Tips for Elderly to Beat Back Depression
Associated Press, 4/7/2004

SEATTLE -- Older adults can learn to beat back depression through problem solving, exercise and social activity, according to a Seattle study published in Wednesday's Journal of the American Medical Association. After one year, study participants were much more likely than others to halve their symptoms of depression, such as feelings of hopelessness, poor appetite and difficulty falling asleep. Their health status and emotional well-being improved and they tended to be hospitalized less, the study said. Many participants managed to shed their depression completely. ``It was a lifesaver for me,'' says Chuck Lazenby, 72, of Seattle, who slipped into despair after his partner of 50 years died of a heart attack.
      Late-life depression affects 15 percent to 20 percent of older Americans, said Dr. Paul Ciechanowski, a co-investigator and psychiatrist on the study, called Program to Encourage Active Rewarding Lives for Seniors, or PEARLS. Only about half of depressed older adults receive treatment, though many don't receive adequate treatment, Ciechanowski said.
      The study was conducted by the University of Washington's Health Promotion Research Center, which is leading a national research effort on healthy aging for the Atlanta-based federal Centers for Disease Control and Prevention, which paid for the study. Driving a national search for solutions are the prevalence of the disorder, the health care costs and the large numbers of aging baby boomers. The goal is to create programs that can be demonstrated to improve the health of older adults at low cost in communities nationwide.
      The study cost $630 a year for each participant, which included eight in-home sessions with a social worker and monthly follow-up phone calls. ``This is an attempt to reach the most vulnerable population in our society,'' said Dr. Jim LoGerfo, the UW center's director. Efforts are underway to make the program available to more seniors throughout the state, in senior centers as well as in homes.
      The UW study extends the 2002 findings of a large national study. Seattle was one of seven cities in that study, which found that depressed patients at clinics improved through problem-solving therapy, increased social activity and medication management. The study extended that approach into the community and people's homes. It also relied on partner agencies in the community: Aging and Disability Services -- a city of Seattle division -- and Senior Services. An editorial in the journal said depression studies such as the UW's ``provide evidence-based hope for millions of elderly persons living in the dark tunnel of major depression or the only slightly less dim tunnels of 'lesser' depressions.''
      Triggers often are life's losses, such as careers ending, family and friends dying, the body weakening, and independence ebbing. Seniors with chronic conditions or physical limitations often stay inside and can feel isolated and unneeded. During the 2 1/2-year study, social workers from Aging and Disability Services visited the homes of 138 low-income seniors, age 60 and older, most of whom were single and had serious disabilities. The social workers focused on a therapy that emphasized exercise and more socializing. The participants learned to identify what was bothering them and to write down step-by-step solutions. ``It's like breaking the bundle one stick at a time,'' Ciechanowski says. Social workers followed up with visits and phone calls to keep patients on track. But patients were expected to solve their own problems, which helped them regain a sense of control over their lives.

Homesick: A Memoir of Family, Food and Finding Hope
ABC News, 4/8/2004

After battling anorexia and bulimia for years, Jenny Lauren -- the niece of fashion icon Ralph Lauren -- began experiencing a new illness that literally brought her to her knees. Meanwhile, a series of doctors told her it was all in her head. In her new book, Homesick, Lauren gives a first-person account of her journey to find the cause of her paralyzing illness and how it related to her lifelong battle with food and her own body image.

