Some random articles and links....
Sep. 2nd, 2010 04:54 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
conuly
A video of a cute kid, with subtitles!
Pakistani delegation mistaken for terrorists.
The classic post on renaming the bathrooms...
And a very long one on more conventional ways of distinguishing between two sets of public toilets.
Worry about bedbugs in flea markets
~~~~~~~~
In a summer when bedbugs have crawled deep into New York City’s psyche, no one is more anxious than those shoppers who live to scout secondhand clothing shops and used-furniture stores. They are connoisseurs of what is hot, hip, a bargain. They know where the flea markets are and when the vintage shops are open.
And they are scared that bedbugs from the home of a former owner still call that $20 designer jacket or that fabulous $65 chair their castle.
That explains why a puzzled-looking Elizabeth Borné was standing on East 23rd Street one afternoon last week. Should she risk the $325 sofa with the paisley fabric that she had just seen in the Housing Works thrift shop near Third Avenue? Was it worth feeling jittery and jumpy about something whose history she could not know? Would she fret every time she invited someone over or curled up for a nap?
“I like and I want it,” she said. “It looks sort of reproductiony. It’s quirky, it’s eclectic, it’s rustic-slash-retro. But my first thought is bedbugs — and bedbugs are freaky.”
Ms. Borné is hardly the only secondhand-store shopper whose first thought has been Cimex lectularius, the speck-size common bedbug. In the spring, the first question from a student at a Fashion Institute of Technology course called “Is Vintage for You?” was, “Have you ever experienced any issues with bedbugs?”
“One girl in particular in the class had an issue,” said the instructor, Bridgett Artise, a fashion designer and an author of “25 Ways to Deconstruct, Reinvent and Recycle Your Wardrobe.” “She said, ‘I had a problem with a jacket.’ She said they were in the lining, so it was hard to know they were even there.”
“They” might find a funky 1950s housedress as appetizing as a so-last-year strapless number. “Obviously, these bugs do not respect economic level or social status or neighborhood — they found them in Abercrombie & Fitch,” said Jose Medellin, a spokesman for Goodwill Industries of Greater New York and Northern New Jersey.
And so secondhand-store buyers worry about something the size of a lentil that could have been on a pipe near the ceiling or in a book on a shelf before it made the jump to clothing or furniture that was consigned or given away. Ms. Borné, a nursing student, said she had looked at pictures of bedbug bites online to see how they differed from spider bites and mosquito bites, just in case she ever needed to know.
Ms. Artise said: “I only worry about newbies, new vintage shoppers. People like myself already know the telltale signs, and what to do.
“The first thing I always tell people who buy vintage clothing is if they see any type of anything that looks like it might have remnants of bedbugs, put it in a plastic bag and freeze it. You keep it in there, I would say, for at least three days. It can’t survive freezing. And after it thaws out, I would take it to a dry cleaner.”
Lisa Slocum, a lawyer who bought a velvet coat for $33 at the City Opera Thrift Shop —“I just can’t resist a bargain,” she said — lived through bedbugs a couple of years ago.
“I swore if I ever bought anything in a thrift shop again, I’d wrap it in plastic and take it right to the dry cleaner,” Ms. Slocum said. “You really do believe you’ll never get rid of them.”
The infestation was enough for her to stop making the rounds of vintage shops “for a while,” even though she had no evidence they came from the stores she had frequented. “I’m a hard person to stop from secondhand shopping,” she said as she left the City Opera shop on East 23rd Street.
Managers and clerks at vintage stores said that they were getting a lot of questions from customers but that the bedbug epidemic did not seem to be putting a dent in their business.
“I’ve never seen a bedbug,” said Tiffany Collings, the manager at Beacon’s Closet, on Fifth Avenue in Park Slope, Brooklyn, where party dresses sell for as little as $10. “We’ve never — knock on wood — had a problem with bedbugs, but it’s absolute and utter sheer luck.”
Ms. Collings said some customers asked what precautions the store took. “I tell them, ‘If you’re worried about bedbugs, I’ve read about bedbugs. If you put clothes in a dryer under high, high heat, it’s supposed to kill the bugs and eggs,’ ” she said. “We’re looking, physically looking at clothes” when a customer brings in clothing to sell, and if she saw a bedbug, she said, she would hand the item back.
Housing Works said it fumigated its stores and its processing and distribution center in Long Island City. For furniture, said Matthew Bernardo, the senior vice president for business service, Housing Works has a screening policy: someone from Housing Works inspects it at the prospective donor’s apartment first.
“We always say when people set up for us to pick up furniture that we have the right to refuse,” Mr. Bernardo said.
