Noteworthy News Articles on Mental Health Topics, June 1-9, 2007 Tim Jones, Chicago Tribune- 6/3/2007 LAURENS, Iowa -- Methamphetamine has claimed every tooth in Dennis Patten's head, which is why his face is caving into his jaw and why just about everything south of his neck is falling apart. The squat Patten is a 28-year veteran of Iowa's drug wars, 25 of them spent as an addict, and the last three as an uncertain just-say-no convert torn by gnawing cravings for the drugs that have crippled him. "I can't honestly say that if you dumped some [meth] right here," he said, tapping a couple of fingers on a table in front of him, "that I'd turn it down." Like Patten, Iowa is struggling with meth. In the two years since the state enacted a law limiting the availability of pseudoephedrine, a major ingredient in the manufacture of methamphetamine, the number of homemade meth lab incidents across the state has plummeted. At the same time, though, investigators say imports of a more powerful form of meth called "ice," from the Southwest U.S. and Mexico, are soaring. "Ice trends in Iowa over the last three years have an eerie resemblance to the explosion of meth labs in our state in preceding years," a recent state report said. And in Iowa as well as the Midwest, it's not clear that anyone is winning the drug war. In 2006, the Midwest had six of the nation's top 10 states in the number of meth lab incidents, according to the U.S. Drug Enforcement Administration. It's not even clear that the drug-clean Patten, who weighs 387 pounds, down from 450, can say he's winning. He blames prolonged drug abuse for his congestive heart failure, diabetes, emphysema and short-term memory loss. At 44, he has already had two strokes. Doctors would like to perform a gastric bypass operation to get another 150 pounds off him, but they aren't sure Patten's heart could handle the stress. The cartilage in both his knees is shot and his breathing is labored and difficult, which is why Patten carries a small oxygen tank with a clear plastic hose that wraps around his head and clips to his nostrils. "If I run into someone who's used [drugs], I get cravings," Patten said, silently acknowledging that, as drug counselors point out, 9 out of 10 meth addicts fall back into meth abuse. The battle against illegal drugs is often measured in numbers -- grams, ounces and pounds, street sale value, state and federal dollars available for drug investigations, and arrests and convictions. But numbers alone often obscure the struggles of police agencies battling the gopher-hole-type challenge of illegal drugs and of addicts trying to recover from years of addiction and the physical toll on their bodies. Addiction produces its own set of numbers, such as rising health-care costs, increased caseloads at drug treatment centers, more children exposed to drugs and higher rates of burglaries and domestic abuse. 'Do you want to look like me?' By one measure, Patten is a victory because he has stopped taking drugs and vowed to stay clean. He lumbers to health clinics, offering himself as a human testimonial of what not to do. There is no masking the damage to Patten and other addicts who agreed to talk about their years with meth. When asked what he tells his 5-year-old son Jere about the dangers of drug abuse, Patten said, "Well," and paused, apparently losing his train of thought. He looked quizzically at his common-law wife, Kathy Crapser, and asked, "What do I tell him?" It would not be the first time Patten would lose his way in a 30-minute conversation. He recovered and explained he "has a hard time focusing on questions." He remembered where he was and said, "I tell him this is what happens when you take drugs. 'Do you want to look like me?' " Iowa is a sparsely populated state, ranking 30th nationally, with just under 3 million people. But the combination of wide-open spaces and a good road system has helped make Iowa and other agriculture-oriented states in the Midwest a haven for homemade meth. Just about any farm will have anhydrous ammonia, a key ingredient in fertilizer and in the production of meth. Bob Cooper has intimate knowledge of the gently warped farmland and back roads of this region of northwest Iowa because he skillfully used them to manufacture and sell meth and, by hiding in cornfields, repeatedly eluding capture by authorities who spent years chasing him. Meth "became a way of life," said Cooper, who can still methodically explain his production method, from the pills and the blender to the drain cleaner and a shot of salt. He pocketed a thousand dollars a week making the stuff. "They were on my heels. They never could catch me," said Cooper, barely hiding his satisfaction. Winning battles, losing the war The law caught up with Cooper in late 2000. He was convicted of manufacturing and selling meth and spent 42 months in prison. Now 32, Cooper is trying to put his life back together in Laurens, the tiny hometown of Alvin Straight, famous for the 240-mile trip he took on a lawn mower to visit his sick brother in Wisconsin. That was in 1994, shortly before Cooper got into the meth business. Cooper's tattooed arms draw attention away from the anhydrous burns on his wrists and forearms. He talks slowly and complains of forgetting things. "I have to write stuff down," he said. His physical damage is limited to memory loss, a single lost tooth and cavities. He also lost custody of his four children, whom he is allowed to visit every other weekend. Sipping a Pepsi at a pizza restaurant downtown, Cooper says prison has changed him. He's now working to become a counselor at a halfway house in South Dakota, to try to persuade kids to stay away from drugs. Cooper's younger brother Bill has not been as fortunate. Bill Cooper, large like his brother Bob, is 31 and started taking meth when he was 19. "I did it to fit in," he said. Cooper works 70 to 80 hours a week at a wood-pallet factory he started and as a supervisor in a beef-jerky factory. He said he quit meth "cold turkey." Today he suffers from high blood pressure. He passes blood and is seeing a nephrologist. His wife, Amy, 27, was on meth for one year. No family trouble, job trouble or emotional stress led to their drug use, they said. They just did it. "I think the drug problem is getting worse. They're afraid to admit it. It's everywhere," Bill Cooper said. There has been a big drop in homemade meth lab incidents, and that, said Gary Kendell, director of the Governor's Office of Drug Control Policy, has reduced the threat to the environment and to children. "But we still have a real problem," Kendell said, pointing to a rising number of adults treated for substance abuse other than alcohol -- up 36 percent since 2000. Over the same time period, cocaine and crack cocaine seizures have soared. At the Clay County Sheriff's office, in Spencer, Investigator Casey Timmer tries to put the progress into perspective. "I think we win the battles we get into, but I don't know if that's winning the war," Timmer said. Patten's war is more personal. He says there's not much more doctors can do for him. He can't do a lot of physical work because it puts too much strain on his heart. He and his wife have had to make new friends because their old ones are either still on drugs or in jail. Patten says he's available to anyone who wants advice about drugs, but the phone doesn't ring often. His wife added, "It's usually someone asking if this is a good price for an 8-ball" -- a street term for an eighth of an ounce of drugs. No Group Discount For Autism Care Susan DeFord, Washington Post- 6/3/2007 Randy and Lynn Gaston received the distressing diagnosis not once but three times. Their sons, Zachary, Hunter and Nicholas, are triplets, and as the brown-haired boys grew into toddlers, Lynn noticed how oddly they played, how little they babbled, how they cried inconsolably at doctor's offices and family gatherings. Two years ago, when the boys were 4, specialists confirmed the Gastons' suspicions: The boys have varying degrees of autism, a neurological disorder that hampers communication and social interactions and can include obsessive-compulsive behavior. "It was shocking," Lynn said, "but in my heart, I knew, yes, somebody finally sees it." The diagnosis launched a transformation of the Gastons' lives. Now even mundane details of the daily routine are carefully orchestrated, driven by the boys' need for sameness: identical sheets on their beds, baths in the same order every night, the same kind of pizza from the same kind of box. The Gastons rarely go out as a couple; it's difficult to find babysitters. The family has never eaten in a restaurant together, because crowded, unfamiliar