Chapter 1: Twitch
This twitch is driving me crazy. It's 1997, I am twenty-four years old, and for a year I have been in physical discomfort. That is 365 days with my butt twitching and an inability to contract my gluteus maximus muscles. Three hundred and sixty-five days with bugs up my a--, 365 days of wanting to jump out the window, 365 days watching the entire lower half of my body turn into jelly and atrophy. This is a sick joke.
     Now, understand, it is with these muscles that women often feel sexy. The tight squeeze, the swaying of hip to hip, the alignment of the pelvis and the flattened stomach are what gives a woman so much strength to conquer the day. Losing this sensation is basically losing my connection to any kind of sensuality. So it doesn't surprise me that the depression I've often suffered from has become stronger and more unbearable this past year. Of course, this darkness, my old and dear friend, has led to the recurrence of my bulimic symptoms and to the deterioration of my emotional self.
You might say, especially if you are a psychiatrist, that it's my emotional fears, depression, feelings about my sexuality, past disappointments, and all that crap that have caused my building to collapse. I will not deny this. My coping skills are far worse than they were, but after a year (and, yes, I am as bored with this as my world-famous neurologist suggested I ought to be), I am at my wit's end. I'm trying so hard not to lose my mind, but I'm very aware that my power to intellectualize and make any sense of this is descending rapidly. I've tried to become as spiritual as possible; I've always believed in the mystical and magical journey through life, but after such pain, I need a tangible answer.
     I used to be able to heal myself from my depression. I learned how to use my body to ward it off, with vigorous runs, enlightened yoga, and techno-electric-charged race walks. Only, now I can't do any of that. And without that, my mind is not getting enough juice, and my creative soul, the one that carries the nervous depression and adrenaline out of me, is utterly blocked. It was the same when I painted. I want to paint again, but that, too, is locked within my ailing body. I need to dance while I move the paintbrush, or simply feel the energy flowing throughout my body onto the canvas. I studied ballet for thirteen years. The mirrors, the leotards, all of it had an impact on my self-esteem. I had to stop in my last year of high school. I thought I'd never find anything as fulfilling. When I began to paint I was relieved. I was able to merge these two passions. Music or silence set the backdrop as I moved my body to the rhythm of my strokes, to the colors I saw and heard, and to the composition I was creating. I was using a freestyle improvisation. My gestures, my actions, and my inspiration came most deeply from my pelvis, deeply from my core. But now thinking about painting depresses me because I no longer have the energy to get downtown to my studio, let alone paint. Some osteopath actually said that I had no chi.
     It's these painful twitches, though -- they're absolutely maddening -- and in the most demoralizing place. Of course the twitches are not in my eye, not in my shoulder, but in my a--hole. And they just keep on pulsing and breathing constantly. It's quite the symphony, with a wonderful crescendo. Great large and climactic twitches fizzle into small fluttering twitches that keep me gripping my thighs for hours. It's like there is a huge monster grabbing me between my legs. I've been telling the doctors that I think this actually all began in my stomach, that it's gotta be a digestive problem.
After I eat, even the tiniest of meals, a sucking candy or a rice cake, for God's sake, my stomach begins to fill up with air. I begin to choke and the food just doesn't want to go down. It stays lodged in my chest and flows back up into my throat. Then, every sensation, especially an overwhelming sense of muscle weakness, becomes pronounced.
     Ugh, and taking a sh-- (vulgar no matter how you put it) is like giving birth, with the baby's head getting stuck for hours. I even have to stand and massage my stomach as I go, just to make things move. But then the sensation is always there, singing its lullaby or rock music all freakin' day long. Me and my twitch. I can't exercise at all, can't even walk comfortably. The other day I taped myself up to see if it would help me run. I thought it might make my buttocks feel stronger and help me forget the twitch a little if my cheeks were pushed tighter together. I wrapped a large piece of masking tape around my cheeks as if it were a belt that kept them squeezed together, and I ran. God, how I need to sweat and pant. But I had to keep stopping to redo the tape because it wouldn't stay stuck to my sweats. Then I just gave up because it also made my hamstrings burn and ache. I had to limp from the reservoir in Central Park to Fifth Avenue to hail a cab. I was afraid I was going to have to ask my doorman to carry me upstairs to my apartment.
     All year I've begged my internist, Dr. W (for Dr. Worthless), to make this stop, to find the cause. It has taken him months to take me seriously. When I first went to see him last summer, he reasoned that I was too young to be put through a series of medical tests, and he attributed my discomfort to stress. So I carried on with my life, trying to move through the days like a machine. I painted at my studio, worked at a nonprofit art organization, and scouted for beautiful/eccentric homes for a well-known design magazine.
     Okay, maybe it'll go away, maybe it's nerves, I thought. The problem, though, was that I was depressed and tired all the time, and then the physical symptoms became worse. It was getting harder and harder to leave the house. I would wake up, attempt to go to the bathroom, and then the twitch would just take over. Forget the studio. Forget work. Forget seeing friends. Forget everything.
     I would panic most mornings and rush up to 87th Street and Park and sit and wait in Dr. W's office, sometimes for hours, to see him. As I sat there holding my breath and clenching my legs together to stop the twitch, I'd rummage through the pile of magazines, flipping through all the fashion ads. Oh, there's Uncle Ralph with his two dogs in a Purple Label ad. Whadda ya know, there he is again. Not his face but a Ralph Lauren fragrance ad with a young beautiful couple wrapped in velvet and in love. The good life, huh? … things to aspire to. Reminding me of everything I hated, everything I loved, everything I wished I could be … but that was then. Look at me now. By the time Dr. W called me into his office, I had finished skimming the magazines from the late eighties, with Paulina and Christie Brinkley splashed all over them, and gotten through the nineties, with enough of Crawford, Turlington, and the fashion world up my nose.
     Dr. W aggravates the living sh-- out of me. He listens, takes notes, and then speaks to me in his calm, methodical, and patronizing style. He has been my parents' internist forever, and they have great confidence in him. Six years earlier, when my father suffered a subarachnoid hemorrhage and was lying in bed in severe pain during recovery, it was Dr. W who found the phlebitis in his lung and leg that could have killed him. My dad was rushed into surgery on Thanksgiving Day as I shoved hospital cafeteria turkey and cranberry sauce into my mouth. I know I owe him a lot for saving my dad's life, but my confidence in him helping me is fading. He has never been able to provide relief.
Everything is always fine; he says my blood is good and I don't have hemorrhoids. He suggested I watch my diet, give up acidic and gassy sugar-free foods, and come back if I didn't feel better. How come he can't make it stop? He's a doctor for goodness' sake!
     After six months of this, Dr. W starts to shift his position ever so slightly. He gives me a sigmoidoscopy, a test where they shove a scope up the lower part of the colon to take a picture of what's going on inside and they look for tumors or obstructions. It shows nothing, so he sends me to other gastroenterologists. Dr. D is a specialist who is known for a unique device he uses. It can measure the fluttering and spasms of my rectum. I've now visited him and his device five times. I have a ritual: I wait on the corner of Central Park West drinking coffee and watching the gorgeous guys go Rollerblading into the park. When the spasms get really intense, I rush to his office so he can stick this thing in my butt and see what I'm talking about. Each time he has said, "Well, they certainly exist, but I'm not sure why."
     Dr. W finally gives me an esophagoscopy, which shows that I have an irritated esophagus and stomach lining (they call it a hiatal hernia), a symptom common to bulimics. But that only explains some of my discomfort, like the choking sensation and the acid reflux, and not the twitch or the overall muscle malaise. W's diagnosis doesn't stop me from continuing to vomit a few times a week even now. Sometimes I convince myself that purging will stop the twitching. As if I could only just vomit up the alien between my legs everything would be fine. Then, two months ago, he gave me two colonoscopies (these evaluate the entire colon) as well as a barium series (X-rays taken after digesting radioactive dye). Took him long enough.
     The barium series showed that I have a dilated small intestine, which is evidence that something else must be going on. But Dr. W can't figure out what it's from. All year he prescribed various medications...Propulsid, Levbid, Prilosec...so many meds I can't keep track, but they've warped my body even more. Now I have glycerin suppositories to stick up my a-- to calm the spasms, and I use them frequently, praying they'll do something, but they don't. Even with these medications, I can feel the limpness in the lower half of my body, my tummy drooping, my thighs turning to mush. I can barely stand up. How can this not be some major disease?
     I have questioned everything. Is this PMS, hormonal? I went to see an endocrinologist, who said that some of my fatigue and symptoms might be because I have low estrogen levels. She suggested I go on hormone-replacement pills. No way. I didn't believe this was the problem. Anybody with a continuous twitch in the a-- would get exhausted. That in itself probably caused these severely depressed hormones. Then my kinesiologist said my adrenal glands were definitely shot from all the pain. So last year I tried to address the hormone issue and took progesterone to bring on my period, but I got even more whacked. I just sat in the studio for hours staring at my blank canvases.
Two months ago I went to an acupuncturist, who also suggested that my sensations might be because I never get my period. Needles were placed all over my body. I tried to do what he suggested, to focus my energy on my pelvis "smiling." I was so tense that I couldn't even enjoy this narcissistic candlelit ritual. It didn't work. I loved him, though. I mean, at least he heard me. He thought it was my spleen or liver and had me taking about twenty-four herbs a day for a month. Trust me, any bit of Jenny that was left has been washed away with those strange, crazy herbs.
Since then, my eyes and the lower part of my cranium have been twitching too, and I feel spacey all the time. My other daily ritual is hauling myself up to Barnes & Noble to read up on my symptoms. I've read about cancer, connective tissue disease, the candida yeast syndrome. I've checked for parasites and have had five tests for Lyme disease. At one point I even believed the mercury of my fillings could have been the cause. As I sit in the bookstore I wonder who else has come in that day to solve their own puzzle, who else is forced to diagnose themselves, who else is as desperate as I am for relief.
     Eastern, western medicine … who the hell knows anymore. I've been to chiropractors, kinesiologists, massage therapists, along with doctors with Harvard MDs on the wall … those arrogant f---s who just take notes and stare at me like I'm nuts. Meanwhile, I keep bingeing on chocolate. I'm like the person with lung cancer who keeps on smoking.