Mr. Medellin, the Goodwill spokesman, said Goodwill Industries sprayed all its 39 stores and its processing center.
“We do not take home pickups, and we have not received any reports of bedbugs,” he said. “We have an ongoing contract with an exterminator. We asked them, ‘Please, make sure that we’re covered for bedbugs as well.’ ”Mattresses are a particular concern, because many consider them the passport for bedbugs through the city. Gale A. Brewer, a city councilwoman who represents the Upper West Side, pressed for a ban on used and reconditioned mattresses. It turned out used mattresses were already covered under a state law passed years ago requiring that they be sanitized, thus killing any bedbugs, before they can be resold. But state regulators have yet to publish standards for accomplishing that.
“I tell people — given the fact that the Centers for Disease Control has declared bedbugs a pretty big menace, an epidemic, actually, and when you have an epidemic you take precautions — that I don’t shop in secondhand stores,” Ms. Brewer said. “That’s everything from the Salvation Army stores to fancy vintage-clothing stores.”
And Ms. Borné and the sofa at the Housing Works shop? “I’m not sold on it,” she said.
But she did buy a $20 Zara dress.
“A dress,” she said, “you can wash.”
~~~~~~~~~~~~
On giving antipsychotics to small children.
~~~~~~~~~
At 18 months, Kyle Warren started taking a daily antipsychotic drug on the orders of a pediatrician trying to quell the boy’s severe temper tantrums.
Thus began a troubled toddler’s journey from one doctor to another, from one diagnosis to another, involving even more drugs. Autism, bipolar disorder, hyperactivity, insomnia, oppositional defiant disorder. The boy’s daily pill regimen multiplied: the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines and one for attention-deficit disorder. All by the time he was 3.
He was sedated, drooling and overweight from the side effects of the antipsychotic medicine. Although his mother, Brandy Warren, had been at her “wit’s end” when she resorted to the drug treatment, she began to worry about Kyle’s altered personality. “All I had was a medicated little boy,” Ms. Warren said. “I didn’t have my son. It’s like, you’d look into his eyes and you would just see just blankness.”
Today, 6-year-old Kyle is in his fourth week of first grade, scoring high marks on his first tests. He is rambunctious and much thinner. Weaned off the drugs through a program affiliated with Tulane University that is aimed at helping low-income families whose children have mental health problems, Kyle now laughs easily and teases his family.
Ms. Warren and Kyle’s new doctors point to his remarkable progress — and a more common diagnosis for children of attention-deficit hyperactivity disorder — as proof that he should have never been prescribed such powerful drugs in the first place.
Kyle now takes one drug, Vyvanse, for his attention deficit. His mother shared his medical records to help document a public glimpse into a trend that some psychiatric experts say they are finding increasingly worrisome: ready prescription-writing by doctors of more potent drugs to treat extremely young children, even infants, whose conditions rarely require such measures.
More than 500,000 children and adolescents in America are now taking antipsychotic drugs, according to a September 2009 report by the Food and Drug Administration. Their use is growing not only among older teenagers, when schizophrenia is believed to emerge, but also among tens of thousands of preschoolers.
A Columbia University study recently found a doubling of the rate of prescribing antipsychotic drugs for privately insured 2- to 5-year-olds from 2000 to 2007. Only 40 percent of them had received a proper mental health assessment, violating practice standards from the American Academy of Child and Adolescent Psychiatry.
“There are too many children getting on too many of these drugs too soon,” Dr. Mark Olfson, professor of clinical psychiatry and lead researcher in the government-financed study, said.
Such radical treatments are indeed needed, some doctors and experts say, to help young children with severe problems stay safe and in school or day care. In 2006, the F.D.A. did approve treating children as young as 5 with Risperdal if they had autistic disorder and aggressive behavior, self-injury tendencies, tantrums or severe mood swings. Two other drugs, Seroquel from AstraZeneca and Abilify from Bristol-Myers Squibb, are permitted for youths 10 or older with bipolar disorder.
But many doctors say prescribing them for younger and younger children may pose grave risks to development of both their fast-growing brains and their bodies. Doctors can legally prescribe them for off-label use, including in preschoolers, even though research has not shown them to be safe or effective for children. Boys are far more likely to be medicated than girls.
Dr. Ben Vitiello, chief of child and adolescent treatment and preventive research at the National Institute of Mental Health, says conditions in young children are extremely difficult to diagnose properly because of their emotional variability. “This is a recent phenomenon, in large part driven by the misperception that these agents are safe and well tolerated,” he said.