environments sometimes make the boys anxious and upset. And the couple never get a full night's rest. Like many autistic children, the boys don't sleep well, going to bed at 8 p.m. and often waking for the day between 2 a.m. and 3 a.m. A recent attempt to go to a park came to an abrupt halt when Zachary started yelling in the car. Lynn pulled over and found the reason: Hunter had taken off his shoes and socks, disrupting his brother's uneasy equilibrium. The Gastons' experience, though extreme, is shared by growing numbers of families. Once considered rare, autism is seemingly on a rapid climb, researchers say. In the 1980s, based on limited studies, it was believed that 1 in 10,000 to 5 in 10,000 children had autism. Today, this lifelong condition and other closely related disorders are found in 1 in every 150 children in the United States. Boys are four times as likely as girls to have it. The Gaston boys, identical twins and a fraternal brother who turn 6 on Sunday, are winsome and outgoing. Unlike some autistic children, they smile readily and are affectionate with their parents and visitors to their Ellicott City home. But Zachary speaks in snippets, Hunter speaks only occasionally and Nicholas doesn't speak at all. "We want words. We want speech," said Randy, a database administrator with the Maryland Association of Boards of Education in Annapolis. It would be a special day, say the Gastons, if their boys complained of a stomachache or said they were hungry. They keep their house sparsely furnished and childproof, with much of the first floor given over to bins of toys and a computer that runs the boys' preschool games. Although they can make a ruckus, the boys seldom play together. For Families Facing Autism, Worry Is a Way of LifeOn a recent afternoon, Zachary, the sturdy fraternal brother, arranged his beloved Thomas the Tank Engine train cars in the dining room. Hunter, so slender his pants drooped below his pull-up diaper, chortled as he bounced on a small trampoline in the family room. Nearby, Nicholas sat on the floor, leafing through a worn book. His shirt was wet from chewing it, a frequent activity. Zachary, the most verbal of the triplets, spoke in short phrases. "Oh, no!" he cried as he rolled a large blue ball through the kitchen. "Don't!" "Watch out," called his mother. "Say, 'excuse me.' " "Excuse me," Zach repeated. Words slip out almost imperceptibly from Hunter. "Book," he murmured as he picked one up. He went about on tiptoes, holding a small toy, worrying it between his fingers and touching it to his lips like a rosary. Sometimes, inexplicably, he called out loudly. As a toddler, Nicholas lost what few words he had and stopped responding to his name. He doesn't speak, but he will laugh delightedly during a bouncing game or kiss the TV during a favorite Sesame Street video. He pulls his mother by the hand when he wants a drink. There are fleeting moments of recognition among the brothers. In the kitchen, Nicholas sat on the floor as Hunter stood beside him. The twins almost looked directly at each other, then Hunter moved away. Worry is constant for the Gastons -- "What should we be doing? What aren't we doing?" -- Lynn said. Both 40, the Gastons hope their 13-year marriage is strong enough to survive. They mention the high divorce rate -- 80 to 85 percent -- commonly quoted among parents of disabled and chronically ill children. Nevertheless, they have committed themselves to find a way through autism, to draw back its cloak. "It's all we know," Lynn said. An Urgent Public Health Concern The Centers for Disease Control and Prevention, which revised its estimates of prevalence upward this year, calls autism an urgent public health concern. The number of U.S. residents with the disorder, estimated at 1.2 to 1.5 million, could grow to 4 million within a decade, according to the Autism Society of America. "We're seeing at least 10 times as many [autistic] children as we did a decade ago," said Gary W. Goldstein, president of Baltimore's Kennedy Krieger Institute, a research and treatment center for pediatric developmental disabilities. Vincent J. Carbone, a New York researcher who has worked with autistic children for 30 years, says better diagnoses alone can't explain the rising numbers. "There does appear to be a real change in the incidence," he said, describing the latest estimates as "startling and shocking." The disorder might arise from genetic components, but factors such as exposure to environmental toxins, bacterial infections, autoimmune imbalances and even risks associated with older fathers could be driving the disorder's spread, researchers say. Since the diagnoses, the Gastons have searched for the best therapies and educational services for their boys, following experts' advice that early, individualized therapy can ameliorate autistic symptoms. Some children with autism have cognitive impairments; others have near-normal or above-average intelligence. The Gastons have found their search frustrating and costly. The boys initially were in an Anne Arundel preschool with children who had physical and developmental disabilities, after being assessed by school officials as having mental retardation and developmental delays. Each received 15 minutes of speech therapy a week: "a blip," Randy called it. The couple consulted lawyers and educational consultants about demanding more services from the school system, but in the end, Lynn said, "We just moved." A New County Means New Challenges They had hoped for more speech therapy and individual instruction in the Howard County school system, which has Maryland's highest percentage of students with autism disorders. More than 10 percent, or 483 students, of the special education population there has some form of autism. The system has seen enrollment climb 180 percent in the last decade, in part because of Howard's reputation for extensive services that begin with toddlers and include research-based instruction and aides working alongside autistic students. But during the first days of school last fall, the Gastons learned that their boys weren't eating and sometimes slept in class. They decided to postpone kindergarten for a year and hired therapists to come to their home for three-hour sessions on weekday mornings, coaxing the gestures and vocalizations that they hope will lead to coherent speech. Therapy costs about $2,000 a month, which the Gastons say they are paying with proceeds from the sale of their Anne Arundel home. This kind of prolonged, one-on-one therapy often is not covered by insurance companies, which classify autism as a mental illness and often give it limited coverage. Maryland is one of five states that make Medicaid funding available for autism services regardless of the family's income. But only 900 children are served statewide each year, and the Gastons are low on a waiting list of 1,800. "Everything that's associated with autism comes with a price tag," Randy said. "The financial responsibility is enormous. We have three, and there's no discount." Disability advocates say the federal government is behind in marshaling resources against autism. Congress is debating how much money to appropriate under last year's Combating Autism Act for research into the disorder. Another bill, which would increase services to people with autism, has just been introduced in Congress. "There's no federally coordinated autism policy," said Marguerite Colston, director of communications for the Autism Society of America. "States do a better job." That's small comfort to the Gastons. They're busy trying to settle on individualized education plans for their sons. They want school officials to forego the typical classroom setting and place their boys in private school, where intensive therapy can continue. The Gastons also have become advocates for families with autistic members, organizing a day-long seminar at Howard Community College in April that drew an audience of several hundred. "We're trying to go the extra mile to help people," Randy said. "When these kids were diagnosed, nobody gave us a road map." But Dr. Abuzzahab, a Minneapolis psychiatrist, is still overseeing the testing of drugs on patients and is being paid by pharmaceutical companies for the work. At least a dozen have paid him for research or marketing since he was disciplined. Medical ethicists have long argued that doctors who give experimental medicines should be chosen with care. Indeed, the drug industry’s own guidelines for clinical trials state, “Investigators are selected based on qualifications, training, research or clinical expertise in relevant fields.” Yet Dr. Abuzzahab is far from the only doctor to have been disciplined