Study Advises Against Drugs for Children in Depression
Gardiner Harris, New York Times- 4/9/2004

Pediatricians and family physicians should not prescribe antidepressants for depressed children and adolescents because the drugs barely work and their side effects are often significant, Australian researchers have concluded. The researchers analyzed data from five published trials of three antidepressants, Prozac, Zoloft and Paxil, in depressed patients under age 18. They found that the drugs offered only a "very modest" benefit over placebos.
     At the same time, the drugs carry significant risks, the researchers said in their report, published in today's issue of the British medical journal BMJ. "If the drugs were highly advantageous over placebo, then you'd live with the risks," Jon Jureidini, a child psychiatrist in Adelaide and the study's lead author, said in an interview. "If the drugs were completely safe, then you might argue that there's nothing wrong with giving something that's only slightly better than a placebo." However, Dr. Jureidini said, neither is true, so antidepressants should not be prescribed for children and adolescents except in extreme circumstances. "We strongly want to say that non-child-psychiatrists should not be initiating the prescribing of" the antidepressants known as selective serotonin reuptake inhibitors or S.S.R.I.'s, a class that includes Eli Lilly's Prozac, Pfizer's Zoloft, and GlaxoSmithKline's Paxil, Dr. Jureidini said.
     The study is the latest salvo in an increasingly bitter war over whether prescribing antidepressants to children and adolescents is appropriate. Dr. Joseph Glenmullen, author of "Prozac Backlash" and a fierce critic of the pills, said the latest study further vindicated his view that antidepressants can be dangerous. "What this shows is that, on balance, there is no good reason to prescribe these pills," Dr. Glenmullen said.
     However, Dr. Graham Emslie, a professor of psychiatry at the University of Texas Southwestern Medical Center, who was an author of some of the studies reviewed in the article, said the study was "illogical." "I wish the effect size of these drugs was bigger, but at least there's some effect," Dr. Emslie said. "Some of these kids are severely depressed and we've got to do something." Dr. Emslie, like many psychiatric researchers, is a consultant to pharmaceutical companies.
     The Australian researchers suggested that psychiatrists offer children talk therapy in place of the drugs. But Dr. Emslie said that only one study had shown that talk therapy was beneficial. "If people could offer better treatments than drugs, it'd be great," Dr. Emslie said.
     British drug regulators have cautioned doctors against using any antidepressant but Prozac to treat depressed children and adolescents because the drugs have not proved effective against depression and may increase the risk of suicidal thoughts and behavior. The Food and Drug Administration recently issued a warning that all patients taking antidepressants should be closely monitored by doctors, especially in the first weeks. But the agency emphasized that it had not concluded that the drugs caused suicidal thinking or behavior.
     Dr. Laurence Greenhill, a professor of clinical psychiatry at Columbia University, said neither side in the debate had a monopoly on truth. "I think that these medications are neither as much of a silver bullet as the advocates would have it nor as terrible as the critics would say," Dr. Greenhill said.