Even the most reluctant prescribers encounter a marketing juggernaut that has made antipsychotics the nation’s top-selling class of drugs by revenue, $14.6 billion last year, with prominent promotions aimed at treating children. In the waiting room of Kyle’s original child psychiatrist, children played with Legos stamped with the word Risperdal, made by Johnson & Johnson. It has since lost its patent on the drug and stopped handing out the toys.
Greg Panico, a company spokesman, said the Legos were not intended for children to play with — only as a promotional item.
Cheaper to Medicate
Dr. Lawrence L. Greenhill, president of the American Academy of Child and Adolescent Psychiatry, concerned about the lack of research, has recommended a national registry to track preschoolers on antipsychotic drugs for the next 10 years. “Psychotherapy is the key to the treatment of preschool children with severe mental disorders, and antipsychotics are adjunctive therapy — not the other way around,” he said.
But it is cheaper to medicate children than to pay for family counseling, a fact highlighted by a Rutgers University study last year that found children from low-income families, like Kyle, were four times as likely as the privately insured to receive antipsychotic medicines.
Texas Medicaid data obtained by The New York Times showed a record $96 million was spent last year on antipsychotic drugs for teenagers and children — including three unidentified infants who were given the drugs before their first birthdays.
In addition, foster care children seem to be medicated more often, prompting a Senate panel in June to ask the Government Accountability Office to investigate such practices.
In the last few years, doctors’ concerns have led some states, like Florida and California, to put in place restrictions on doctors who want to prescribe antipsychotics for young children, requiring a second opinion or prior approval, especially for those on Medicaid. Some states now report that prescriptions are declining as a result.
A study released in July by 16 state Medicaid medical directors, which once had the working title “Too Many, Too Much, Too Young,” recommended that more states require second opinions, outside consultation or other methods to assure proper prescriptions. The F.D.A. has also strengthened warnings about using some of these drugs in treating children.
No Medical Reason
Kyle was rescued from his medicated state through a therapy program called Early Childhood Supports and Services, established in Louisiana through a confluence of like-minded child psychiatrists at Tulane, Louisiana State University and the state. It surrounds troubled children and their parents with social and mental health support services.
Dr. Mary Margaret Gleason, a professor of pediatrics and child psychiatry at Tulane who treated Kyle from ages 3 to 5 as he was weaned off the heavy medications, said there was no valid medical reason to give antipsychotic drugs to the boy, or virtually any other 2-year-old. “It’s disturbing,” she said.
Dr. Gleason says Kyle’s current status proves he probably never had bipolar disorder, autism or psychosis. His doctors now say Kyle’s tantrums arose from family turmoil and language delays, not any of the diagnoses used to justify antipsychotics.
“I will never, ever let my children be put on these drugs again,” said Ms. Warren, 28, choking back tears. “I didn’t realize what I was doing.”
Dr. Edgardo R. Concepcion, the first child psychiatrist to treat Kyle, said he believed the drugs could help bipolar disorder in little children. “It’s not easy to do this and prescribe this heavy medication,” he said in an interview. “But when they come to me, I have no choice. I have to help this family, this mother. I have no choice.”
Ms. Warren conceded that she resorted to medicating Kyle because she was unprepared for parenthood at age 22, living in difficult circumstances, sometimes distracted. “It was complicated,” she said. “Very tense.”
Behavior Problems
Kyle was a healthy baby physically, but he was afraid of some things. He spent hours lining up toys. When upset, he screamed, threw objects, even hit his head on the wall or floor — not uncommon for toddlers, but frightening.
“I’d bring him to the doctor and the doctor would say, ‘You just need to discipline him,’ ” Ms. Warren said. “How can you discipline a 6-month-old?”
When Kyle’s behavior worsened after his brother was born, Ms. Warren turned to a pediatrician, Dr. Martin J. deGravelle.
“Within five minutes of sitting with him, he looked at me and said, ‘He has autism, there’s no doubt about it,’ ” Ms. Warren said.
Dr. deGravelle’s clinic notes say Kyle was hyperactive, prone to tantrums, spoke only three words and “does not interact well with strangers.”
He prescribed Risperdal. At the time, Risperdal was approved by the F.D.A. only for adults with schizophrenia or acute manic episodes. The following year it was approved for certain children, 5 and older, with autism and extremely aggressive behavior. It has never been approved by the F.D.A. for use in children younger than 5, although doctors may legally prescribe for any use they see fit.
“Kyle at the time was very aggressive and easily agitated, so you try to find medication that can make him more easily controlled, because you can’t reason with an 18-month-old,” Dr. deGravelle said in a telephone interview. But Kyle was not autistic — according to several later evaluations, including one that Dr. deGravelle arranged with a neurologist. Kyle did not have the autistic child’s core deficit of social interaction, Dr. Gleason said. Instead, he craved more positive attention from his mother.