or criticized by a medical board but later paid by drug makers. An analysis of state records by The New York Times found more than 100 such doctors in Minnesota, at least two with criminal fraud convictions. While Minnesota is the only state to make its records publicly available, the problem, experts say, is national. One of Dr. Abuzzahab’s patients was David Olson, whom the psychiatrist tried repeatedly to recruit for clinical trials. Drug makers paid Dr. Abuzzahab thousands of dollars for every patient he recruited. In July 1997, when Mr. Olson again refused to be a test subject, Dr. Abuzzahab discharged him from the hospital even though he was suicidal, records show. Mr. Olson committed suicide two weeks later. In its disciplinary action against Dr. Abuzzahab, the state medical board referred to Mr. Olson as Patient No. 46. “Dr. Abuzzahab failed to appreciate the risks of taking Patient No. 46 off Clozaril, failed to respond appropriately to the patient’s rapid deterioration and virtually ignored this patient’s suicidality,” the board found. In an interview, Dr. Abuzzahab dismissed the findings as “without heft” and said drug makers were aware of his record. He said he had helped study many of the most popular drugs in psychiatry, including Paxil, Prozac, Risperdal, Seroquel, Zoloft and Zyprexa. The Times’s examination of Minnesota’s trove of records on drug company payments to doctors found that from 1997 to 2005, at least 103 doctors who had been disciplined or criticized by the state medical board received a total of $1.7 million from drug makers. The median payment over that period was $1,250; the largest was $479,000. The sanctions by the board ranged from reprimands to demands for retraining to suspension of licenses. Of those 103 doctors, 39 had been penalized for inappropriate prescribing practices, 21 for substance abuse, 12 for substandard care and 3 for mismanagement of drug studies. A few cases received national news media coverage, but drug makers hired the doctors anyway. The Times included in its analysis any doctor who received drug company payments within 10 years of being under medical board sanction. At least 38 doctors received a combined $140,000 while they were still under sanction. Dr. Abuzzahab received more than $55,000 from 1997 to 2005. Drug makers refused to comment, said they relied on doctors to report disciplinary or criminal cases, or said they were considering changing their hiring systems. Asked about the Minnesota analysis, the deputy commissioner and chief medical officer of the Food and Drug Administration, Dr. Janet Woodcock, said the federal government needed to overhaul regulations governing clinical trials and the doctors who oversaw them. “We recognize that we need to modernize the F.D.A. approach in keeping people safe in clinical trials,” Dr. Woodcock said. Drug makers are not required to inform the agency when they discover that investigators are falsifying data, and indeed some have failed to do so in the past. The F.D.A. plans to require such disclosures, Dr. Woodcock said. The agency inspects at most 1 percent of all clinical trials, she said. Karl Uhlendorf, a spokesman for the Pharmaceutical Research and Manufacturers of America, said the trade group would not comment on The Times’s findings. The records most likely understate the extent of the problem because they are incomplete. And the Minnesota Board of Medical Practice disciplines a smaller share of the state’s doctors than almost any other medical board in the country, according to rankings by Public Citizen, an advocacy group based in Washington. Dr. David Rothman, president of the Institute on Medicine as a Profession at Columbia University, said the Times analysis revealed a national problem. “There’s no reason to think Minnesota is unique,” Dr. Rothman said. “Clinical trial investigators must be culled from only the finest physicians in the country,” he said, “since they work on the frontiers of new knowledge. That drug makers are scraping the bottom of the medical barrel is an outrage.” Payments by drug companies to doctors, whether or not the doctors have been disciplined, are a matter of much debate. Drug makers and doctors say the money finances vital research and helps educate doctors about helpful medicines. But others in the medical profession say the payments are thinly disguised incentives for doctors to prescribe more, and more expensive, drugs. Among the other doctors who were disciplined or criticized by the board and paid by pharmaceutical companies: Dr. Barry Garfinkel, a child psychiatrist from Minneapolis who was convicted in federal court in 1993 of fraud involving a study for Ciba-Geigy. His criminal case made headlines across the state. From 2002 to 2004, Eli Lilly paid him more than $5,500 in honoraria, according to state records. Dr. Garfinkel said in an interview that he had wondered why drug makers would hire him as a speaker considering his statewide notoriety. He decided that “they’re hiring me to influence my prescribing habits,” so he quit giving sponsored talks and taking money from drug makers, he said. Dr. John Simon, a Minneapolis psychiatrist who for years shared an office with Dr. Abuzzahab and was told by the state medical board in 1994 to complete a clinical training program after it concluded in a report that he “frequently makes abrupt and drastic changes in type and dosage of medication which seem erratic, not well considered and poorly integrated with nonmedication strategies.” He prescribed addictive drugs to addicts and failed to stop giving medicines to patients suffering severe drug side effects, the board concluded. Dr. Simon earned more than $350,000 from five drug makers from 1998 to 2005 for consulting and giving drug marketing talks. Of this, Eli Lilly paid more than $314,000. Dr. Simon said in an interview that the board’s action was a learning experience, and that drug makers continued to hire him to speak because “I am respected by my peers.” Asked about Drs. Garfinkel and Simon, Phil Belt, a spokesman for Eli Lilly, said that both doctors were licensed to practice medicine and that the company relied on doctors to report disciplinary actions or criminal convictions against them. Dr. Ronald Hardrict, a psychiatrist from Minneapolis who pleaded guilty in 2003 to Medicaid fraud. In 2004 and 2005, he collected more than $63,000 in marketing payments from seven drug makers. In an interview, Dr. Hardrict said it was “insulting” and “ridiculous” to suggest that income from drug makers might influence doctors’ prescribing habits. “I bought the Mercedes because it has air bags, and I use Risperdal because it works,” Dr. Hardrict said, referring to an antipsychotic medicine for schizophrenia. Johnson & Johnson, the maker of Risperdal, paid Dr. Hardrict more than $30,000 in 2003 and 2004. Srikant Ramaswami, a spokesman for Johnson & Johnson, said the company removed Dr. Hardrict as a speaker in 2004 when, as a result of his conviction, his name appeared in a government database. Asked why other drug makers continue to hire him despite a fraud conviction, Dr. Hardrict responded with an e-mail message stating only, “I will pray for you daily.” In cases involving Dr. Abuzzahab over 15 years in the 1980s and ’90s, the medical board found that he repeatedly prescribed narcotics and other controlled substances to addicts, renewing one patient’s prescriptions six weeks after the patient was jailed and telling another that his addictive pills should be thought of as “Hamburger Helper.” He prescribed narcotics to pregnant patients, one of whom prematurely delivered a baby who soon died. In explaining his abrupt discharge of the suicidal Mr. Olson, Dr. Abuzzahab told the medical board that “if a patient is determined to kill himself, he can’t be prevented from doing it and hospitalization postpones the event,” records show. Mr. Olson’s sister, Susie Olson, said Dr. Abuzzahab “had no time for my brother unless David agreed to get into a drug study. He said, ‘You’re wasting my time and the hospital’s.’ It was all about money.” Separately, the F.D.A. in 1979 and 1984 concluded that Dr. Abuzzahab had violated the protocols of every study he led that they audited, and reported inaccurate data to drug makers. He routinely oversaw four to eight drug trials simultaneously, often moved patients from one study to another, sometimes gave experimental medicines to patients at their first consultation, and once hospitalized a patient for the sole purpose of enrolling him in a study, the F.D.A. found. Dr. Abuzzahab, 74, was president of the Minnesota Psychiatric Society and two decades ago was chairman of its continuing education and ethics committees. He would not discuss the specifics of his disciplinary record, saying he did not have the time. But in 1998 he signed an agreement with the board saying that his conduct “constitutes a reasonable basis in law and fact to justify the disciplinary action.” A simple Google search reveals Dr. Abuzzahab’s 1998 medical board disciplinary file, which was reported at the time by a local newspaper and a TV station. In 1998, The Boston Globe featured Dr. Abuzzahab in a front-page article questioning the safety of psychiatric drug experiments. And in 1999, the NBC program “Dateline” did a segment about a woman who committed suicide while in a drug experiment he supervised. In June 2006, the medical board criticized Dr. Abuzzahab, this time for writing narcotics prescriptions for patients he knew were using false names, a violation of federal narcotics laws. Despite all this, drug makers continued to hire him. Dr. Abuzzahab’s résumé lists 11 publications or research presentations since 2000, when the medical board lifted its restrictions on his license. Takeda, a Japanese drug maker, confirmed that Dr. Abuzzahab was doing a study financed by the company on its sleep medicine, Rozerem. Eisai, another Japanese drug maker, said that although Dr. Abuzzahab had signed a clinical trial agreement with the company to study its recent drug, Aricept, it told him two days after a reporter asked for comment on the case that he was not qualified to be an investigator. And at AstraZeneca, for which Dr. Abuzzahab said he had performed clinical trials and still gave drug marketing lectures, a spokesman said the company was “concerned” about Dr. Abuzzahab’s disciplinary record. “We have our own internal processes for dealing with these matters, which are under way,” said Jim Minnick, an AstraZeneca spokesman. The Minnesota records often fail to distinguish between drug company payments to doctors for research and for marketing, so it is sometimes impossible to determine why doctors were paid. Some doctors, like Dr. Abuzzahab, clearly performed both research and marketing. Gene Carbona, who left Merck on good terms in 2001 as a regional sales manager after 12 years in drug sales, said the only thing the company considered when hiring doctors to give marketing lectures was “the volume or potential volume of prescribing that doctor could do.” A Merck spokesman declined to comment. Mr. Carbona, now executive director of sales for The Medical Letter, which reviews drugs, said that had he known that a doctor had a disciplinary record for excessive prescribing, “I would have been more inclined to use them as a speaker.”
The next day, she was referred to Dr. Faruk Abuzzahab and agreed to participate in a drug study he was being paid to conduct, although her suicidal tendencies should have excluded her. Dr. Abuzzahab stopped giving her the antidepressant, and she was forced to wait nearly two weeks before receiving either an experimental drug or a placebo. Throughout those weeks, Dr. Abuzzahab recorded Ms. Endersbe’s adverse effects as “0,” but nurses documented a steady decline. Ms. Endersbe expressed reservations about being part of a study. “I guess I didn’t understand that I would be going off all my other medications,” she told a hospital worker, according to records. She spoke repeatedly of killing herself, even telling a nurse in a late-night talk on June 8 that she planned to jump off the Franklin Avenue Bridge, “but says she is safe in the hospital,” a hospital worker wrote. On June 10, Dr. Abuzzahab wrote in her chart that Ms. Endersbe was “medically improving.” He gave her permission to visit her apartment alone, although leaving the hospital violated the study’s rules and she had spoken of suicide only the night before. Saying she wanted “to water my plants and pick up my mail,” Ms. Endersbe, 40, left at 10:45 the next morning. She walked the five blocks to her apartment, retrieved a St. Francis of Assisi medallion given by her mother, locked up, slid her keys under the door and walked to the Franklin Avenue Bridge where, at noon, she jumped to her death. Dr. Abuzzahab would not comment on particular cases but said the state medical board’s disciplinary action against him was “without heft.” Ed Endersbe, Susan’s brother, said the authorities called him about his sister’s death at his daughter’s birthday party. “My mother was battling cancer and I had to go and tell her that Susan was gone,” Mr. Endersbe said. “I literally watched my mother’s heart break, and she died three months and a day after that.” Mr. Endersbe said he was stunned to learn years later from The New York Times that Dr. Abuzzahab was still overseeing clinical trials. “He should not be allowed to harm anyone else,” he said. Colin Poitras, Hartford Courant- 6/5/2007 An effort to give transgender individuals equal protection under the state's anti-discrimination laws got bogged down in debate Monday, leaving the bill's future in doubt with the legislative session scheduled to end at midnight Wednesday. The proposal had made its way through several legislative committees earlier this year and was approved by the state Senate May 23. But after nearly three hours of House debate Monday afternoon, the bill was set aside, a sign that the legislation is in trouble. Jerimarie Liesegang, director of the Connecticut TransAdvocacy Coalition, took the day off from work to monitor Monday's debate. Afterward, Liesegang, 56, of Hartford, remained undaunted. "I feel great. I'm optimistic," Liesegang said. "This has gone a long way ... we are becoming a society that is embracing its differences." Liesegang plans to return to the Capitol next year if the bill fails to come back for a vote by Wednesday. "We'll be back," Liesegang said. "This is about basic rights." The proposed law adds gender identity or expression to the same law that prohibits discrimination based on race, gender, religion, age, marital status, physical disability and other characteristics. The bill protects transgender individuals from being discriminated against at their jobs, when seeking housing or in obtaining credit or other basic services. Some Republicans in the House expressed concern about the bill's possible impact on primary schools. "Our classrooms have to provide the best educational opportunity for our students," said Republican Rep. Kevin Witkos, a police sergeant from Canton. "Do you honestly think young people will be able to concentrate in the classroom if their teacher is dressed in clothing of their opposite sex? I think not." Witkos said he understood the intent of the bill, but felt it needed more work. State Rep. Arthur J. O'Neill, R-Southbury, questioned how the provision might be applied in cases where students come to school dressed in clothing of the opposite sex and in cases where a boy might want to play on the school's girls' basketball team. "Would the school district be obligated to let the student go to school dressed in that way?" O'Neill asked. "Where would the boy shower?" An amendment that would have allowed elementary school principals to transfer transgender teachers to older student classrooms or to non-classroom positions was discussed but didn't come up for a vote. State Rep. Michael P. Lawlor, D-East Haven, spoke in favor of the legislation. He said the bill is very limited in its scope and he downplayed the concerns raised by others. "This is about burning people's houses down because they are transgender," Lawlor said. Currently, nine states - New Jersey, Rhode Island, Maine, California, New Mexico, Minnesota, Illinois, Hawaii and Washington - have passed transgender non-discrimination laws. Suspect Has Long Record of Addiction Henri Cauvin & Keith Alexander, Washsington Post- 6/5/2007 Tonya Bell's life was already crashing at 15. She had one baby and was pregnant with another, according to court records. She was using PCP, and after her boyfriend was shot and killed, she would turn to smoking crack cocaine, records say. It was the start of a long, destructive addiction that would land her in trouble again and again, and never so glaringly as on Saturday night, when Bell, high on crack, plowed a car into a crowded street festival in Southeast Washington, police say. In a few harrowing moments, dozens of people, some of them small children, were injured. After a daring effort to stop the car, police arrested Bell, 30, whose 7-year-old daughter was in the Volvo station wagon. The child, uninjured, is in the care of the city's child protective services agency. Charged with aggravated assault while armed, Bell was held without bond yesterday after appearing in D.C. Superior Court. Wearing a hospital gown and a black surgical boot for her injured