Book's Critique of Psychology Ignites a Torrent of Criticism
Flecia Lee, New York Times, 4/12/2004

She has been called "the closest thing we have to a doyenne of psychiatric disorder" by The Village Voice, because of her quirky memoirs and her offbeat takes on subjects like self-esteem. Peter D. Kramer, author of "Listening to Prozac," calls her "smart, charming, iconoclastic and inquisitive."
Now Lauren Slater, a 39-year-old psychologist, is being called a liar. The charges, which Dr. Slater denies, are being circulated mostly among academics in psychology and psychiatry. Some say that she put invented quotations in her new book, "Opening Skinner's Box," her reflections on 10 major psychological experiments, which was published in the United States by Norton last month. Others question her methods and data in her own experiment in faking mental illness or challenge the accuracy of her description of some famous past experiments.
     Critics have been publicizing their accusations in book reviews on Amazon.com and other Internet sites, while professors at several schools, including Harvard, Columbia and Emory universities, have been exchanging information on their views of the book's failings. In London, Deborah Skinner, whose father, the behavioral psychologist B. F. Skinner, is referred to in the book's title, criticized Dr. Slater in The Guardian for reviving old rumors that she was a subject of her father's experiments, had sued him and had killed herself. The Daily Telegraph published an apology on March 27 for a review repeating some of those false rumors. On April 2 The Times of London came out with an article with the headline "Great Tale but Is It the Truth?" detailing the controversy over the book.
     "It is one of the first major books to bridge the gap between academic and popular psychology," said Scott O. Lilienfeld, an associate professor in the department of psychology at Emory and the editor of The Scientific Review of Mental Health Practice. For that reason, he said, people are adamant that Dr. Slater get things right. But he added that the sheer number of things Dr. Slater does get wrong - from what words pseudo-patients used in faking mental illness to misspelled names of well-known figures like Thomas Szasz and R. D. Laing - makes the book suspect for many.
     "People have combed through it looking for as many errors as they can find," said Dr. Slater, a mother of two who has a doctorate in psychology and who has written numerous magazine articles, including several for The New York Times Magazine. "The book has been held under a huge magnifying glass because these people are unhappy because of the way they've been portrayed."
Dr. Slater has written four books about being a psychologist and her own depression and anxiety, including "Prozac Diary" (Random House, 1998) and "Lying: A Metaphorical Memoir" (Random House, 2000), which also caused controversy because she included a preface by an invented character. As for charges against her most recent work, she said that although she had identified 10 relatively minor factual errors in the 276-page book, there was no willful deceit. She said she used fact checkers for the manuscript and added that she has answered most of the charges either by letter or by telephone. She and her editors promise to clean up any errors in the next edition.
"I don't have any of the evidence that anyone's words were being changed," said Drake McFeely, the president and chairman of Norton.
     A statement released by the publishing house said in part, "It is regrettable that there seems to be an organized effort to undermine Lauren Slater's engaging new trade book," and cited e-mail messages discrediting the book that have reportedly been sent to academic mailing lists. Written in the first person in a sometimes irreverent way, "Opening Skinner's Box" explores big questions of humanity and morality through the prism of famous 20th century experiments, including Stanley Milgram's work in which he had ordinary people administer electrical shocks to strangers, and David Rosenhan's study in which healthy people were successfully instructed to feign mental illness.
It is a nonacademic book, Dr. Slater said, that attempts to capture science's complexity, drama and outsize personalities. So she also interviews leading psychologists like Elizabeth F. Loftus, known for her memory studies, and Jerome Kagan, a retired professor of psychology at Harvard and a noted developmental psychologist. The two are among at least five people depicted in the book who say Dr. Slater put words in their mouths or were mischaracterized.
     Dr. Slater has her defenders. To Amy Banks, a psychiatrist who is the medical director for mental health at the Fenway Community Health Center in Boston, the hubbub shows the vulnerability many mental health professionals feel when faced with questions about the subjectivity of mental health diagnosis. She said Dr. Slater essentially got things right. "Lauren seems to be a lightning rod in the sense that she's out there talking about herself and her own problems in a field where you don't do that," said Dr. Banks, who teaches psychiatry at Harvard and wrote a book with Dr. Slater on women's mental health.
     Like much of Dr. Slater's work "Opening Skinner's Box" is full of personal anecdotes and interpretations. "I did my first psychological experiment when I was 14 years old," is the first line in the book's introduction. In Chapter 3, Dr. Slater writes that she personally faked mental illness in emergency rooms and walked away with several diagnoses of "psychotic depression" and with powerful drugs. Some experts are suspicious of her story. A group of 10 prominent mental health professionals, including Dr. Lilienfeld, and other professors at New York University, Harvard, Columbia and the University of Southern California, asked Dr. Slater in a letter for more details of the experiment so they could assess the validity of her findings. "The whole thing is done in a lighthearted way," Dr. Slater said, adding that she had no intention of turning over notes or records. "For me it was my own personal inquiry into the question. It's so obviously not science that their letter is baffling to me."
     Throughout the book, Dr. Slater said, she signaled readers by using phrases like "maybe" and "along these lines" or "I imagine" when she approximated an experiment, strayed from fact into speculation or took some literary license. Her critics cringe at such imprecision. "The worse thing you can do in science and scholarship is make things up," said Dr. Loftus, a professor of psychology and criminology at the University of California, Irvine. She claims that Dr. Slater committed a laundry list of errors in the essay about her, from misattributing scholarly work to implying that she freely told Dr. Slater her bra size when Dr. Slater explicitly asked for it.
     As for Dr. Kagan, he said he never demonstrated the concept of free will by ducking under his office desk and remaining there during his interview with Dr. Slater, as she describes. Dr. Slater produced a printout of a fact-checking e-mail exchange with Dr. Kagan in which she mentions his ducking under the desk and his explanation that he did so to demonstrate free will. When asked about the e-mail message, Dr. Kagan said: "I must have scanned it too quickly. I didn't see the line."
     More seriously, Dr. Slater writes that when she mentioned to Robert L. Spitzer, a professor of psychiatry at Columbia and chief of the biometrics research department at the New York State Psychiatric Institute, how the researcher Dr. Rosenhan was paralyzed and had lost his wife to cancer and his daughter in a car crash, h, he responded, "That's what you get for conducting such an inquiry." Dr. Spitzer said that while he disliked Dr. Rosenhan's study of faking mental illness, he never would have gloated over his misfortune and that the quotation was a fabrication. He also identified other misquotations and errors, detailed in a letter to Norton.
     Some critics find the book's first chapter the most provocative. In it Dr. Slater talks about the rumors that have dogged Deborah Skinner. Dr. Slater said these were mentioned to show why and how they persisted as part of B. F. Skinner's legacy. Her conclusion about Ms. Skinner at the end of the book is, "I'm sure she is alive, but I did not come across any data that could convince me of her mental status."
     But Ms. Skinner, an artist, said in a telephone interview that she did not believe Dr. Slater tried to contact her. More egregiously (and she said she has hired a lawyer to pursue the matter), she said she believed that the chapter about her was written in such a jumbled way that it was difficult to untangle fact from rumor. Dr. Slater insisted she was unable to find Ms. Skinner, even though she was in touch with her older sister, Julie S. Vargas, the president of the B. F. Skinner Foundation.
Dr. Vargas, who lives in Cambridge, Mass., said she told Ms. Slater that her sister lived in London. Dr. Vargas said that she not only disliked how her sister was portrayed, but that she and Dr. Slater disagreed about the accuracy of another passage in Chapter 1. Dr. Slater wrote that when she was alone in Skinner's study, she surreptitiously bit into a chunk of chocolate, more than a decade old, that Dr. Vargas had saved and had said her father was eating "just before the coma came." Dr. Vargas said that Dr. Slater was never alone in the study, and that her father never fell into a coma but died of leukemia in a hospital. She did, however, say that the chocolate with her father's teeth marks was probably there, but not on a china plate as Dr. Slater described.