“He had trouble communicating,” Dr. Gleason said. “He didn’t have people to listen to him.”
After the neurologist review, the diagnosis changed to “oppositional defiant disorder” and the Risperdal continued.
“Yes, I did ask for it,” Ms. Warren said. “But I was at my wit’s end, and I didn’t know what else to do.”
Dr. deGravelle referred her to Dr. Concepcion, who in turn diagnosed Kyle’s condition as bipolar disorder.
“Some children, when they come to me, the parents are really so frustrated,” Dr. Concepcion said in a phone interview. “Especially the mothers are so scared or desperate in getting help. Their children are really acting psychotic.”
Dr. Concepcion also spoke with Dr. Charles H. Zeanah, a Tulane medical professor, who disagreed with both the diagnosis and the treatment. “I have never seen a preschool child with bipolar disorder in 30 years as a child psychiatrist specializing in early childhood mental health,” Dr. Zeanah said.
More Pills
“It’s a controversial diagnosis, I agree with that,” said Dr. Concepcion. “But if you will commit yourself in giving these children these medicines, you have to have a diagnosis that supports your treatment plan. You can’t just give a nondiagnosis and give them the atypical antipsychotic.”
He also prescribed four more pills.
Kyle’s third birthday photo shows a pink-cheeked boy who had ballooned to 49 pounds. Obesity and diabetes are childhood risks of antipsychotics. Kyle smiles at the camera. He is sedated.
“His shell was there, but he wasn’t there,” Ms. Warren said. “And I didn’t like that.”
Dr. Concepcion referred Kyle to the early childhood support program, which has helped about 3,000 preschoolers from low-income families at risk for mental health problems since 2002.
His speech improved. He threw fewer tantrums. “They started working with us as a family,” said Ms. Warren, who also received parenting advice. “That helps.”
Kyle’s treatment was directed by Dr. Gleason, a Columbia medical graduate who had led a team that wrote 2007 practice guidelines for psychopharmacological treatment of very young children.
“Families sometimes feel the need for a quick fix,” Dr. Gleason said. “That’s often the prescription pad. But I’m concerned that when a child sees someone who prescribes but doesn’t do therapy, they’re closing the door that can make longer-lasting change.”
Off most drugs, Kyle started losing weight and his behavior improved. Ms. Warren’s life also improved. She met a man and they moved into their own house five miles out of Opelousas, a town of 25,000. They were married last Saturday.
At their home recently, Kyle and his brother, Jade, ran and played while their baby sister watched from a playpen. Their clothes were neatly folded in a shared bedroom. They often responded “Yes, ma’am” or “Yes, sir.”
“They’re respectful, but they’re hyper kids,” Ms. Warren said. “Once he came off the medication, he’s Kyle. He’s an intelligent person. He’s loud. He’s funny. He’s smart. He’s bouncy. I mean, there’s never a dull moment. He has a few little behavior issues. But he’s like any other normal 6-year-old.”
Kyle paused to show a reading report card from the end of his kindergarten year, with an A grade.
“Awesome job, Kyle!” his kindergarten teacher wrote.
Pakistani delegation mistaken for terrorists.
The classic post on renaming the bathrooms...
And a very long one on more conventional ways of distinguishing between two sets of public toilets.
Worry about bedbugs in flea markets
In a summer when bedbugs have crawled deep into New York City’s psyche, no one is more anxious than those shoppers who live to scout secondhand clothing shops and used-furniture stores. They are connoisseurs of what is hot, hip, a bargain. They know where the flea markets are and when the vintage shops are open.
And they are scared that bedbugs from the home of a former owner still call that $20 designer jacket or that fabulous $65 chair their castle.
That explains why a puzzled-looking Elizabeth Borné was standing on East 23rd Street one afternoon last week. Should she risk the $325 sofa with the paisley fabric that she had just seen in the Housing Works thrift shop near Third Avenue? Was it worth feeling jittery and jumpy about something whose history she could not know? Would she fret every time she invited someone over or curled up for a nap?
“I like and I want it,” she said. “It looks sort of reproductiony. It’s quirky, it’s eclectic, it’s rustic-slash-retro. But my first thought is bedbugs — and bedbugs are freaky.”
Ms. Borné is hardly the only secondhand-store shopper whose first thought has been Cimex lectularius, the speck-size common bedbug. In the spring, the first question from a student at a Fashion Institute of Technology course called “Is Vintage for You?” was, “Have you ever experienced any issues with bedbugs?”