ankle, she was in a place she has come to know well over her troubled life, having cycled through the courthouse many times. Bell was also a familiar face in the neighborhood where Saturday's mayhem took place. She grew up on nearby Chicago Street SE. She attended Ballou Senior High School for a time, according to court records. And since April, she had worked as a temporary clerical assistant in the office of the Ward 8 D.C. Council member, Marion Barry (D), where she answered phones and distributed mail. To people who know her from her time growing up, Bell was a troubled girl who was often on drugs and would argue and fight with neighbors when she was high. "When she wasn't high, she wasn't a bad person," said Stephen Cook, 52, who grew up in the area. "She was always struggling, I think." Nearly every year since she became an adult, Bell has been in court for one case or another, winding up with convictions and prison or jail stays for drug and other charges. The court records -- in particular a 2000 psychological evaluation of Bell -- show a woman whose life has been defined by drugs and whose problems escalated after a great deal of personal loss. The psychological examination was done in April 2000 at the request of Bell's defense attorney in a felony drug case. It was an effort to secure meaningful help for Bell's drug addiction and her mental health problems, which had three times led her to seek assistance at St. Elizabeths, the city's public psychiatric hospital. The report is packed with details about Bell's struggles as a teenager and young adult. During an interview with the psychologist who prepared the report, Bell traced her drug use to age 14, around the time she dropped out of school, where she said she had been an honor roll student. Bell said her boyfriend, who was five years older, had introduced her to drugs. At 14, she began using marijuana, and at 15, she started using PCP, the report quoted her as saying. When she was 14, she had a child with her boyfriend, and the following year she was pregnant with their second child. That's when the boyfriend was shot and killed, she told the psychologist. At 16, she began smoking crack, she told the psychologist. At 19, Bell faced another personal crisis. In June 1996, her mother, Betty Jo Patterson, 53, and her grandmother Myrtle Patterson, 87, were killed when a fire swept through their brick rowhouse in the 1100 block of Chicago Street SE. In the 2000 interview, the psychologist asked Bell how the fire affected her. "I don't know. It has a lot of impact," Bell said, according to the psychologist's report. Questioned further, Bell was "unemotional" in her response, the psychologist wrote. "I loved them. . . . [T]hat's about it. . . . I miss 'em a lot." She told the psychologist that at age 20, which would have been soon after the fire deaths, she was admitted to Riverside psychiatric hospital. Based on Bell's explanation, the psychologist said she believed that Bell had had a drug-induced psychotic episode. Bell stayed at Riverside for 30 days and was prescribed the antidepressant Zoloft. But after being discharged, Bell did not follow through with her outpatient care and resumed using crack, she told the psychologist. "The child had one big tragedy after another," said David J. White, 49, president of the Chicago/Shannon Civic Association, the neighborhood group for the area where Bell grew up. "There has always been trouble with her," White said. When she was sober, Bell was more the energetic young girl who grew up on the block and attended regular parties with neighbors. Neighbors described Bell as a "chameleon" whose demeanor would change, depending on whether she was high. Bell's relationships with her children had been upended by her addiction. A judge placed her two eldest children with a relative, according to the psychological report. A third child, born in late 1999, was being cared for by a close family friend at the time the psychological report was completed. That friend sees a pattern in the timing of Saturday's incident. "Ever since the fire," she said, "every year around the same time, [Tonya] either relapses or she gets arrested or something." Yet it has been more than three years since new criminal charges were filed against her. Officials at NAI Personnel, the temp agency where Bell had been working lately, did not return a call yesterday seeking comment. Keith A. Perry, Barry's chief of staff, said the agency sent Bell to work in the council office about six weeks ago. Although Perry said he didn't know Bell well, there was no indication that there was "anything untoward in her behavior." "She came to work. She did her job," Perry said. "We're all pretty much in shock." Bell, of Oxon Hill, faces considerable legal jeopardy after Saturday's events, unlike anything else in her long history of arrests and convictions. According to court papers filed yesterday, she told authorities that she had used drugs within the past 30 days. And she failed a drug test given after her arrest, the court papers said. The U.S. attorney's office has charged her with one count of aggravated assault while armed, and once prosecutors begin presenting evidence to a grand jury, Bell could be indicted on additional charges. In charging documents filed in Superior Court, authorities provided their account of the sequence of events Saturday night: About 7:25 p.m., she drove her Volvo 740 station wagon through a barricade set up at Martin Luther King Jr. Avenue and W Street SE for Unifest, an annual event sponsored by Union Temple Baptist Church. After going through the barricade, she struck several people, including one who was thrown onto the hood and into the windshield of the car. The chaos continued on those and nearby streets, finally coming to an end when two police officers threw their scooters under the vehicle to stop it. Inside a packed courtroom yesterday afternoon, Bell was the center of attention. She said nothing as she stood next to her attorney, Daisy Bygrave of the D.C. Public Defender Service, who contended that the injuries detailed in the charging documents were not grave enough to support such a serious charge. Magistrate Judge Milton C. Lee rejected the argument and ordered Bell held without bond, pending a hearing Thursday. Benedict Carey, new York Times- 6/5/2007 “This shirt is scratchy, this shirt is scratchy, get it off!” “This oatmeal smells like poison, it’s poisonous!” “My feet are hot, my feet are hot, my feet are boiling!” Such bizarre, seemingly overblown reactions to everyday sensations can end in tears, parents know, or escalate into the sort of tantrum that brings neighbors to the door asking whether everything’s all right. Usually, it is. The world for young children is still raw, an acid bath of strange sights, smells and sounds, and it can take time to get used to it. Yet for decades some therapists have argued that there are youngsters who do not adjust at all, or at least not normally. They remain oversensitive, continually recoiling from the world, or undersensitive, banging into things, duck-walking through the day as if not entirely aware of their surroundings. The problem, these therapists say, is in the brain, which is not properly integrating the onslaught of information coming through the senses, often causing anxiety, tantrums and problems in the classroom. Such difficulties, while common in children with developmental disorders like autism, also occur on their own in many otherwise healthy youngsters, they say. No one has a standard diagnostic test for these sensory integration problems, nor any idea of what might be happening in the brain. Indeed, a diagnosis of such problems is not yet generally accepted. Nor is there evidence to guide treatment, which makes many doctors, if they have heard of sensory problems at all, skeptical of the diagnosis. Yet in some urban and suburban school districts across the county, talk of sensory integration has become part of the special-needs vernacular, along with attention deficit disorder and developmental delays. Though reliable figures for diagnosis rates are not available, the number of parent groups devoted to sensory problems has more than tripled in the last few years, to 55 nationwide. And now this subculture wants membership in mainstream medicine. This year, for the first time, therapists and researchers petitioned the American Psychiatric Association to include “sensory processing disorder” in its influential guidebook of disorders, the Diagnostic and Statistical Manual. Official recognition would bring desperately needed research, they say, as well as more complete coverage for treatment, which can run to more than $10,000 