Supreme Court Hears Debates on HMO Limits
Gina Holland, Associated Press- 1/15/2003

WASHINGTON -- The Supreme Court wrangled Tuesday over whether states could push health maintenance organizations to enroll more doctors, giving patients broader choices in their own care. About half the states have laws requiring managed care or insurance companies to accept care providers as physicians, pharmacists or specialists like nurse practitioners. The providers agree to the insurer's reimbursement rates and contract terms. The HMO industry says forcing health plan expansions raises insurance costs for everyone and adds to the escalating price of health care.
    The justices, some of whom have battled their own health problems, seemed energized in Tuesday's debate over doctor options. They talked about pregnant women forced to see a different in-network physician because of a health plan change and the limited choices of people who want to see a chiropractor rather than a doctor. "It is really important to patients to choose a doctor because of the personal relationship," said Justice David H. Souter, who at 63 is the second-youngest member of the court. The oldest, Justice John Paul Stevens, is 82. Chief Justice William H. Rehnquist, who returned to the bench this week after missing a month of arguments because of leg surgery, seemed skeptical of some of the arguments made by the HMO attorney. "That really does not seem to make sense to me," Rehnquist interrupted at one point.
    The case turns on whether a Kentucky HMO law is regulating insurance, as states are allowed to, or regulating employee benefits, which is an area reserved for Congress. The 1994 law was challenged by a group of HMOs and an industry trade association. Their attorney, Robert Eccles, said the Kentucky law was among the broader of the so-called "any willing provider" laws requiring health plans to open closed networks. Some states have laws that affect only hospitals or pharmacies, and some apply to all health care professionals. Eccles argued that the laws increase administrative costs, make it harder for HMOs to monitor quality and jeopardize deals that health plans have made with providers. "It creates an uncertainty in the network," he told justices.
    Elizabeth Johnson, the attorney defending Kentucky's law, said the Supreme Court should let states help patients have more control over their health care. She said under "common sense" analysis, the law is an insurance regulation. "I don't trust common sense," said Justice Antonin Scalia, who appeared concerned that the law goes too far.
    The case brings up a common complaint about managed care plans: People want to be able to see their favorite physicians even if they are not in their network. Many managed care companies have doctors and hospitals under exclusive contracts to serve patients enrolled in one plan. The doctors and hospitals agree to accept lower fees in return for a guaranteed stream of patients.
    Michael Morrisey, a health insurance expert at the University of Alabama at Birmingham, said the success of managed care depends on cost-cutting contracts that are challenged in the Kentucky case. "In theory it really guts what managed care is all about, negotiating lower prices in exchange for volume," Morrisey said.
    Justice Ruth Bader Ginsburg said during the argument that managed care companies seem worried that the laws would "spell the end of HMOs." Eccles responded that costs have gone up in states with willing provider laws, some studies show increases of 15 percent. The Bush administration urged the Supreme Court to uphold Kentucky's law. The Supreme Court will hear arguments in another health care case next week, that one involving whether states could control the prices of prescription drugs by pressuring drug companies to lower costs for the poor.

Once an Addict, She Now Helps Others
M.L. Lyke, Seattle Post-Intelligencer- 1/15/2003

The emaciated teen ran after Lynn Eul's car yelling "Wait! Help me! Help me!" The 16-year-old boy had been up for eight or nine days, and hadn't eaten in four, she says. He was picking at his skin. He'd been missing school. Eul, who'd just given a talk on methamphetamine addiction to a Granite Falls High School assembly, knew a tweaker -- a meth user -- when she saw one. The youth addiction specialist used to be one.
    The assembly, and a group of mocking boys who sat at the back of it talking about getting high, made a January Rolling Stone magazine story on meth. The running boy didn't make the story, nor did his desperate plea to Eul to help him stop using. "The story made the assembly look like a failure," said the Edmonds mother of three. It is one of the few complaints Eul has with the wrenching story of meth's march into the rural heartlands of America, a story that features the self-described "sick tale" of her troubled past prominently.
    Eul, who has served as a youth, violence and drug prevention coordinator for the Snohomish County Prosecutor's Office for three years, says she started drinking at age 11. Through high school in Shoreline, she pulled good grades and was elected student body president. But she was also popping amphetamine pills and sloshing vodka. By the end of high school, she would be voted "the least likely to be seen in class."
    When she took her first hit off a crack pipe, she was 18, with a new daughter. Within months, she'd hit the streets in Los Angeles, dealing and doing 10-20 "rocks a day." She gradually moved from crack to less expensive meth. The crack high had lasted 20 minutes, the meth kept her up seven to eight days. She became paranoid and started seeing things. She didn't eat. She scratched at herself. "With meth, I did not feel normal. I felt agitated and scared," says Eul.
    When her family finally got her into treatment -- threatening to take her daughter away -- she was down to nearly 90 pounds. This 5-foot-3 woman with the smart, frosted hair and perfect makeup has been sober 15 years. At first, she says, she dedicated her life to helping addicts for the people she'd left behind on the streets. Then she did it for her children. Now, she says, she does it for everybody's children. She estimates she has done 100 interventions for addicts of all ages. "It's moved from college age, to high school, to junior high," she says. "Now we're seeing kids using at 12- 13."

Supreme Court to Make Milestone Gay Rights Decision?
Geraldine Sealey, ABC News- 1/16/2003

Sticks and stones may break your bones, but some names may lead to lawsuits. At least that's true in most states if someone calls you gay, even if the name-calling did not result in major economic damage. But that may be changing. The U.S. Supreme Court has the chance to hand down a milestone gay rights decision this spring when it considers Lawrence vs. Texas, a case that challenges Texas' same-sex sodomy law, which criminalizes sexual practices among gays that are legal between heterosexuals.
    Sodomy laws, on the books in more than a dozen states, do not just regulate sexual behavior; they have also served as a basis for slander and libel lawsuits. A Texas appellate court just upheld an argument last month made by a state inmate who says he was slandered by a corrections officer who allegedly called him "queer" within earshot of other prisoners. In the Texas case, the inmate claimed he was automatically slandered and should not have to prove damages because being called gay is "defamatory per se." In laymen's terms, that means the phrase used is so well-understood to be damaging, that no damages need be proven.
    If someone is called gay in a state where sodomy is a crime, they are by definition also being accused of criminality, which could be grounds for a defamation per se claim. Historically, other categories included being implicated to have a "loathsome disease," such as leprosy, having one's business or profession damaged and being accused of sexual misconduct.

Thinking Less of Being Gay
Legal experts say that even if the high court does not decriminalize sodomy when it rules on Lawrence this spring, individuals called "gay," "queer" or any similar name will still have a case for defamation per se because in most places, a significant percentage of the community still considers homosexuality to be a form of sexual misconduct. "It has nothing to do with the fact that the American Psychiatric Association has declassified homosexuality as a disorder, nothing to do with the fact that you may be living in a community with a large number of gay people," said W. Wat Hopkins, a professor at Virginia Polytechnic Institute and State University. "The question is, would a significant minority of the community think less of the person?"
    Defamation per se is more clear cut if the plaintiff says that he has been wrongly called gay. Gay people who have been "outed" do have grounds for claims, but many may not want to pursue litigation if they are trying not to draw attention to their sexual orientation, experts say. "The people protected here are usually straight people who do not want to be associated with homosexuality," said Jonathan L. Entin, professor of law and political science at Case Western Reserve University.