Advanced Scanning Being Used for Autism
Associated Press, 4/12/2004

WASHINGTON -- Only Michael Berman's small thumbs move inside the giant MRI machine, pushing buttons in a video game-like test as the scanner measures how the youngster's brain processes light and motion. At 6, he's one of the youngest children to undergo such advanced scanning as part of a new effort to discover what goes wrong inside brains affected by autism. It's work that might lead to much earlier diagnosis of the mysterious neurological disorder. It usually goes undetected until age 3 or later, when much of the damage to the developing brain is thought already to have been done.
     ``The feeling is if you intervene early, it'll be more effective,'' explains Dr. Thomas Zeffiro of Georgetown University Medical Center, who is researching technology that he hopes will go a step further and one day scan preschoolers' or even infants' brains. ``It's very controversial if there is a critical period'' for thwarting autism, he cautions. ``If there is, there could be a dramatic change in the way we approach kids with developmental disorders.''
     Autism is a complex brain disorder, most common in boys, best known for interfering with a child's ability to communicate and interact with others. Symptoms range from the mild, like Michael, to so severe that children can't speak and appear profoundly retarded. No one knows the cause and there is no cure, although intense behavioral training can improve some patients' symptoms significantly.
     As part of the new research, scientists at Georgetown and Children's National Medical Center are matching youngsters' behavior and cognitive skills with advanced imaging, called functional MRI, that tracks changes in blood flow to show how their brains fire when they do tasks. Most previous studies have focused on autism's hallmark emotional and communication problems. Lead researcher Dr. William Gaillard of Children's National says these children's brains are being scanned to track the disorder's myriad other symptoms: sensory problems, motor control, problems with planning and reasoning.
     So far, only ``high-functioning'' autism patients can undergo such detailed testing because of the cooperation required. Michael, for instance, has Asperger syndrome -- excellent language skills and the ability to read at 2, but he has social-interaction and other problems. The scientists are attempting to perform functional MRI on children younger than ever before, to the delight of Michael, who intently quizzes them on the different sounds the noisy scanner makes as it focuses on different brain regions. ``Ooh, that one sounds kind of like an electric saw,'' Michael says. ``Do this other one, it's the fastest, right?'' After just a day's testing, ``he knows all the pulse-sequence names,'' marvels Zeffiro.
     The taxpayer-funded MRI work is part of a bigger collaboration:
--Scientists at Baltimore's Kennedy Krieger Institute are hunting ways to detect autism as early as age 6 months through behavioral clues, such as how babies look at their parents' faces and follow their gaze, how they manipulate toys, how they respond to language.
--Other Kennedy Krieger scientists are studying animals to see if autism is related to abnormal levels of the brain chemical serotonin, found in some patients.
--And Zeffiro is comparing the MRI images to easier-to-use technology that beams harmless infrared light through fiber-optic cables strapped on the head. Financed by an autism family group, the Nancy Lurie Marks Foundation, the idea holds out hope that ``optical tomography'' could provide a way to examine the brains of autistic toddlers or older but nonverbal patients who don't qualify for MRI.
     It's all part of an increased national focus on autism spurred by families angered that the disorder has long been sparsely funded despite studies suggesting a 10-fold rise in cases in a decade. Most of the rise is thought to be better diagnosis, but autism's cause is unknown. As a result, the National Institutes of Health last year began a five-year, $65 million project, designating eight centers around the country to focus on cutting-edge autism research. ``We're trying to sift through what is the first sign of autism and how does it unfold,'' explains Dr. Rebecca Landa, who heads the NIH-designated Kennedy Krieger autism center and its Children's-Georgetown collaboration. But, ``whatever we discover through autism is going to benefit children with a variety of developmental disabilities.''