a year. But many psychiatrists, pediatricians, family doctors and school officials fear that if validated, sensory processing disorder could become rampant — a vague diagnosis that could stick insurers and strapped school districts with enormous bills for unproven therapies. The decision is not expected for three or four years, but the controversy is well under way. “There’s a real resistance to recognizing this, and you can see why, because you’re introducing a whole new vocabulary,” said Dr. Randi Hagerman, a developmental-behavioral pediatrician who is medical director of the MIND Institute at the University of California, Davis. Dr. Hagerman added, “Many of the behavioral difficulties that are being labeled today as anxiety or A.D.H.D., for instance, may be due to sensory disorders, and that forces you to rethink the treatments,” as well as diagnoses. Everyone seems to agree that sensory problems are real and disabling in children with diagnoses like autism or Fragile X Syndrome, a genetic disorder that causes social difficulties and learning delays. Most youngsters with these diagnoses react strongly to certain sounds, textures or other sensations — or appear unusually numb to sensory stimulation. They may gag at the mere whiff of common smells, or cry out when touched. They may spin or flap their arms as if seeking stimulation (or, in some cases, to relieve pain). Children with attention deficit disorders, too, frequently appear to have unusual sensitivities. A common treatment for sensory symptoms is occupational therapy. For these children the therapy typically involves activities and games, guided by a therapist, intended to make the youngsters more comfortable as they engage the sensations that disturb them — or more alert to those they usually do not notice. It was a California occupational therapist and psychologist named A. Jean Ayres who, in a widely read 1972 book, first argued that sensory problems were more than symptoms of other disorders. They were the primary cause of many motor and behavioral problems, she argued, and far more common than doctors recognized. Pediatricians, psychiatrists and psychologists mostly ignored Dr. Ayres’s message at the time, and most do so today. Occupational therapists are not M.D.’s, many don’t have Ph.D.’s, and they have little voice in mainstream medicine. But increasing numbers of parents have been listening, particularly in the last few years. To explain why, they usually point to their own children. “All I know is that when I heard a loud sound in first grade, I hid under my desk,” said Matthew Pougnet, who just finished third grade and lives in Denver with his parents and two brothers. A capable student who seemed unable to relax, Matthew soon was told he had attention deficit disorder and was given a prescription for the stimulant drug Ritalin. “It made no difference at all,” his father, Antony Pougnet, said in an interview. Convinced there was more to it than that, the Pougnets found their way to the Sensory Therapies and Research Center near Denver, a clinic devoted to treatment and study of sensory problems in children and adults. The center’s director, Lucy J. Miller, an occupational therapist, is the country’s leading research scientist specializing in sensory processing disorder. She assembled the petition that was sent to the American Psychiatric Association, and she has been working to develop the first manual-based standards for diagnosis and treatment of sensory problems to be used for research. For a child particularly sensitive to certain sensations, Dr. Miller said, the first step in treatment is simply to make the parents aware of what is causing many of the disruptive behaviors. “This is a very important step in itself, because it means that the family now understands the cause of the behaviors, and the extended family too, so it gives the child a community that is looking out for these sensitivities,” she said. Occupational therapists’ child clinics typically look like indoor jungle gyms, with an assortment of swings, mats, blow-up balance balls, blocks and other toys. And the therapy itself, usually given in hourlong sessions that meet once or twice a week, looks a lot like one-on-one playtime. But it is playtime with a purpose. If you calm an over-aroused child, the theory goes, by using low lighting, gentle touch and rocking movements, then he or she will be better able to handle the sensations that are upsetting — sudden, sharp noises, for example — when they are presented gradually. Being absorbed in a game can also blunt a child’s response to the dreaded sensations. For children who seem undersensitive, the approach is reversed: Get them lifting, pushing, pulling — working — until they gradually become more alert to the feel of their body and its surroundings. “You are playing with them with a very specific goal: to get them back into the classroom more organized, more settled, so they can learn,” said Debra Fisher, an occupational therapist who works at the Manhattan School for Children. Watching this therapy, many parents say, it is hard not to wonder whether another half-hour of recess would not be just as good and far cheaper. And some techniques intended to help treat sensory problems for which occupational therapists are best known, like brushing children’s limbs with a soft brush, or spinning them, have no proven benefits, researchers say. But parents who have good experiences with occupational therapy say that over time, and usually within months, the techniques somehow teach their children how to better manage their behavior in ways that regular playtime had not. The youngsters may still tense when touched or hug others too tightly, for instance, but they stop tackling classmates. Matthew Pougnet still hates the sound of fire alarm drills, but he no longer ducks for cover. At a national conference in Denver in May held by the SPD Foundation, which promotes education and research on sensory processing problems and supports Dr. Miller’s clinic, hundreds of parents and therapists, and some children, traded stories of frustration, breakthroughs and hope. It had the feel of a revival meeting. Spencer Cambor, 9, of Boulder, Colo., said that he had an assortment of sensitivities, from smells and tastes (“Lettuce is so bad I almost throw up. Really throw up.”) to a feeling of being cramped or crowded, which kept him in perpetual motion. Spencer is still unusually sensitive, said his father, Roger Cambor, a psychiatrist, but added that after months of occupational therapy, “there was a marked change; all of a sudden he could sit in a circle when asked, he settled down, his handwriting got much better.” Other families have tales, too, of children who do much better in class when allowed to fidget, handle a small rubber toy, bounce in place, even sit against the wall on a blow-up cushion. As with any therapy, there are also parents who say they saw no change, that the therapy was a waste of money and time. Whether these diverse anecdotes fit together into a coherent picture of a stand-alone, treatable disorder is not yet clear, at least not to researchers, and many say there is good reason for caution. The current interest in sensory processing echoes the 1970s theory that learning problems were caused by impaired eye-tracking abilities, said Stephen P. Hinshaw, professor and chairman of the psychology department at the University of California, Berkeley, and co-author of a cultural history of mental health stigma, “Mark of Shame.” “Back then people tried all sorts of therapy to correct eye tracking, and it turned out to be mostly misguided,” Dr. Hinshaw said. “This idea that there are deep, underlying sensory problems, and if we treat those it will bubble up and the child’s behavior will improve — boy, that idea has a checkered history.” “It does make some intuitive sense, all right,” Dr. Hinshaw added, “but I keep looking and hoping that the evidence base for this will get better.” Researchers have in fact laid down a fragile thread of evidence, publishing several small studies in just the past year of children identified with sensory processing problems and normal I.Q.’s — that is, no developmental problems. In one study, Patricia Davies of Colorado State University led a research team that analyzed how children identified as having sensitivity to sounds responded to pairs of sharp clicks, heard through headphones. The team used EEG technology to measure brain waves, and found that these youngsters responded to the first click normally, showing the same pulse of brain activity as children without sensory problems. But this comparison group muted its response to the second click, whereas the children