Being Called Black Once Slanderous
Defamation per se is an argument Tom Cruise used when he sued a gay porn star and his ex-wife for alleging in tabloids that Cruise had an affair with the man. Cruise alleged that being called gay in California is libel per se because being called gay exposed him to "hatred, ridicule and humiliation." A Los Angeles judge awarded him $10 million in a default judgment after defendant Chad Slater admitted his story was false and said he would not defend himself against the suit, according to Cruise's attorney.
    Tom Selleck and Liberace are among other celebrities who have cited defamation per se for being called gay. But such lawsuits are not just the domain of the rich and famous. When Daniel L'Hommedieu of Holly Springs, N.C., put his name into an Internet search engine, he found a Web site called DanLHommedieuLovesMen.com that appeared to claim he is gay. The site listed L'Hommedieu's former address and phone number and barely attempted to hide his true identity. He found out who started the site and is suing the creator for defamation and libel.
    As long as courts find that a community for the most part considers being gay as immoral or a handicap, defamation per se suits will remain viable, experts say. But if the Supreme Court makes sodomy legal, it will be another step toward making calling someone homosexual less of a legal issue. There are historical precedents, after all. At one time, it was considered defamation per se to be falsely accused of being black. More recently, women had a basis for defamation per se if they were wrongly called victims of rape, because society often blamed women for participating in the crime.

Polls Split on Gay Morality, Sodomy
Is American society ready to move past gay defamation? So far, the American public splits on the question of whether being gay is immoral and whether homosexual relations should be outlawed, according to recent public opinion polls. Fewer and fewer states have sodomy laws, as well. In the mid-'80s, half the states regulated sodomy. Now, the number has dwindled to 13. Kansas, Oklahoma and Missouri have same-sex sodomy laws like Texas. Alabama, Florida, Idaho, Louisiana, Mississippi, North Carolina, South Carolina, Utah, and Virginia outlaw sodomy for all, regardless of sexual orientation.
    Rob DeKoven, a professor at California Western School of Law in San Diego, says it's already time for the courts to find that referring to one's lawful sexual orientation, even if the statement is untrue, is not defamatory per se anymore due to changing morals. Instead, he says, plaintiffs could make an accusation of homosexuality libel or slander per quod, meaning that individuals would have to prove the statement was particularly damaging to him or her. "In the case of Tom Cruise, for example, he could argue that, being accused of having had a gay relationship while married, would implicate his marriage vows and the statement really accuses him of adultery, which may or may not be libel per se," DeKoven said.

Times Changing?
Potential consequences of the court's Lawrence decision could be sweeping, affecting how the court scrutinizes laws that treat people differently according to sexual orientation and outright legalizing sodomy in every state once and for all. Whether being called gay is automatic grounds for a lawsuit is one of the more minor potential side effects of a ruling in Lawrence but one that could have historic legal impact.
    "Times are changing generally and the social situation for gays and lesbians is improving, maybe slowly, but a favorable decision by the Supreme Court will certainly be part of the improvement," said Ed Stein, who teaches sexual orientation, gender and the law at Benjamin N. Cardozo School of Law in New York. "Along the way it would probably make it less of a bad thing to be called gay or lesbian and thus weaken the argument of slander per se over time."

Severe Postpartum Depression Leads to Seattle Suicide
Carol Smith, Seattle Post-Intelligencer- 1/16/2003

Alexander Soukakos has his mother's deep brown eyes and heart-shaped chin. But he doesn't have the comfort of her arms, or the sound of her voice. At 16 months, he says Mama. But his mama never comes. He was asleep in the car, buckled in his safety seat, a year ago when Carol Soukakos hanged herself from a basement water pipe. She had to work to die. On her first attempt, she tied a length of electrical wiring to a metal heating duct. The duct gave way and she crashed hard to the floor, gashing her head. She must have been frantic. Her husband, a Seattle restaurateur, would be coming home soon. It was the first time she'd been left alone in weeks. She tied the wire again. There was blood on her hands. The space was barely high enough to stand up in. To end her life, she had to bend her knees. She left no note.
    But she did leave, in retrospect, a chilling message. Carol may have died by her own hand, but the noose around her neck was a severe form of postpartum depression, a widely under-recognized disorder that affects 10 to 20 percent of new mothers. In one or two cases out of 1,000, the depression becomes so extreme it verges into psychosis. This is a stealthy, lethal invader that steals one of a woman's most primal urges: her maternal instincts. A lion will kill for its cub. Postpartum depression is the lion turned on itself.
    A week before Christmas, Thomas Soukakos, 45, bustles around his kitchen, packing a bag for a babysitter. Alexander chirps "cookie, cookie" from his highchair. Bright even in winter, the kitchen feels like the soul of this small, shingle-sided house nestled in the belly of Madison Valley. Toys and bottles litter the countertops where Thomas cooks for his son every day. Hand-written signs on the fridge tucked in among family photos say: "Stay present" and "Patience." They're written in Carol's hand.
    The first signs that something was going terribly wrong started just after Christmas a year ago. Normally cheerful, compassionate and highly organized, Carol, 34, became increasingly confused and depressed. She was convinced she wasn't a good mother, that she wasn't producing enough milk, that she was failing her baby. Sometimes she would grab her breast, squeeze hard, and say, "See?" She would look at Thomas wildly when nothing came out. Sari Gallegos, the naturopathic doctor who delivered Alexander, assured her the baby was thriving. Thomas assured her she was a good mother. But Carol couldn't be convinced. "Why she thinks all those things I have no idea," he would say later.
    Thomas, who came to the States from Greece 18 years ago, is an earnest, passionate man. Sometimes, when he talks, he clutches at his heart, as though trying to rip the right words from it. He has something to say. He wants people to listen. He wants them to understand about postpartum depression and psychosis so no other child will lose his mother. He doesn't want them to look away.

'She could do anything'
Thomas surprised Carol with a trip to Canada for her 33rd birthday. The following year their son, Alexander, was born. Months later, Carol, usually cheerful, became increasingly depressed. She committed suicide from postpartum depression a year ago. Thomas was engaged to someone else the day Carol, a pretty, down-to-earth woman with a soulful laugh, walked into El Greco, his cozy Capitol Hill restaurant, to apply for the pastry chef's job. Carol, a native of Syracuse, N.Y., had graduated from the New England Culinary Academy, eventually making her way to Seattle in 1990. "My biggest fear was I would die without feeling really in love," Thomas said. "Boom, she walked in, and I recognized it." He handed her the job that day. And his heart. They married three years later. Her "maid of honor" was her best friend from culinary school, Jim Goodall.
    "We were on top of the world. We had everything for 5 1/2 years," said Thomas. They bought a house together, and she indulged her passion for gardening and yoga. They traveled together: Greece, Paris, Canada, California. They cooked together. Their customers became friends, and their friends, customers as their restaurant became an extension of their living room. "It was like a family there," said Misha Whitfield, who worked at the restaurant and became one of Carol's closest friends.
    Carol and Thomas tried to conceive for several years. On New Year's Eve 2000, they found out she was pregnant. She was so excited, she called Goodall, who was in Paris, to tell him. It was midnight across the ocean, and as Carol shared the news of Alexander's nascent presence, fireworks lit the sky. Alexander arrived Sept. 4, three days after their fifth anniversary. He was a breech birth, but she gritted out the pain. She didn't want a Cesarean. "She was very courageous," Thomas said. "I was so proud of her. She was a strong lady."
    At first, Carol appeared to handle motherhood the way she handled the rest of her life. "She was very passionate about everything she did," said Whitfield. "She was so strong-willed; she could do anything." Then at four months, her outlook suddenly changed. Carol described it as a "veil coming down over her head." Over the next few weeks, Carol became increasingly distraught. In the last weeks of her life, she was visiting Gallegos, who was also Alexander's doctor, nearly daily, looking for support. One time, she showed up at 9 a.m. for a 5 p.m. appointment. She stayed most of that day in the waiting room. She told her husband she went there to feel safe. She was having disturbing thoughts.
    On Jan. 4, 2001, her doctor's handwritten notes say Carol "worries b/c feels Tomas (sic) and Alexander would be better off without her -- i.e. 'bad thoughts in her head.' Carol says she would never/could never kill herself b/c she could not do that to her husband and her son. She denies a plan." The doctor also noted that Carol brought up having gone through depression years earlier and worried that things would get "out of control."
    She went home and told her husband "I'm losing my mind." That night, he stayed up to watch her. "She stared at the ceiling the whole night," he said. He brought the baby to her, and although she let him breast-feed, she wouldn't cradle him in her arms. In desperation, Thomas called the midwife. It was 5 a.m. Gallegos said she reassured him that although Carol should be seen by specialists, she would be OK. Thomas remembers being told not to worry; women go through this all the time.