Michigan Law Now Requires Licenses for Social Workers
Associated Press, 4/12/2004

DETROIT -- In a move aimed at boosting accountability among those who work with the state's neediest residents, Gov. Jennifer Granholm signed a bill on Monday requiring that social workers be licensed. Currently, Michigan certifies the state's 26,000 social workers. The new law requires licensing, thereby ensuring that only qualified people are performing care services. "This new law helps ensure that only the most highly qualified men and women are performing this critical work and that the citizens served by them are getting the most professional care," the Democratic governor said in a news release.
     The move has won the support of the Michigan chapter of the National Association of Social Workers where officials say it will better protect the public and enhance reciprocity with other states by allowing social workers more mobility. Michigan is the last state to require social workers to be licensed. "It's been a long time that this has been on the table," Laura Martinez of Bloomfield Township, who serves on the board of the association's Michigan chapter, told The Detroit News for a Monday story. "It brings professionalism to our field and protection for the people we are seeing."
     The law would require new social workers to complete at least two years of full-time, post-degree experience under the supervision of a social worker with a master's degree. Those who have been working in the field will need to meet different educational requirements, depending on the category of license sought. Many social workers also said they support the move. They said it puts them in line with other professions such as psychologists, counselors and marriage and family therapists who must all be licensed.

Psychologist Uncertain About Abusers
John Ellement, Boston Globe- 4/14/2004

TAUNTON, Mass-- A psychologist suggested yesterday that there is no valid way for mental health specialists to predict whether former Catholic priest James R. Porter will commit new sex crimes if he is released from the state prison where he has been since admitting to molesting dozens of children in the Fall River Diocese. Appearing as a defense witness in Bristol Superior Court, Daniel Kriegman told Superior Court Judge David A. McLaughlin that the methods and theories used by psychiatrists and psychologists to predict the future behavior of sex offenders are flawed. He testified that one technique, which predicts future behavior based on a clinical examination of a sex offender, is no more accurate than tossing a coin.
     McLaughlin must decide whether there is probable cause to believe that Porter is a "sexually dangerous person" who should be civilly committed to the Massachusetts Treatment Center in Bridgewater for a period ranging from one day to life. If McLaughlin rules against Porter, a trial must be held before the designation becomes permanent.
     Porter, 69, has essentially completed his prison sentence and, if released, would be on probation for 10 years. He was sentenced to 18 to 20 years in prison in 1993 after pleading guilty to 41 counts of sexual assault and other crimes. Prosecutors allege that Porter molested nearly 100 boys and girls in Massachusetts between 1960 and 1967 while working in the Fall River Diocese.
Porter was sent out of state, and during the next several years he molested children in Texas, Arizona, Nevada, and Minnesota, officials have said.
     Porter's court-appointed defense attorney, Michael Farrington, is trying to convince McLaughlin that Porter is not currently dangerous. His second and final witness, another psychologist, is expected to testify today, rebutting prosecution specialists who have predicted that Porter will commit new crimes if freed. Kriegman testified that widely published studies of sex offenders show that someone in his late-60s is unlikely to reoffend.