identified as more sensitive did not. This automatic adjustment, called sensory gating, “was clearly different in the group with sensory processing problems,” the authors concluded. Similar studies have found that children identified as having sensory problems also have an atypical brain response, as measured by EEG, when exposed to two things at once, like a click and touch. And in March, The Journal of Occupational Therapy published the first scientifically rigorous trial of guided therapy. In the study, which included 24 children, those who received a 10-week course of occupational therapy showed greater improvements, on specific goals set by their parents, than a comparison group of children who did not receive such therapy. “We don’t have as much data as we’d like, but honestly, I’ve been at this for 33 years, and it’s just nice to see some solid, experimental data,” Dr. Miller said. “We desperately need more, and for that we need money.” The money is likely to flow only when sensory processing is recognized as a legitimate disorder. And the American Psychiatric Association’s decision (on this proposal and many others) is not expected for three to four years. So sensory processing disorder is entering a kind of limbo state: present but not fully arrived; noticed but, like many of the children struggling with symptoms, not entirely accepted by peers. And experts say that it is likely to be the experience of parents and children that determine its future. “My experience is that when parents learn about this, they say, ‘Oh, I never thought about it that way’ — it gives them a whole different way to look at their child’s behaviors,” said Roseann Schaaf, a neuroscientist and occupational therapist at Thomas Jefferson University in Philadelphia. “And parents are pretty savvy; they know pretty quickly if it makes sense” and whether treatment is helping.
Sex Offenders Younger, More Violent Associated Press, 6/9/2007 STOCKTON, Calif. -- Courts have seen the number of sex offense cases involving juvenile offenders rise dramatically in recent years, an Associated Press review of national statistics found, and treatment professionals say the offenders are getting younger and the crimes more violent. Some psychologists blame the increase in numbers -- 40 percent over two decades -- on a society saturated with sex and violence and the fact that many of the accused were themselves victims of adult sexual predators. Others say there aren't more children committing such crimes, simply more awareness, better reporting and a general hysteria about sex offenders. ''I don't think it's appropriate to suggest we have whole schools full of sexual predators ... but we're seeing more of it and more sexually aggressive acts,'' said Scott Poland, past president of the National Association of School Psychologists. ''How do these kids even know about this? It's permeated throughout our society.'' Robert Prentky, a psychologist and nationally renowned expert on sex offenders in Bridgewater, Mass., thinks the statistics are misleading. ''There aren't more kids, there are more laws,'' he said. ''We now have fairly draconian laws with very harsh sanctions that apply to juveniles.'' The number of children under 18 accused of forcible rape, violent and nonviolent sex offenses rose from 24,100 in 1985 to 33,800 in 2004, the AP's analysis found. Violent offenses include attempted rape and sexual assault, while nonviolent offenses including fondling, statutory rape and prostitution. By comparison, rape and sexual assaults by adults decreased more than 56 percent from 1993 to 2004. Comparable statistics were unavailable before 1993. The AP analyzed state and federal crime statistics, as well as independent research on juvenile sex offenders. Sources included the U.S. Department of Justice's Bureau of Justice Statistics; the National Center for Juvenile Justice, a Pennsylvania-based nonprofit that specializes in statistical and policy research; and The Safer Society Foundation Inc., a Vermont nonprofit that works to prevent sexual abuse. Sharon Araji, an Alaska psychologist who took one of the first broad looks at the problem in her book ''Sexually Aggressive Children,'' thinks the number of child-on-child sex crimes is actually even higher than the statistics indicate. Only 28 percent of all violent sexual assaults are reported to police, according to a 1999 National Crime Victimization Survey. And cases of incest between siblings are widely thought to be underreported and may drive the numbers even higher, Araji says. ''The whole society is not yet up on this problem,'' Araji said. ''These kids, on the extreme end, if nothing is done to catch them, they're going to become our adult offenders of tomorrow.'' Studies show that one in two sex offenders began their sexually abusive behavior as juveniles. The rise in juvenile sex offenders has spawned hundreds of new treatment facilities for children as young as 5. In 2002, there were 937 programs in the U.S. treating adolescent offenders -- generally ages 12-17 -- up from 346 in 1986. During the same period, the list of programs specifically aimed at children under 12 grew from zero to 410, according to The Safer Society Foundation. However, Franklin Zimring, a juvenile justice expert at the University of California, Berkeley, thinks many children are unnecessarily treated as sex offenders. True pedophiles are extremely rare among young people, he says. ''As long as the public temperature is up, you're going to get more referrals from the courts for treatment,'' he said. ''If you don't want to lock a kid up, treatment is a politically safe outcome.'' Many experts agree that some amount of sexual exploration by young people is healthy, a line is crossed when force and violence are involved, they say. Recent incidents include the cases of two 13-year-old boys in Omaha, Neb., who were accused in January of videotaping their assault of two 5-year-old girls and a 3-year-old boy, and of an 8-year-old Buffalo, N.Y., boy accused of assaulting a 6-year-old boy after he saw a prison rape scene in an R-rated movie. In Alaska, lawyer Dennis Maloney calls it an epidemic. His state has one of nation's highest per capita rates of youth sex offenders in treatment and one of the highest rates of treatment programs per capita. Others in the top seven are Hawaii, Idaho, Minnesota, Montana, New Hampshire and Vermont, according to the Safer Society Foundation. Maloney represents the family of a 6-year-old boy raped by a fellow kindergartner. ''He said 'Please, I'll be your best friend,''' the alleged victim said, according to a transcript of an interview with a police officer. Experts say certain trends emerge among the cases of children charged with sex crimes against other children. Many -- estimates range from 40 percent to 80 percent -- were molested themselves. And 42 percent have been exposed to hardcore pornography, the Office of Juvenile Justice and Delinquency Prevention, an arm of the U.S. Department of Justice, said in a 2001 report. Psychologists prefer to refer to juveniles charged with sex crimes as ''sexually aggressive children,'' rather than as sex offenders. Psychologist Heather Bowlds, who runs a sex offender treatment program within California's Department of Juvenile Justice, says sexually aggressive children often have a skewed sense of sexuality in which force or violence becomes normal. ''Some kids see it as how you show affection, how you get your needs met,'' she said. ''If you're a kid watching your father rape your mother ... if I feel like I want it, I can get it, no matter what.'' Associated Press, 6/9/2007 STOCKTON, Calif. -- Tony was 12 when he sexually assaulted the 10-year-old sister of his best friend. Now 20, he's about to be released following eight years of treatment. Sixteen-year-old George was caught sexually assaulting an 11-year-old girl last year. He'll remain locked up until at least 2009, and like Tony he'll likely be required to register as a sex offender for life. Both are locked up at the O.H. Close Youth Correctional Facility in Stockton and agreed to speak with an AP reporter on the condition their last names be withheld. While each is aware of the considerable challenges posed by returning to a society that despises sex offenders, experts say Tony and George have much better chances than adult sex offenders. ''A man who has a deviant sexual arousal to children, he would rather have sex with a child. Adolescents don't generally have deviant sexual arousal. ... They've been abused, they feel insecure, immature, unwanted,'' explained Marti Fredericks, who runs seven juvenile sex offender treatment facilities serving about 400 children in