Many women hide symptoms
Postpartum mood disorders are common, but usually not extreme. Experts say about 80 percent of new mothers experience feelings of anxiety and sadness, commonly known as the baby blues, in the first two weeks after birth. Postpartum depression is more severe and can appear anytime in the first year. Mothers may have difficulty sleeping, despite exhaustion. They may feel detached from their child and guilty because of it. They may have trouble coping, and struggle with feelings of isolation and inadequacy. Many feel deeply ashamed.
    "We are told that pregnancy and childbirth should be the happiest time of your life, but that's a cultural myth," said Diana Lynn Barnes, a clinical psychologist and specialist in postpartum mood disorders in Woodland Hills, Calif. "It's a very tumultuous time in the life of a woman, and one of the most stressful periods in her life. It's a developmental crisis and needs to be treated as such." As a result, women tend to hide or minimize their symptoms. When they do bring them up, doctors and others sometimes make things worse by dismissing them as normal adjustment problems.
    Women with histories of depression or mood disorders, and those who have had trouble with severe premenstrual syndrome symptoms -- both of which Carol had -- also appear to be more vulnerable to postpartum depression. Postpartum psychosis is much rarer, and more typically happens soon after delivery, although a depression can also escalate into a full-blown delusional mindset, experts said.
    Although researchers don't fully understand the brain chemistry of postpartum depression, many believe it to be biologically based and triggered in part by the massive drop in hormones that occurs after delivery. Once the placenta is delivered, the levels of estrogen and progesterone drop precipitously. By one week out, levels of progesterone drop from 20 to 30 times their pre-pregnancy levels to next to nothing. The level of estrogen plunges to less than 1 percent of its pregnancy level.
    These hormones act in part on the limbic system, the part of the brain that governs our most basic drives -- appetite, sex, aggression, memory and the menstrual cycle -- essentially the functions that sustain and protect life. Disrupting the regulation of these functions can prove deadly. About 5 percent of patients with postpartum psychosis kill themselves. About 4 percent kill their babies, a phenomenon that some believe drove Andrea Yates to drown her five children in June 2001. No one knows how many patients with diagnosed postpartum depression, but not psychosis, also kill themselves.

Screening test a cry for help
Despite Gallegos' assurances, Thomas felt uneasy. "My wife was in a fog," he said. He called Goodall in Paris, but Carol refused to talk to him -- her oldest and best friend. That was the first time Thomas got really scared. Goodall was scared as well. Too late, he had picked up a message Carol had left on his Seattle answering machine a few days earlier. "She was quite distressed, in a fairly bad state," he said. He told Thomas to get her to a psychiatrist. Thomas called medical centers asking to see a psychiatrist, but it was the weekend and none were immediately available. Several frantic hours later, he was referred to Fairfax Hospital, a psychiatric facility in Kirkland. On the way to the hospital, she told him she was thinking about walking into the lake, or jumping from a balcony, but that she would never do that to him. He believed her. "I trusted my wife," he said. "We had the strongest, unconditional love you can imagine."
    The hospital evaluated her and consulted with the psychiatrist she'd seen many years earlier for depression and anxiety. They gave her the choice of checking into the hospital for treatment, or going home and seeing a psychiatrist the next day. She wanted to go home. They cooked dinner together that night and she seemed better.
    On the hospital's recommendation, they made arrangements for her to visit family in New York. They contacted a doula, a woman trained to help mothers through labor and the transition to motherhood, to come in a few days a week to give Carol some support. The doula put them in touch with a social worker and psychiatric nurse-practitioner.
    A week later, Jan. 14, Carol saw the social worker who gave Carol a standard postpartum depression screening test with 36 statements. Carol had to indicate how she felt about each of them: "Did not know who I was anymore." She marked a 5, meaning "strongly agree." "Felt like a failure as a mother." Strongly agree. "Started thinking that I would be better off dead." Strongly agree. Three times, in three different ways, the test probed for suicidal thoughts. Each time, she marked a 5.
    Thomas never saw the test, or her scores. He was never told their implications. "Nobody said anything to me except go home, this is normal," he said. "They said, 'Yeah, everything's going to be fine.' " The next day, they went together to see the nurse-practitioner. They left with a sample of Zoloft, an anti-depressant, and a prescription for more. On the way home, Carol told Thomas he should take a little break to get some paperwork done at the restaurant. She dropped him off at 1 p.m. Forty-five minutes later, she was dead. He found her hanging when he came home.

Support from church, friends
"It was a death for me," he said. "It's like I died." Thomas sits at his dining room table on a gray January day as the horrible, inevitable anniversary of her death approaches. The table, where they once shared meals, now doubles as a desk. He shuffles through reports and articles, information he's gathered about postpartum depression, trying to make sense of the unthinkable. He rubs freckled hands over his face, and through a stubby crop of graying hair. His auburn eyes are tired.
    Since her death, Thomas' friends and neighbors have wrapped their collective arms around him and the boy. There is always someone to watch Alexander, to take him to the park. Neighbors gave Thomas a jogging stroller for his first Father's Day. They bring food. They've set up a trust fund for the baby.
    Thomas has sold the restaurant. The 80-hour weeks were too much, and it wasn't the same without his wife. Now he's trying to start a new business where he can make a schedule that lets him be with his son. Perhaps a small cafe that serves just breakfast and lunch, or a catering service. "I'm a strong believer everything happens for a good reason," he said. "I just don't know how I'm right." He wants to see changes. He wants more education for fathers, so they can better recognize mothers suffering from postpartum depression. He wants caregivers to be more alert to those most at risk. He wants insurance companies to better cover care for it.
    In his grief, he has found a mission. "It's like searching your soul. You go to the deepest place to find out who you are. What is my purpose?" He spends much of his energy trying to educate all those involved in the care of pregnant women and new mothers about the risk of depression. Last June, he went to Santa Barbara, Calif., to the Postpartum Support International meeting. The people who devised the screening test his wife took were there. They said if a woman scored 120 to 130 on the test, caregivers should take "extreme measures" to intervene. Carol's score was 151.
    The focus of the session was on training people how to give the test. Thomas, filled with emotion, found himself suddenly on his feet. "What's important is not to give the test, but to pay attention to it," he told them. "You expect a woman to put a lifetime on a piece of paper, yet if you're not going to pay attention. . . ." Carol could have been immediately hospitalized or sedated in the caregiver's office so she could rest, then be observed. She shouldn't have been left alone. Even for a minute.
    In California, mental health advocates are working to get legislation to mandate depression screening for pregnant women so that a support plan is in place when the baby is born. In Illinois, where four women committed suicide in summer 2001, a governor's task force is developing guidelines for identifying and treating postpartum mood disorders. U.S. Sen. Richard Durbin, D-Ill., has introduced the Melanie Stokes Bill, named for a Chicago woman who jumped from a 12-story hotel window, that would provide for more research on, and better services for, postpartum depression and psychosis.
    In the meantime, those who cared for Carol are left with "what-ifs." Carol saw at least a half-dozen people who tried to help her in the last weeks of her life, from a "spiritual therapist" to a psychiatrist. None seemed able to shake her delusion that her family would be better off without her. At the time, each thought the right things were getting done. Gallegos, who cared for her the longest, is still tormented by how her death might have been prevented. "It was so fast-moving," she said. "It literally felt like trying to stop a charging bull."
    Abby Myers, the nurse-practitioner who saw Carol for the first time the day she died, said early intervention is critical in treating depression. Myers, who heads Depression After Delivery, a postpartum support group, said lack of awareness about postpartum depression contributed to Carol's death. "We need to educate all different kinds of providers about this," she said. Myers said Washington should copy New York's law mandating that women be informed in the maternity ward before they are discharged about what signs to look for and how to get help.
    Gallegos has her regrets. "What I do wish is maybe if we had all talked more -- all of us, and Thomas -- that maybe then we could have caught this." If there's a lesson, it's that denial can be deadly. "As health care providers we have to deal with our own sense of belief that it couldn't happen," she said. "The part we all missed, we thought no matter how difficult it was, she would never leave her son." Thomas believes his wife didn't really want to kill herself, that she was not in her right mind. Almost to himself, he said: "I forgive her."