Royal Oak Delays Mental Health Facility
Erin Chan, Detroit Free Press- 4/14/2004

Royal Oak officials said they didn't have enough information Tuesday to make a decision about whether a vacant children's day care facility should be converted into a daytime drop-in clubhouse for people with mental illness. The city's Plan Commission postponed a decision on the issue until its June 8 meeting. The issue has been contentious for people in the neighborhood near Catalpa and Fernwood. The meeting drew about 125 residents.
     Resident Julie Supanich, 44, said she's not opposed to the clubhouse; she just doesn't want it in her neighborhood. "We're not a bunch of devils," Supanich said. "We care about these people. We just don't think it's a good location. My primary concern is for my family."
     Elizabeth Boyce, vice president of business development and marketing for Easter Seals Michigan, which plans to move the Dreams Unlimited Clubhouse from Oak Park to the Royal Oak site, said the organization did not want to rush answering plan commissioners' questions. Easter Seals now has until May 17 to finish answering the commission's 50 questions about the proposed clubhouse.
     The commission also tabled a decision on the issue at its March 9 meeting, which gave Easter Seals a chance to offer Royal Oak residents a second open house at its proposed site on Catalpa.
Opened in 1986, the Dreams Unlimited Clubhouse currently occupies a converted convent on Oak Park Boulevard in Oak Park. The clubhouse averages 18 to 25 clients daily. They used its computers, cooking facilities and gained job skills by running the snack and thrift shops. Dreams Unlimited is one of four clubhouses for people with mental illness in Oakland County. People who use Dreams Unlimited are required to be under a doctor's care and show a history of stability.

Heavy Social Drinkers Show Brain Damage
Reuters News Service, 4/14/2004

WASHINGTON -- Heavy social drinkers show a pattern of brain damage similar to that seen in hospitalized alcoholics -- enough to impair day-to-day functioning, U.S. researchers said today.
Brain scans show clear evidence of damage, and tests of reading, balance and other functions show people who drink more than 100 drinks a month have problems, the researchers said. "Oftentimes alcoholics are the last ones to know they have a problem," said Dr. Peter Martin of Vanderbilt University in Tennessee, who wrote a commentary on the report. "I think this is the first study of its kind that has looked at brain functioning in individuals who are heavy social drinkers who have not gone to get treatment for their alcoholism," added Martin, a professor of psychiatry who specializes in addiction.
     Dieter Meyerhoff of the University of California San Francisco and colleagues examined 46 chronic, heavy drinkers and 52 light drinkers recruited using newspaper ads and flyers. They used magnetic resonance imaging to look at physical brain structures and measured various brain chemicals associated with healthy brain function.
     "The enrollment criterion for heavy drinkers was the consumption of more than an average of 100 alcoholic drinks per month for men over 3 years before the study (80 drinks for women)," the researchers wrote in their report, published in the journal Alcoholism: Clinical & Experimental Research. One drink is usually defined as a serving of spirits, a glass of wine or a can or bottle of beer.
     Standard tests of verbal intelligence, processing speed, balance, working memory, spatial function, executive function, and learning and memory were given to the volunteers. "Our heavy drinkers sample was significantly impaired on measures of working memory, processing speed, attention, executive function, and balance," the researchers wrote. Measures of brain chemicals and structures showed some of the same damage seen in alcoholics who were in the hospital or treatment centers, although with a slightly different pattern in the brain, they said.
     The study is unusual in that most studies of brain damage from alcohol are done in people who have undergone treatment. "What our findings indicate is that brain damage is detectable in heavy drinkers who are not in treatment and function relatively well in the community," Meyerhoff said in a statement.
     Martin noted the volunteers in the study had gone without a drink for 12 hours and could thus be showing evidence of alcohol withdrawal rather than actual permanent brain damage. "The problem of studying people who are out there drinking is you are never sure whether these are enduring effects or acute effects," Martin said in a telephone interview. "Would these people, if they dried for a period of three or four weeks, would they have these abnormalities?" Martin said it was most likely the damage was real and long lasting. "My personal experience is that there is an awful lot of evidence ... showing that the more people drink and the longer they drink, the more likely they are to have cognitive impairments."
     Meyerhoff said moderate alcohol use for most adults translated to up to two drinks a day for younger men and one drink a day for women and older people. "Our message is: Drink in moderation. Heavy drinking damages your brain ever so slightly, reducing your cognitive functioning in ways that may not be readily noticeable. To be safe, don't overdo it," Meyerhoff said.

House Panel to Probe FDA, Antidepressants
Lauran Neergaard, Associated Press- 4/15/2004

WASHINGTON -- A House committee says it will investigate whether the Food and Drug Administration fully disclosed the disagreement among its scientists about whether antidepressants might be linked to suicide in children. The FDA insists it is not clear whether the drugs have any link to suicidal behavior by children or teenagers, noting that depression itself can lead to suicide. An extensive agency investigation is under way; results are due this summer. But at a Feb. 2 public meeting, FDA officials announced that some agency scientists believe a link already is proved, and presented the cases of possibly suicidal behavior.
     At that meeting, the FDA's scientific advisers concluded that such a link has not be proved. They said that until the issue is settled, parents need to be warned that the drugs may cause agitation, anxiety and hostility among patients unusually vulnerable to rare side effects. Critics complain that the FDA scientist who told his bosses he was convinced of a link, Dr. Andrew Mosholder, has been muzzled. Mosholder attended that February meeting but did not discuss his conclusion.
     In a letter to Congress that was released Thursday, the FDA offered an explanation: While his boss presented Mosholder's data, top officials did not think Mosholder should argue the case was closed when that was not the agency's position. "Having Dr. Mosholder present his conclusion to the advisory committee, with the appearance that it was an agency determination ... might lead patients who were actually benefiting from the use of these drugs to inappropriately discontinue therapy," the FDA wrote the House Energy and Commerce Committee.
     The agency has urged caution in prescribing adult antidepressants for children. In addition, bowing to pressure from families, the agency warned last month that patients of any age should be monitored closely for signs of suicide when they first start antidepressants or change a dose. But members of Congress question whether the FDA has gone far enough. Rep. Joe Barton, the House committee chairman, promised further investigation. "There are troubling questions of whether FDA supervisors inappropriately suppressed significant information that would have been of consequence to their own advisory committee, not to mention the public," said Barton, R-Texas.
     The FDA's drug chief, Dr. Robert Temple, said it is not unusual for agency scientists to disagree. He said the agency's advisers were given a clear picture of that disagreement and the data behind it.
"Nobody should think we're shrinking from this -- we raised it," he said. "We don't want to scare people off drugs that may very well be useful. We don't want to exonerate drugs if they really are increasing the risk," Temple said. "We thought the investment of a few more months was worth it to get it right."
     Last spring, the FDA spotted puzzling side-effect reports in studies of the use of the drug Paxil by children. The FDA ordered details from the makers of Paxil and other antidepressants, reports that mentioned possibly suicidal behavior. That led the FDA to warn doctors to use caution when prescribing the drugs for minors while the agency assessed the risk. British health authorities went much further, saying that because only one drug, Prozac, has been proven to alleviate pediatric depression, others are unsuitable for depressed youth.

