and tracking domestic violence in the state's criminal justice system. Posthumus said he hopes the task force's recommendations will be implemented by year's end. He said several of the initiatives will require legislation and others will need approval of the judicial branch. But he didn't know how much money the initiatives would cost.

 

Day-Care Study Notes Struggles With Staffing
Erika Hayasaki, Los Angeles Times- 4/29/2001

Child-care centers are losing well-educated teachers and administrators and hiring less qualified replacements, according to a study being released today. The California-based study also reports that salaries for child-care teachers, which average about $24,600 a year, have fallen in the last six years when adjusted for inflation. "The child-care work force is very unstable," said Marcy Whitebrook, a researcher at UC Berkeley who conducted the study. "It creates a climate of chaos."
    Although the study was conducted over six years in three Northern California counties--Santa Cruz, Santa Clara and San Mateo--its conclusions point to difficulties facing child-care centers nationwide, Whitebrook said. "The problem we address here is probably more severe in [other] areas where quality child care is not as available," she said. "It's rampant." The findings follow a recently released nationwide study that concluded that the more time toddlers spend in child care, the more likely they are to display behavior problems in kindergarten. The implications of those findings are a subject of great debate, even among the researchers themselves.
    Whitebrook said that instead of blaming child care, we should work to improve it. "The issue isn't to make the parents feel guilty for having their children in child care," she said. "How much turnover have these kids experienced? What kind of relationship do they have with their caregivers?" High rates of turnover and teacher staffing shortages have created detrimental environments for young children because less time is spent teaching and nurturing, and children sense stress, she said. "Quality makes a difference," she said. "As a nation, we should be doing everything possible to make sure that care is as good as it should be."
    Among the study's key findings:
* Just 24% of teaching staff employed in 1996 were still on the job at the centers in 2000.
* More than half of the centers reporting turnover last year had not replaced the staff they lost.
* When teachers and administrators left their jobs, only half continued to work in child care.
* Wages for teaching positions, when adjusted for inflation, decreased 6% for teachers and 2% for assistants over six years.
* New teachers were not as educated as those they replaced, and fewer had degrees in early childhood education.
* Centers that paid higher wages were better able to retain qualified teachers and directors.
Child-care workers are not well compensated because the profession is undervalued, Whitebrook said.
"Female-dominated occupations are still lower paid in our country," she said. Day care "is viewed as quintessentially women's work--taking care of children."
    Whitebrook said the findings point to a system that is falling apart. "The turnover was really getting people down," she said. "When there are vacancies, that means people have to work longer hours. Instead of taking a break or planning their curriculum, they are on the floor with kids."
    Diane Johnson, director of City Kids child-care center in Torrance, knows of these problems first-hand. She has been trying to fill one position since December. "It's been a long haul," she said. She has put ads in newspapers, visited community college teaching programs and conferences to recruit and offered bonuses to staff members if they find someone--but to no avail. Part of the problem is the relatively low pay. "Sometimes they have to get two jobs to make ends meet," she said. "They start to find out right away that this is not a career that you're going to make the bucks [in]."
    Emma Smith, director of the ABC Educational Center in Los Angeles, also seconded the study's conclusions.
"It's always difficult to find employees," she said. "It's hard sometimes to find what you want. Because you are working with small children, you want someone caring and soft, but at the same time professional and smart."
Smith doesn't expect pay rates to change, because people who work in child care tend not to do it primarily for the money. Most choose such jobs because they enjoy working with children in a low-stress environment, she said.
"A very educated person is not going to work in this field because the financial reward is not there," she said. "It's not going to be someone who graduated from Berkeley or UCLA."
    In addition, educated women are moving into better-paying professions, said Elizabeth Burr, a researcher in early education policy analysis at UC Berkeley. "A generation ago, options for women were you could either be a teacher or a nurse," she said. "Now, women have many other avenues open to them. But I think it's really too bad, because one of the most important things you can do is contribute to the growth of young children."
    Robert O'Conner, who teaches preschool administration classes at the West Valley Occupational Center, said the biggest concern the study raises is the quality of teachers, especially in low-income neighborhoods and areas that have had recent population increases. "People are starting to realize that a lot of the family [day-care centers] are just warehousing kids and not educating kids," he said. Whitebrook said she hopes the report will encourage the government to find ways of attracting and retaining qualified child-care teachers. "If we have an increasing pool of not-very-well-trained people doing this work, then it is going to be harder," she said. "There's no doubt about it, this is a hard job."