Prescription-Drug Abuse Soars; Youth at Forefront
Aparna Kumar, Los Angeles Times- 1/17/2003

WASHINGTON -- A record 36 million Americans, an increasing number of them young, have at one time misused prescription drugs recreationally, according to a government study released Thursday. Of the 11 million people estimated to have used prescription drugs non-medically in 2001 alone, nearly half were younger than 25, according to a national household survey conducted by the government's Substance Abuse and Mental Health Services Administration. Nearly 3 million adolescents ages 12 to 17 used prescription drugs for recreational purposes or other nonmedical reasons at least once, according to the annual survey. The findings highlight a burgeoning public health crisis -- the use of highly addictive but commonly prescribed painkillers, tranquilizers, stimulants and sedatives for nonmedical purposes -- that is spreading most rapidly among youth.
    The number of Americans using prescription painkillers for the first time jumped from 400,000 in 1984 to more than 2 million in 2000, the survey showed. The estimates were based on questionnaires given to 69,000 people 12 years and older by the agency, which is part of the Department of Health and Human Services. "People perceive a prescription drug as safer, cleaner and healthier than heroin or other illicit drugs," said Dr. H. Westley Clark, a director at the substance abuse agency. To battle that misperception, the Department of Health and Human Services is launching television, radio and print ads and brochures aimed at teenagers, warning that even a single pill can lead to a dangerous addiction or even death. One of the taglines warns, "The buzz takes your breath away." In contrast with other strategies employed in its war on drugs, the U.S. government is stressing awareness and prevention of the problem over punishment. "If prevention fails, then treatment becomes critical," Clark said.
    Emergency room visits related to the abuse of painkillers more than doubled from 1994 to 2001, from 41,687 to 90,232, according to a separate survey by the Drug Abuse Warning Network, a public health system within HHS that monitors drug-related medical emergencies. The painkillers most commonly cited for abuse were hydrocodone, oxycodone and methadone. The name-brand drug Vicodin contains hydrocodone; Percocet contains oxycodone; and methadone is a legal substitute for heroin. Among teenagers and young adults, prescription painkillers were the most often abused, according to government research. Besides Vicodin and Percocet, name-brand versions of these drugs include OxyContin, Percodan, Demerol and Darvon. Among young adults, whites were more likely to have misused prescription drugs than Latinos, blacks or Asians. Teenage girls were more likely than boys to have abused the drugs, but for those 18 and older, the opposite was true.
    At a news conference Thursday, Kyle Moores, 19, of Manassas, Va., described his struggle to overcome an addiction to oxycodone, which he used to buy from a classmate. "It put me in a zombie mode for a year and a half," he said. "Personally I don't think it should be prescribed because of how addictive it is." But Clark stressed a different point -- that prescription drugs are safe and effective when used correctly under a physician's care. "The misuse of prescription drugs can have tragic consequences, the first of which is to stigmatize the legitimate use of medications," he said. "The most important thing to keep in mind is that these medications have a legitimate therapeutic purpose."

Boy Sheds Light on Autism Mysteries
ABC News, 1/17/2003

Imagine your child locked behind a wall of his own words, helpless to communicate, unable to look into your eyes and frantic with odd behaviors fueled by frustration. That is the reality for the parents of children with autism. Half a million children in the United States are currently diagnosed with autism, for which there is no known cause or cure. The numbers are inexplicably growing.
    Half or more of those afflicted with autism will never speak, leaving desperate parents to wonder if, deep inside, there is a child they will ever know. But thanks to one unusual little boy from India, some parents are getting a rare glimpse into the isolated world of autism. Deep in the heart of India, in a two-room house in the city of Bangalore, the unimaginable took place. Tito Mukhopadhyay, a severely autistic 11-year-old boy, was writing poetry. His language skills proved that, despite his odd behavior, his cognitive mind was alive. "With the help of my imagination, I can go to places that do not exist and they are like beautiful dreams," Tito wrote in his book of poetry. "But it is a world full of improbability racing toward uncertainty."

Mysterious Rise in Autism
In 1992 there were 250,000 cases of autism in the United States. By 2002, that number had nearly doubled, rising to 425,000. In California, the number of cases of autism has jumped a staggering 273 percent in 10 years. No one really knows why. "If you asked a hundred specialists about what could contribute to the increase, you'd get at least 30 or 40 answers," said Dr. Mike Merzenich, a neuroscientist at the University of California in San Francisco. The average level of intelligence among autistic individuals is unknown because their impaired communication skills make testing of cognitive abilities often nearly impossible.
    Theories about what causes autism range from childhood vaccines to delayed development in utero. A Danish study released last year studied 50,000 children given vaccines and 50,000 not vaccinated, and the autism rates were about the same. Still, some cling to the theory that vaccines have something to do with autism. But as the experts debate, autistic children remain at the heart of it all, which made Tito's case all the more compelling.
    Tito's mother, Soma Mukhopadhyay, had somehow found a way to communicate with her autistic son. She forced him to focus by gently prodding him, sometimes raising her voice to keep him on track whenever she asked him a question and required an answer. And Tito responded. First by pointing and then, slowly, by writing out sentences. The sentences grew into elegant observations about life as a child locked in the body of an autistic. "The thoughts are bigger than I can express," Tito wrote.. "Every move that I make shows how trapped I feel under the continuous happenings."

Thousands of Titos?
His case raises the question: Are there more children like him? "There might be thousands of children like Tito, and one of our challenges is to determine whether anything can be done about that and whether there are more children that can be in a sense awakened like Tito," Merzenich said. Tito's poetry caught the attention of world-renowned autism experts, who wanted to study him. The boy was one of the few people with autism able to describe his inner experience.
    Halfway across the world in Los Angeles, another mother, Portia Iversen, was doing everything she could to give her son Dov a chance. "There's certain intensity and vigilance you feel when you're the parent of an autistic child," Iversen said. "A vigilance to help them break through and break out of the disorder."
    Like Tito, Dov was severely autistic. But Iversen had refused to accept her son's fate and had started a foundation, Cure Autism Now, to fund research into the condition that ruled Dov's life. And it was that foundation that brought Soma and Tito to the United States. "I was just filled with questions to ask Tito about all these behaviors," Iversen said. "So that I could understand my son Dov better."

The Unexpected Happens
During Soma and Tito's visit something unexpected happened. Soma taught Dov the method she used with Tito, getting him to focus, point and spell out entire sentences. For the first time, Dov could tell his own mother, in rich detail, everything she wanted to know. "This is not a cure for autism, it's a tool," Iversen said. "It will probably not work for everybody the way it has for Tito, or for Dov, but we have to try and determine if it can."
    For Iversen, the changes have been astonishing. "Every day was a new excitement," Iverson said. "Making up for all these years of 'what do you want to be when you grow up? What's your favorite subject in school? Do you like school? What's your favorite color? How do you like having brothers and sisters?,'" she said.
    Soma and Iversen are at work on a manual that aims to teach other parents what they call the "rapid prompting method." Now Soma has begun to teach the method at Dov's school, working with nine other autistic students. When Iversen asked Dov what being able to communicate has given him, he spelled out an answer: "I am understood."
    Merzenich says Soma and Mukhopadhyay's efforts should be examined closely by the medical world. "So we need to look at the strategy more widely and determine whether or not it is a valid strategy for a large number of children," Merzenich said. "That's still unresolved . But The initial observations are extremely hopeful."