California. ''We're not dealing with the same problem. Are they less dangerous? Yes. They have shame. They don't understand why they did it. They want help.'' Studies have shown treatment programs for young sex offenders to be more effective than those treating adult predators. A study conducted in Utah found that 87 percent of juvenile sex offenders never committed another sex-related offense. An Arizona study put it at 95 percent. Rates of non-sexual recidivism are generally higher. ''This isn't something I want to do again,'' George said softly. ''I don't want to molest another kid.'' Like many children accused of sex crimes, George revealed in treatment that he also was abused, saying a friend's cousin would take him out to the garage and molest him. He said knew it was wrong but didn't want get anyone in trouble. Tony's mother was hospitalized in a state mental institution, and his father was addicted to cocaine. He was raised by a great-grandmother. Starting around age 7, he was repeatedly molested by an older sister, and by 10 he'd been expelled from school and had begun using drugs. ''I did whatever I wanted to do,'' he said. ''School didn't matter.'' Stories like these are typical of children who become sexually aggressive, said Heather Bowlds, the psychologist who runs the treatment program at O.H. Close. ''Their histories are so horrific,'' she said. ''The system has failed them many, many times.'' Tony, George and 53 other young sex offenders attend one three-hour therapy session per week, as well as anger management, social skills and healthy sexuality classes. They also get individual counseling. ''They're so needy for any type of positive attention and contact that you can really see some changes,'' Bowlds said. In California, 460 boys and four girls were identified as sex offenders as of March 1, according to the state's Department of Juvenile Justice. Of those, 192 were receiving treatment at four separate facilities and 120 were waiting for treatment space and participating in general behavorial and educational programs, Bowlds said. Because he's been a ward of the state, Tony will be eligible for education assistance and he plans to use that to become a mechanic. He has no high school diploma or GED, and no family support. ''I'll find a community to embrace me,'' he said confidently during a recent therapy session. ''I committed my sex offense when I was 12. If people don't accept me for who I am or what I did, I can handle that.'' Indian Reservation Reeling in Wave of Youth Suicides and Attempts Evelyn Nieves, New York Times- 6/9/2007 The young man, 19 years old, played varsity football and basketball at Todd County High School. He was admired across the reservation, in that way small towns follow and celebrate their teenage athletes. The girl, weeks shy of her 14th birthday, made straight A’s at Todd County Middle School, played volleyball and basketball and led a traditional Lakota drum corps. They hanged themselves. This happened at the end of a particularly brutal two and a half months, from Jan. 1 to March 13, when tribal authorities were called to three suicides and scores of attempts. The next day, with the reservation (population 13,000) reeling, tribal officials declared a state of emergency. Since then, a woman in her early 20s killed herself with pills, and scores more young people have tried to kill themselves — a total of 144 so far this year, at doctors’ best count; the computer used for recordkeeping was down for six weeks. In May, seven youths who tried hanging, poisoning or slashing themselves to death were admitted to the reservation hospital in one 24-hour period. What is happening at Rosebud is all too common throughout Indian Country. American Indian and Alaska Native youth 15 to 24 years old are committing suicide at a rate more than three times the national average for their age group of 13 per 100,000 people, according to the surgeon general. Often, one suicide leads to another. For these youths, suicide has become the second-leading cause of death (after accidents). In the Great Plains, the suicide rate among Indian youth is the worst: 10 times the national average. Here at Rosebud, when six high school girls were approached at the Boys and Girls Club one recent afternoon for their reactions to the suicides, four said they had tried suicide. The four compared notes on their methods — two slashed their wrists, two overdosed on pills — and their motives. “There are a lot of reasons,” said Areina Young, a 16-year-old cheerleader at Todd County High who overdosed on sleeping pills and codeine in February. “We have a lot of issues.” Plains reservations are among the poorest places in the country, with all of poverty’s consequences. But the why of the suicide phenomenon — why American Indian youth, why the Great Plains — is complicated, experts say. The traumas Plains tribes have experienced over the last 175 years — massacres like the one at Wounded Knee, the decimation of their land and culture — are part of it. “Very generally, adolescence is a time of trouble for all youths,” said Philip May, a professor of sociology at the University of New Mexico who has been studying suicide among American Indians for more than 35 years. “But in many American Indian communities, it’s compounded by limited opportunities, historical trauma and contemporary discrimination. The way the Lakota people and other Plains tribes have experienced history in the last 100 years has reduced the mental health factors that are available to them to cope.” Tribal leaders at Rosebud took a survey of Todd County students in March. The students’ biggest complaint was that they did not feel safe for fear of gangs. They said that they had no refuge, that their parents were not present, and that they saw too much tragedy, alcoholism and hopelessness. In response, tribal and community leaders have redoubled their efforts to stem the reservation’s gang problem. They have organized after-school programs, sponsored talks by motivational speakers and made school counselors widely available. At the same time, schools and the community at large are not commemorating those that kill themselves, said Victoria Sherman, the principal at Todd County High School. She refused, she said, to allow an elaborate memorial during this year’s graduation for a student who killed himself last year on graduation day. “We don’t want to encourage desperate acts,” Ms. Sherman said. Federal lawmakers are also beginning to address the problem. Senator Byron L. Dorgan, Democrat of North Dakota and chairman of the Senate Indian Affairs Committee, recently introduced a bill to combat child abuse and Indian youth suicide. The legislation would provide increased resources for suicide prevention training and treatment. With few places for students on this sprawling reservation to congregate — some commute as far as 40 miles each way to school — the Boys and Girls Club, a former bowling alley, opened before it was ready so students could have a place to gather after school. Rosebud and the neighboring Pine Ridge reservation, using a $400,000 federal grant, have started training community members and school employees in suicide prevention and intervention. But tribal leaders say they need more concrete help to turn the situation around. The reservation has only four full-time mental health professionals, and two are leaving soon, said the Rosebud tribal president, Rodney Bordeaux. “We did the emergency declaration because we needed to get attention,” Mr. Bordeaux said. “We’re saying, we need more funding, more help, now.” Health services are seriously underfinanced on reservations nationwide. For over a decade, Congress has failed to reauthorize a law that would increase aid. Officially, three youths at Rosebud committed suicide last year and 193 tried. But not all suicides or attempts involve calls to the police, officials here said. The group of girls who had attempted suicide said they all knew others who had tried several times. “A lot of people are just trying to get attention,” Areina Young said. One girl in the group, a 15-year-old, had swallowed a bottle of Tylenol on April 14 and spent two weeks in the hospital. “Me, I had a really good explanation,” she said. She started into a horrific story of being raped by her half-brother for years before he was arrested two years ago; of her and her siblings being routinely abandoned for months at a time by their mother, an alcoholic; of her grandmother beating her. “But now I know that suicide is the permanent solution to temporary problems,” she said. “Counseling really helped me a lot. Put down that we need more counseling. For me, right now, I need it every day.” |