Expert Kept From Speaking at Antidepressant Hearing
Gardiner Harris, New York Times- 4/16/2004

Top Food and Drug Administration officials admitted yesterday that they barred the agency's top expert from testifying at a public hearing about his conclusion that antidepressants cause children to become suicidal because they viewed his findings as alarmist and premature. "It would have been entirely inappropriate to present as an F.D.A. conclusion an analysis of data that were not ripe," Dr. Robert Temple, the Food and Drug Administration's associate director of medical policy, said in an interview. "This is a very serious matter. If you get it wrong and over-discourage the use of these medicines, people could die." Dr. Temple was seeking to quell a growing controversy into whether the agency's warnings on March 22 that antidepressant therapy could lead patients to become suicidal were sufficient. "There is concern that we hid data," said Dr. Temple. "We did not hide data. It was there for all to see."
     Recent studies have shown that children given antidepressants are more likely to become suicidal than those given placebos. But the studies have led to different interpretations by psychiatrists. The refusal by drug companies to publish the studies has worsened the confusion. Internal agency documents obtained by The New York Times show that federal health officials are divided, too.
     Dr. Andrew D. Mosholder, an agency epidemiologist, was the man charged with analyzing 22 studies involving 4,250 children and seven drugs. In a carefully argued, 33-page memorandum, he concluded that children given antidepressants were almost twice as likely as those given placebos to become suicidal. He urged the agency to discourage doctors from prescribing to children all antidepressants except Prozac. Prozac is the only antidepressant proven effective in treating depressed children, and its studies showed no link with suicide, Dr. Mosholder wrote. Dr. Mosholder's conclusions mirrored those made by British health authorities. But Dr. Mosholder's supervisors, Drs. Mark Avigan and Anne Trontell, wrote memorandums disagreeing, according to the documents. "In particular, we disagree that the data are sufficiently robust to advocate preferential use" of Prozac in children, Dr. Trontell wrote.
     Health officials convened a special advisory committee on Feb. 2 to offer guidance on how the agency should respond to the studies. As the agency's principal reviewer, Dr. Mosholder was scheduled to speak. He was removed from the agenda, Dr. Temple said.
     Senator Charles E. Grassley, a Republican from Iowa and chairman of the Senate Finance Committee, said he was investigating whether the agency inappropriately suppressed crucial findings. Representative Joe L. Barton, a Republican from Texas who is chairman of the House Energy and Commerce Committee, said he was also investigating. "It would have been very wrong for the F.D.A. to withhold any information it had about unintended consequences that might result from the use of antidepressants, especially for children and adolescents," Mr. Grassley said.
     Dr. Temple was unapologetic about the decision.He said that Dr. Mosholder's underlying data were presented to the committee but that agency officials explained that Dr. Mosholder had failed to treat with the appropriate skepticism some reports of suicidal behavior. The Food and Drug Administration has hired investigators at Columbia University to examine reports from about 400 of the 4,250 children and determine independently which should be classified as suicidal.
     The controversy had its start when GlaxoSmithKline sought a six-month extension to its patents on Paxil. To help guide pediatricians' prescribing habits, federal law grants such extensions when companies test their medicines in children. The company's studies in depressed children failed to show any positive effect. It was a disappointing finding, but patent extensions are granted even when studies fail. Reviewing the data, Dr. Mosholder noticed in October 2002 that they showed a disturbing number of problems listed under the category, "emotional lability." Suicidal thoughts and self-injurious behavior were among the things lumped into this category. Dr. Mosholder asked GlaxoSmithKline to provide more detail about these cases, according to one of the documents.
     In May 2003, the company submitted a new report. It showed that children given Paxil were more likely to become suicidal than those given placebos. In June, the agency announced that doctors should avoid using Paxil in depressed children. Three days later, according to documents and interviews, the agency asked for similar data from the makers of Prozac, Zoloft, Luvox, Celexa, Wellbutrin, Effexor, Serzone and Remeron. Dr. Mosholder found that 108 of the 4,250 children had done something that merited being called suicidal. He divided the cases into those who were given drugs and those given placebos and found that children given drugs were almost twice as likely to become suicidal as those given placebo. The agency declined to make Dr. Mosholder available for an interview.