Parents of Autistic Children Start School
ABC News, 1/18/2003

The long journey began with 2-year-old Paul Kotler's devastating diagnosis — autism — a little-understood disorder whose victims live in a world of isolation, unable to communicate or control their body movements. Before long, Paul's parents realized that they didn't have a way to help him within their community, or even in their state. "We wanted a full-time speech and language program, but none existed in Pennsylvania," his mother, Melinda Kotler said.
    Later, they had a stroke of luck. In the fall of 2001, Kotler met Michael Dinda at a meeting for parents of children with autism, and they had a conversation that would change their lives. Together, they founded the Magnolia Speech School Demonstration Program, which opened in Berwyn, Pa., four months ago.
    The school's philosophy is that the only truly appropriate program for severely language-disordered children is one that immerses them in language, full-time. The founders say that the communication helps them break through the children's isolation and catch sight of the spark that is inside of them.

The Part That Breaks Your Heart
Before she met Dinda, Melinda Kotler and her husband worked hard on a specialized program in their home, but slowly realized that while Paul was learning, he was not learning to speak. When he turned 6, his parents resolved to find a school that could teach him, and the location didn't matter. "I went out and did the one-week trial placement, and he was accepted, and that was wonderful," Melinda Kotler said. "But it was very scary to think that we were going to split up the family."
    Melinda and Paul Kotler moved across the country to San Francisco. At about the same time, the Dinda family learned that their son, John, had autism. "To this day I can remember like the out-of-my-body, walking, watching me, John in his little toddler shoes and his blue and white jumpsuit, hand in hand between his mother and father walking down the hall," Michael Dinda said. "And, you know, at that moment that your life is irrevocably changed. The part that breaks your heart is you know that your son's going to have to work harder than anybody else."
    First, the Dindas tried intensive home-schooling, and later they made a disastrous attempt at regular first grade. Finally Michael Dinda, a senior vice president at Fleet Bank, took a pay cut so he could focus on his son. If he couldn't find a solution out there, he would create one himself. "John was coming home frustrated, he was regressing," Dinda recalled. "And I said, 'This is nobody's fault, Maude, but we're going to have to build a school.'" Meanwhile, the Kotlers were also at a crossroads.
    "At the end of that fifth year, we decided we just could not live apart as a family anymore," Melinda Kotler said. "And I knew that Paul was far enough along in the program that if I brought him back to Pennsylvania with the idea of starting a school that I could maintain his skills at home while we were starting the school."

A Life-Changing Conversation
Kotler and Dinda met in the fall of 2001 at a meeting for parents of kids with autism, and had a conversation that would change their lives. She had a curriculum, and he had a knack for raising money and a Rolodex full of wealthy clients. In eight short months, they raised a remarkable $250,000, recruited a highly trained staff, and on Sept. 3, 2002, opened their doors to a class of seven severely language-disordered children, most of them autistic. "I was elated. I got there, and I looked around, and I thought, 'Oh my gosh, I finally have my school and I can make sure that these kids have everything they need,'" Kotler recalled.
    The need extends far beyond the Philadelphia suburb where the school was founded. In fact, parents across the country have had to do the same thing: create schools for autistic children. But only the Magnolia School has a full-time curriculum teaching spoken language through the Association Method, sound by sound. The Association Method is phonics-based, and was developed by the late Mildred McGinnis at the Central Institute for the Deaf in St. Louis over 50 years ago.

Comfortable in their Own Skin
In addition to language, the school employs something called Sensory Integration Occupational Therapy, which involves buzzing and brushing the skin's surface to interact, and applying deep pressure to calm students down. The stimulation helps the children feel literally more comfortable in their own skin. The students also participate in "floor time," careful responsive play that teaches the children something that they don't know automatically: how to relate socially with other people.
    "If the people that saw him in school last year could see him the way you guys saw him today, it's night and day," Maude Dinda said. "He's a different child. He's entirely different." Her husband says that his son's hard work inspires him. "You know that he's working right along with you and that you owe it to him every step of the way to support him," Michael Dinda added.
    Kotler feels the same sense of dedication to her son. "I owe that to him because he's a wonderful, delightful, loving person, and he just shouldn't have to live that way," Kotler said. If there's a problem at the school, it is satisfying for her to be able to address it with a staff member who has the expertise, or to go out and find the expertise. The children are thriving, she said. "Every time we see a spark that he's in there, and he wants to relate, and he wants to be a part of this family, it just makes you hungry for more," Maude Dinda said. "I think when you have children, you know, as soon as you hold them in the hospital, that you would go to the ends of the earth and back again for them if you had to, and with John we've had to. It's just as simple as that."

Asperger's Syndrome: 'Wired Differently -- Not Defectively'
Lisa Barrett, Washington Post- 1/18/2003

"I've never seen a 2-year-old with an ability to concentrate like David," our day care provider told us when our son was little. "He's so smart, it's almost scary. He concentrates so hard on what he's doing that you can't distract him from it." Unfortunately, that meant that when she tried to get him to do anything else -- especially art projects -- he'd pitch a long, loud fit. That wasn't news to me and my husband. Our son had definite opinions and interests from the time he was an infant. Only a certain extra-soft silicone nipple on his bottle, no matter how hungry he was. Either the silver rattle or the red-white-and-black one, but no others. But he could stare at his book of black-and-white line drawings all day, even at 8 weeks old.
    As David grew older, he would both baffle and amaze us -- and those around us. At 3, he knew by heart the license plate numbers of all our neighbors within a two-block radius. By 4, he'd memorized detailed plot lines from books and videos, and would recite them -- over and over and over again. Halfway through kindergarten, David could read as well as many kids in the upper grades.
    But our brilliant little boy could be difficult as well. Meltdowns were a fact of life. Hours of inconsolable crying as an infant evolved into horrendous temper tantrums as a toddler and preschooler. Every child has tantrums, but David's were longer and more extreme than most, and seemed to come at the tiniest provocation: Turning off a video that he had already seen a dozen times; giving him the red sippy cup when he wanted the blue one; having to walk down the block when it was too sunny outside; trying to coax/cajole/force him to eat any food that wasn't on the very short list of what he considered edible.
    Advice from child care experts (reinforce his good behavior and ignore the bad) didn't work. Advice from family (give him a good swat on the behind when he acts up) only led to his adding hitting and kicking to his tantrum repertoire. Sometimes it felt like we were walking on eggshells, trying to avoid the many things that would set him off.
    It wasn't David's tantrums, though, that kept him from making friends. He just wasn't particularly interested in other kids. Oh, he'd sometimes find one other child whom he'd build a relationship with and be fiercely dedicated to, but he could be in the same day care class with 10 kids for two years and not learn their names. He couldn't be bothered, unless they wanted to listen to him talk about Superman (or another topic of the moment) for hours on end, and allow him to dictate exactly what game they'd play. Usually the game involved action figures, and David would have to script the entire process, typically with dialogue lifted from a comic book. David's pediatricians kept saying he was developing normally -- but then, as their practice grew, we never seemed to see the same doctor two times in a row, so how could they really evaluate his problems? If only we'd known then: David was exhibiting textbook Asperger's symptoms.

A Brain Wired Differently
Psychologist Tony Attwood, considered one of the top experts in the field, likes to describe Asperger's as "having a brain that's wired differently -- not defectively." That's more than just an analogy: Last fall, London scientists published findings that showed there are significant differences in the connectivity of nerve cells in the brains of people with Asperger's. The more severe the symptoms, the more abnormal the MRI scans.
    By definition, people with Asperger's, which is considered a form of high-function autism, are of at least normal intelligence. Many, like my son, are gifted. But they act, and interact, differently from their peers. Typical symptoms include: intense interest in one or two objects; abnormal speech content, often with very advanced vocabulary; trouble interacting with peers; repeating certain activities; and resisting change in routine.
    The different wiring underlying the condition, says Attwood, whose book "Asperger's Syndrome" (Jessica Kingsley Publishers, 1998) has sold more than 150,000 copies, means that people with Asperger's are "going to have difficulties as children in making friends, in reading body language and in the art of conversation. They can be somewhat pedantic and poorly organized. But they may have a special interest in a particular area, with encyclopedic knowledge and a lot of skills that are self-taught. "Some have sensory problems, that they are upset by certain sounds or textures. And some can be a bit clumsy for catching and running skills. But they can have a very original way of thinking, often combined with a dazzling memory for facts and information." That means that some things the rest of us take for granted, such as the social "skills" of reading a person's facial expression or body language, may have to be taught to an "aspie," as many in the Asperger's community call themselves.
    On the other hand, that deficit is often balanced with intuitive abilities in areas such as science or art that are beyond most of us "neurotypicals." Speculation is that many of the world's great thinkers may have had Asperger's: Thomas Jefferson, Wolfgang Amadeus Mozart, even Bill Gates -- all brilliant, determined thinkers who may have obsessed over their particular areas of interest while ignoring social niceties.
    The high intelligence, technical abilities and impressive vocabularies of many aspies have led to several nicknames for the disorder: Geek Syndrome, Nerd Syndrome, Little Professor Syndrome. But at a December conference in Richmond attended by more than 300 parents and teachers of Asperger's kids, Attwood suggested another name: "Frank Sinatra Syndrome": As in, "I Do It My Way."

The Little Prof at School
David most definitely has to do things his way -- and unfortunately, that's not always the teacher's way. At Montessori school, while other children happily moved from station to station, David took to wandering the perimeter of the classroom -- all day, if he could get away with it -- absorbed in his thoughts. Writing with a pencil or crayon "hurt," and at age 5 he still wasn't predominantly right- or left-handed. At recess, he complained that the other children hit him, but his teacher said it was usually minor, accidental brushes against him.
    At the recommendation of a social worker friend, we took David to an occupational therapist to be evaluated for sensory integration problems. The diagnosis: David had sensory defensiveness -- an over-sensitivity to light, noise, tastes, smells and textures -- along with motor coordination problems. A year of occupational therapy tamed David's tantrums to a large degree, and day-to-day life became less stressful for all of us. Transferring him into a public school -- where there was more structure and less emphasis on sensory activities than in Montessori -- helped, too. But sensory integration wasn't "the" answer we'd hoped for. David still wasn't connecting with other kids (the ones he called "best friends" were just other kids on the block who smiled and said hello to him), and life at school was continuing to deteriorate. By first grade, David could tell you endless complex stories about superheroes traveling through "inter-dimensional portals." But he'd hide under his desk and cry when given an assignment to write three sentences about his favorite pet.

Web Diagnosis
When David began developing tics -- first an odd blinking, then a nose scrunching, and soon an occasional funny walk (step, hop, step, pause) that he said he "couldn't help" -- the pediatrician referred us to a neurologist at Children's Hospital in the District. Because a tic disorder isn't life-threatening, we were faced with a several-month wait for an evaluation. In the meantime, I decided to do more research on my own. I had already learned a lot about sensory integration, but could the tics be connected in some way? I was floored when a quick search for "sensory integration and tics" produced more than 2,500 hits -- most on sites related to autism or a related disorder I'd never heard of: Asperger's syndrome.
    It would be seven months before we could get in to see a psychiatrist for an official diagnosis, but my husband and I knew as soon as we read the list of symptoms that we'd found our answer. That approach wasn't in any way unique. At a recent parent support group meeting I attended, more than half the moms there said they found the diagnosis on the Internet first -- then took it to the doctors.

I'll Have the Usual
Ironically, one of the things that sets Asperger's kids apart initially is their insistence on sameness. Many Asperger's kids, for example, can't tolerate any changes in routine: They want the same clothes every day, the same food at every meal, and pity the poor teacher who has to change the class schedule without notice. Mess with their agendas and these kids can have major meltdowns.
    Actually, eating problems can come both from the aspie's desire for sameness and from sensory sensitivities. An amazing 10-year-old boy from England, Kenneth Hall, wrote a book about what it is like to be a child with the condition: "Asperger Syndrome, the Universe and Everything" (Jessica Kingsley Publishers, 2001). In it, he says: "Another unusual thing about me is that I definitely can't take most foods. Eating is one of my biggest difficulties. I can't explain why I have this difficulty, but for me this is the worst thing about [Asperger's syndrome]. . . . Most food has a horrible texture. Like mashed potato, for example. It is like paper which has been soaked in water. It feels like papier-mâché which might go into every crevice of my mouth like a sculpture." What Kenneth likes to eat most is Red Leicester cheese in a bowl, which he has every day for lunch. He likes to grate it himself, so he can be sure it will be exactly the right consistency. The good news for parents of aspies -- many of whom get criticized by well-meaning relatives for not giving the child a varied diet -- is that Attwood says many aspies outgrow their eating difficulties, at least to some degree.

Literally Speaking
Two weeks before Christmas this year, David told me he had to go out with his dad for a little while and I couldn't come. When I asked him where they were going, he didn't say, "It's a secret." Instead, my 7-year-old told me "I'm sorry, Mom, but I'm just not at liberty to divulge that information at this time." That kind of comment from a child tends to charm the heck out of grownups, but it can baffle other kids.
    Words, for people with Asperger's, have very literal meanings. Author and adult aspie Liane Holliday Willey -- who has a doctorate in education with a specialty in psycholinguistics and learning-style differences -- says that even after years of therapy, she still often can't tell whether someone is joking with her or teasing her or angry with her.
    "I'm really not quite clear with words, what the intent is. I can't tell if they're being straightforward with me. If someone asks me 'How are you doing today?', I'm going to tell them. And I've been told over and over again, 'They don't really care.' " But that doesn't make sense to a person with Asperger's. Why would someone ask a question they didn't want an answer to? That literal interpretation -- as well as difficulty interpreting body language and facial expressions -- can make an aspie not just naïve, but vulnerable, and Willey cautions parents not to let their children become the prey of bullies or worse.
    We experienced that firsthand when our son was in first grade and he liked to spend recess walking alone, thinking about his stories. Lots of aspies need their "alone time," as David likes to call it. In David's case, a bully started following him around and snatching his new glasses. "But Mom, I just don't understand it. He hits me but keeps saying, 'I'm your friend, David. You don't want to get your friend in trouble.' Why does my friend hit me?" It took several nights of tortured coaching before we could convince our little guy that this bully wasn't his friend -- even though he said he was -- and that he had to stand up to him and get a teacher involved.

Everything Spider-Man
In many ways, the most interesting aspect of Asperger's Disorder is the child's (or adult's) focus on an all-consuming interest. If they're lucky, it's an interest common among their peers. My son, for example, studies Spider-Man as if he were working on his Ph.D. It's not unusual to find him with four or more books spread out, because he's comparing and contrasting how Dr. Octopus has been portrayed across the years, especially minute changes to his appearance. He can manage to turn almost any conversation back to the topic of Spider-Man. And if he can't, that doesn't especially bother him -- he'll just keep talking about Spidey, whether you're listening or not. (In fact, I can verify that he will continue talking about it even if you put your hands over your ears and cry, "No more! I cannot stand to hear one more word about Spider-Man today!" He'll just smile sweetly and say: "I'm sorry, but I just can't help it. I just love to talk about it so much!")
    Often, the focus of a child with Asperger's is a topic that's popular with other kids -- cartoons, video games, computers and animals are all very common, says psychologist Sally Ozonoff, co-author of "A Parent's Guide to Asperger Syndrome and High-Functioning Autism" (Guilford Press, 2002). The difference is the intensity of their interest: The aspies want to talk/read/think about nothing else but their special interest (the clinical term for this is "perseveration"), and can resent activities that take them away from it.
    Donna Cravey of Cross City, Fla., says her 12-year-old is now totally into Pokemon, but before that he was obsessed with RV campers, specifically the slide-in kind that fit on the back of pickup trucks. He had downloaded and printed schematics and designs of dozens of different RV trailers and carried them around on a little clipboard, as well as drawing and designing new ones of his own.
    A focus on things mechanical is also rather common because aspies tend to have a good understanding of mechanics and physical sciences, says Ozonoff, who sees patients at the M.I.N.D. Institute, a national center for autism spectrum disorders at the University of California, Davis. Ozonoff has treated four children obsessed with vacuum cleaners. Their knowledge base was amazing: "I'd tell them, 'Oh, I have a Hoover Elite 2000,' and the child would recite every detail about that vacuum, even though it was now out of production." Other children Ozonoff has seen had interests in very specific parts of history. She currently has a patient who talks constantly about the Greco-Roman War. He's 9.
    The older the child is and the more unusual his interest, the more difficult it can be for a child to fit in. The 16-year-old who talks incessantly about Ford Mustangs comes across as eccentric. The one who talks constantly about game show hosts or teeth or deep fat fryers (all real examples) is going to be called weird.
    Some aspies grow up to be very successful in their fields of interest, especially computers or mathematics or a particular academic pursuit, says Attwood. (Remember that computer science major at college who would get so caught up in programming that he'd forget to sleep, eat, bathe or go to class? He's a millionaire now; he may be an aspie.) Others, unfortunately, may have difficulty getting past the job interview and keeping the job -- not because the employer questions their honesty, integrity or knowledge, but because of their lack of interpersonal skills. What makes the difference, says Attwood, is the severity of their case of Asperger's and the amount of intervention they get.

A Different Ending
It's been nearly a year since we "discovered" Asperger's syndrome, and it feels like we are finally pulling together the variety of services David needs. While other parents of aspies often tell horror stories of dealing with school systems, we've been fortunate. Matching the right teacher to the Asperger's child is critical, according to autism expert Carol Gray, director of The Gray Center for Social Learning and Understanding in Jenison, Mich. She says the best teacher for an aspie child is affectionate, unassuming, has a sense of humor and, most important, has a lot of flexibility. We've been lucky this year to get a teacher whom David adores. Last month, the school agreed to provide several hours per week of special services to David, and a county-wide expert on Asperger's is being called in to evaluate what other services might be appropriate.
    Outside school, David has started going to a social skills group once a week -- a form of therapy for kids with social communication problems. A psychologist at Children's Hospital who specializes in Asperger's has agreed to begin behavioral therapy for David (as well as training for my husband and me, so we can implement her plan at home).
    Meanwhile, David remains unaware of his Asperger's diagnosis, although he understands that there are areas where he needs help, and that's why he's going to have therapy and extra assistance at school. He's generally a very happy child, other than his rather fierce resentment over being allowed to play video games for only 30 minutes per day. He's made a close friend in school this year who invites him over to play at least once a week, which is a wonderful new experience for him.
    In preparing this article, I've had the unique opportunity to ask some of the world's top experts on Asperger's, "When do we tell him?" Their answer -- "When he asks, 'Why am I different?' " That's the day we'll sit him down and show him this article and explain that, yes, he's a little different, but he's not defective.
    David might need extra help in some areas others take for granted, but he also has capabilities that most of us don't. His incredible determination and thirst for knowledge will take him far, and all the therapy isn't designed to fundamentally change him, but to help him navigate through the world we "neurotypicals" have designed. I have no doubt that he'll find his own way to contribute to it.

Treatment for Asperger's Syndrome
The ideal treatment for Asperger's is multi-part, says international expert Tony Attwood:
*Social skills training is a form of group psychotherapy focused on personal interaction: How do you ask another child to play? What does it mean when someone rolls their eyes? Why do they back away when you talk close to their face? (Note: Experts advise that you shouldn't ever refer to "social skills group" when talking with your insurance company -- always call it "group therapy.")
*Cognitive behavioral therapy can help the more explosive or anxious patients learn to manage their emotions, as well as cut back on some detrimental repetitive routines.
*Medication may be appropriate, not for the Asperger's itself but for other disorders that often come along with it. The stress of trying to manage every day in the social world can sometimes bring on a secondary depressive or anxiety disorder.
*Occupational or physical therapy may be called for when an aspie has sensory integration problems or poor motor coordination.
*Specialized speech/language therapy may be indicated because, even though aspies often have great vocabularies, they often have trouble with the pragmatics of speech -- the back-and-forth workings of normal conversation.
*Parent training and support is absolutely essential. The psychotherapist may only see the child for one hour per week, but Mom and Dad can learn behavioral techniques to help their Asperger's kids venture outside their comfort zones.
    Unfortunately, not only is it often hard to find a specialist who's qualified to diagnose and treat Asperger's, but getting insurance to pay for the therapies can be even trickier. Virginia law mandates that health insurance policies sold to companies with more than 25 employees must cover "biologically based mental illnesses," including autism (Asperger's is considered to be a high-functioning form of autism), and only charge the same co-pays they'd charge for any physical illness. Many families throw up their hands at the bureaucratic roadblocks the insurance companies have piled in front of them and instead pay out of their pockets for therapies.
    Fortunately some of the therapies may also be provided by the child's school -- depending on whether: a) it can be shown that the child needs the therapy to function in the classroom; b) the school system has the funding to provide it; and c) the administration is cooperative. (Actually, a public school is required to provide the services that a disabled child needs to function in the classroom -- but the services vary tremendously.)

Know Someone With Asperger's?
Think you know someone with Asperger's? Odds are you do, or you have in your past. Best estimates are that roughly one out of every 250 people suffers from Asperger's. Most adults with Asperger's have probably never been diagnosed because, although it was first described by Hans Asperger in 1944, Asperger's disorder wasn't added to the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association's authoritative diagnostic reference, until eight years ago. That means most doctors weren't taught about it in medical school, and may dismiss the diagnosis at first. Still, as it's become better known and understood, diagnoses have skyrocketed.
    On the other hand, experts emphasize, it's important to understand that not everyone who's shy and bookish has Asperger's syndrome. "Normal" has a huge range of variation. A person has to fit specific clinical criteria, and their behaviors and characteristics must severely affect their functioning before it's considered a disorder.
    For more information on Asperger's, the best place to start is the Internet, including many of the sites listed below. In fact, thanks to the dissemination of info on the Web, psychologist and author Tony Attwood says family members of Asperger's patients are often much better informed about the condition than clinicians.

Resources
• Asperger Syndrome Coalition of the United States: www.asperger.org
• Autism Society of America: www.autism-society.org
• Future Horizons: www.futurehorizons-autism.com
• Liane Holliday Willey: www.aspie.com
• Online Asperger Syndrome Information and Support (OASIS): www.udel.edu/bkirby/asperger/
• Tony Attwood: www.tonyattwood.com
• Gray Center for Social Learning and Understanding: www.thegraycenter.org

Imprisoned Teen Challenges Kansas 'Romeo and Juliet' Law
Geraldine Sealey, ABC News- 1/17/2003

Matthew Limon was one week past his 18th birthday when he performed oral sex on a younger male teenager in the residential center for developmentally disabled youth where they both lived. By all accounts, there was no violence or aggression involved. Because the younger teen was not even 15, however, Limon's actions were considered criminal sodomy by the state of Kansas. Even if Limon had performed sodomy on a girl, he would have been in trouble. But he and his family were shocked to find out just how much trouble he was in. Under Kansas law, Limon's actions earned him a 17-year prison sentence. If he had performed the same sex act on a girl, his sentence would have been about 15 months. Now, he's in the Ellsworth Correctional Facility and will be jailed until he is 35; once he gets out, he must register as a sex offender. Limon, who has already served three years of his term, is not challenging whether Kansas has the right to punish older teens for having sex with younger teens, says his lawyer, ACLU staff attorney Tamara Lange. "The unfairness in the Kansas rules is what he's challenging," she said.
    Today, the U.S. Supreme Court will decide whether to hear arguments in Limon's case. The court has already agreed to hear a challenge to a Texas law that hands out stiffer penalties to gays than heterosexuals for committing sodomy. With this case, the court will take another look at its 1986 decision in Bowers vs. Hardwick that said the Constitution did not protect the rights of gays and lesbians to engage in sex in the privacy of their homes. If the court also agrees to hear the Limon case, the decisions in both cases could amount to the most monumental rulings the high court has issued in the area of gay rights certainly since Bowers.
    While rulings in either case could have significant consequences for the legal status of gays and lesbians in the United States, Limon has much more at stake than the plaintiffs in the Texas case. "Most of us cannot imagine what it's like to be in prison let alone because it's something about our identity," Lange said. "He feels scared and upset. He hasn't had an opportunity to live an adult life, or to go out into the adult world."

Testing the ‘Romeo and Juliet’ Law
In Lawrence vs. Texas , two gay men say the state deprived them of privacy rights and equal protection under the law when they were arrested in 1998 for having sex in a Houston home. A neighbor had reported a "weapons disturbance" at the home of John G. Lawrence, and when police arrived they only found two men having sex. Lawrence and another man, Tyron Garner, were held overnight in jail and later fined $200 each for violating the state's Homosexual Conduct law. The neighbor was later convicted of filing a false police report.
    At issue in Limon's case is how Kansas treats gay and heterosexual behavior differently using two different statutes. The "Romeo and Juliet" law provides for penalties when a teen younger than 19 engages in voluntary sexual intercourse, sodomy or lewd touching with a teen between the ages of 14 and 16, provided the teens are of the opposite sex. The purpose of the Romeo and Juliet law, according to the Kansas Court of Appeals, was to differentiate sex between a full-fledged adult and a young teen from sex between teens of different ages. But the legislature decided not to make the statute applicable to gay teenagers. Thus, teens of the same gender engaging in the same sexual behavior fall under the state's criminal sodomy statute, which prohibits sodomy with a child between 14 and 16 years of age, without regard to consent, the offender's age, or the gender of the participants.

Penalties far Different by Sexual Orientation
The two statutes provide for dramatically different penalties. Under the Romeo and Juliet law, first and second offenses receive probation, and a third offense carries a maximum sentence of 15 months imprisonment. Under the criminal sodomy law that Limon was convicted under, a first offense carries a sentence of 55 to 61 months; a second offense gets 89 to 100 months, and a third offense gets 206 to 228 months. Because criminal sodomy is a sexually violent crime under state law, violators must register as sex offenders. Most states have some kind of "Romeo and Juliet" law, legal experts say, but most of those statutes are neutral on the issue of sexual orientation. Only Kansas and Texas have laws that treat gay teens different from straight teens.

Defending Same-Sex Sodomy Laws
Advocates of same-sex sodomy laws say the states have every right to differentiate between homosexual and heterosexual conduct under the law. "We feel sympathy for a young person facing a long prison sentence for this kind of act, but should that justify overruling a principle of law that has benefits for society?" said Scott Lively, director of the Pro-Family Law Center in Citrus Heights, Calif. States have the prerogative to make a moral distinction between homosexual and heterosexual conduct, said Lively, who co-authored a brief in the Lawrence case in support of same-sex sodomy laws. Gay individuals have no grounds for an equal protection challenge because they are not similarly situated as heterosexuals, he said. Further, Lively noted the disproportionate effect of sodomy by gays and heterosexuals. "Same-sex sodomy carries a much bigger social price tag on AIDS alone," he said. He noted that gay men make up a disproportionate number of the nation's HIV/AIDS cases.
    Advocates and opponents of same-sex sodomy laws agree on one thing: The court's ruling on the issue could be a milestone in how sexual orientation and traditional views of marriage and family are treated under the law. The justices could decide whether sexual orientation deserves special scrutiny under the equal protection clause of the 14th Amendment. "The Supreme Court has not reached the question of whether sexual orientation warrants strict or intermediate scrutiny. Some have argued it deserves heightened scrutiny," said Ed Stein, a professor of sexual orientation, gender and the law at Benjamin N. Cardozo School of Law in New York.
    Advocates of traditional marriage, like Lively, hope the court will decide that states should still have the option to regulate sodomy. "In the end, the social policy we'll hopefully be operating by is one that encourages marriage and discourages promiscuity in every form," he said. "Hopefully the Supreme Court will lead the way in restoring this perspective of marriage and sexuality. I'm hoping they're concerned about the disintegration of our moral culture. We'll just have to see."

Study: Women's Sex Problems Overestimated
Associated Press, 1/19/2003

INDIANAPOLIS— A new study suggests sex researchers have been overestimating the prevalence of sexual problems in women for years perhaps because they have been looking at things from a man's point of view. The Kinsey Institute study found that a quarter of American women are significantly distressed about their sex lives far less than the 43 percent a 1999 study labeled as suffering from sexual dysfunction.
    Research on the topic has tended to focus on physical aspects of sex, such as orgasms and arousal. But the new study found that the best predictors of a woman's sexual satisfaction are her general emotional well-being and her emotional relationship with her partner. "This study emphasizes the importance of non-physiological components of sexuality as well as the general importance of mental health," said John Bancroft, director of the Indiana University-based Kinsey Institute. "It's not conclusive, but it counterbalances what I believe to be the rather extraordinary conclusion that 43 percent of women suffer from sexual dysfunction."
    The Kinsey study, which will appear in the June issue of the Archives of Sexual Behavior, was a random telephone survey of 853 women, ages 20 to 65, who had been in a heterosexual relationship for at least six months. Among other things, it found that 24.4 percent of those women reported "marked distress" about their sexual relationship, their own sexuality or both, within the previous month. That contrasts with a University of Chicago study that questioned more than 1,700 women, ages 18 to 59. That 1999 study found 43 percent of women reported having one or more persistent symptoms of sexual dysfunction, such as a lack of desire for sex, during the previous year.
    University of Chicago sociologist Edward Laumann, who led the 1999 research, said the new work cannot be directly compared to his study. While that study involved face-to-face, 90-minute interviews with women, he said the Kinsey study was an impersonal, random telephone survey. He also said the Kinsey study excluded women who had not had a regular sexual partner within the preceding six months, potentially eliminating women with serious sexual problems.
    Other researchers said science has for decades disregarded the fact that some women's sexual lives are encumbered not by physical problems, but relationship or emotional turmoil unrelated to sexual performance. Beverly Whipple, president of the Society for the Scientific Study of Sexuality, based in Allentown, Pa., said researchers who have studied women in the past based their findings on what is important to men: desire, arousal and orgasm. "I don't think we should try to lock women into a male model of what's important. Women are not men; there's so much we don't know," she said.
    Patricia J. Aletky, a clinical psychologist with the Minneapolis Clinic of Neurology, noted that decades ago women were labeled "frigid" if they had little or no sexual desire. It was a diagnosis that often disregarded factors such as domestic violence or overwork from caring for children, she said. "There has been a long history of over-pathologizing women, and in that regard I think it's very encouraging that we're starting to look at the bigger picture," Aletky said.

Arkansas Mental Health Suit Deal
Associated Press, 1/19/2003

LITTLE ROCK— A federal judge approved a settlement in a lawsuit that accused the state of violating the rights of mentally ill inmates by delaying psychological examinations and treatment. The settlement obligates the Arkansas State Hospital as of July 1 to mentally evaluate prisoners within 30 days of a trial judge's order. "They have a long way to go. But they have started," said lawyer Bettina Brownstein, who sued the state Department of Human Services in 2001 on behalf of the Arkansas chapter of the American Civil Liberties. The lawsuit claimed that inmates' constitutional rights were violated because they had to wait up to a year for evaluation or treatment at the Little Rock hospital, which the department oversees.
    U.S. District Judge Stephen M. Reasoner ruled in May that the state must improve care for the inmates. In September, the two sides reached a settlement. Reasoner approved a version this week. In the settlement, the hospital agreed to develop a system to help them evaluate the more urgent cases first when a judge has ordered treatment aimed at restoring competency for trial. On Wednesday, the Department of Human Services told the court that 92 inmates are waiting to be evaluated. The report said the department is trying to add staff members to do more evaluations and hopes to have the process speeded up significantly in the next few months.