“One girl in particular in the class had an issue,” said the instructor, Bridgett Artise, a fashion designer and an author of “25 Ways to Deconstruct, Reinvent and Recycle Your Wardrobe.” “She said, ‘I had a problem with a jacket.’ She said they were in the lining, so it was hard to know they were even there.”
“They” might find a funky 1950s housedress as appetizing as a so-last-year strapless number. “Obviously, these bugs do not respect economic level or social status or neighborhood — they found them in Abercrombie & Fitch,” said Jose Medellin, a spokesman for Goodwill Industries of Greater New York and Northern New Jersey.
And so secondhand-store buyers worry about something the size of a lentil that could have been on a pipe near the ceiling or in a book on a shelf before it made the jump to clothing or furniture that was consigned or given away. Ms. Borné, a nursing student, said she had looked at pictures of bedbug bites online to see how they differed from spider bites and mosquito bites, just in case she ever needed to know.
Ms. Artise said: “I only worry about newbies, new vintage shoppers. People like myself already know the telltale signs, and what to do.
“The first thing I always tell people who buy vintage clothing is if they see any type of anything that looks like it might have remnants of bedbugs, put it in a plastic bag and freeze it. You keep it in there, I would say, for at least three days. It can’t survive freezing. And after it thaws out, I would take it to a dry cleaner.”
Lisa Slocum, a lawyer who bought a velvet coat for $33 at the City Opera Thrift Shop —“I just can’t resist a bargain,” she said — lived through bedbugs a couple of years ago.
“I swore if I ever bought anything in a thrift shop again, I’d wrap it in plastic and take it right to the dry cleaner,” Ms. Slocum said. “You really do believe you’ll never get rid of them.”
The infestation was enough for her to stop making the rounds of vintage shops “for a while,” even though she had no evidence they came from the stores she had frequented. “I’m a hard person to stop from secondhand shopping,” she said as she left the City Opera shop on East 23rd Street.
Managers and clerks at vintage stores said that they were getting a lot of questions from customers but that the bedbug epidemic did not seem to be putting a dent in their business.
“I’ve never seen a bedbug,” said Tiffany Collings, the manager at Beacon’s Closet, on Fifth Avenue in Park Slope, Brooklyn, where party dresses sell for as little as $10. “We’ve never — knock on wood — had a problem with bedbugs, but it’s absolute and utter sheer luck.”
Ms. Collings said some customers asked what precautions the store took. “I tell them, ‘If you’re worried about bedbugs, I’ve read about bedbugs. If you put clothes in a dryer under high, high heat, it’s supposed to kill the bugs and eggs,’ ” she said. “We’re looking, physically looking at clothes” when a customer brings in clothing to sell, and if she saw a bedbug, she said, she would hand the item back.
Housing Works said it fumigated its stores and its processing and distribution center in Long Island City. For furniture, said Matthew Bernardo, the senior vice president for business service, Housing Works has a screening policy: someone from Housing Works inspects it at the prospective donor’s apartment first.
“We always say when people set up for us to pick up furniture that we have the right to refuse,” Mr. Bernardo said.
Mr. Medellin, the Goodwill spokesman, said Goodwill Industries sprayed all its 39 stores and its processing center.
“We do not take home pickups, and we have not received any reports of bedbugs,” he said. “We have an ongoing contract with an exterminator. We asked them, ‘Please, make sure that we’re covered for bedbugs as well.’ ”Mattresses are a particular concern, because many consider them the passport for bedbugs through the city. Gale A. Brewer, a city councilwoman who represents the Upper West Side, pressed for a ban on used and reconditioned mattresses. It turned out used mattresses were already covered under a state law passed years ago requiring that they be sanitized, thus killing any bedbugs, before they can be resold. But state regulators have yet to publish standards for accomplishing that.
“I tell people — given the fact that the Centers for Disease Control has declared bedbugs a pretty big menace, an epidemic, actually, and when you have an epidemic you take precautions — that I don’t shop in secondhand stores,” Ms. Brewer said. “That’s everything from the Salvation Army stores to fancy vintage-clothing stores.”
And Ms. Borné and the sofa at the Housing Works shop? “I’m not sold on it,” she said.
But she did buy a $20 Zara dress.
“A dress,” she said, “you can wash.”
On giving antipsychotics to small children.
At 18 months, Kyle Warren started taking a daily antipsychotic drug on the orders of a pediatrician trying to quell the boy’s severe temper tantrums.
Thus began a troubled toddler’s journey from one doctor to another, from one diagnosis to another, involving even more drugs. Autism, bipolar disorder, hyperactivity, insomnia, oppositional defiant disorder. The boy’s daily pill regimen multiplied: the antipsychotic Risperdal, the antidepressant Prozac, two sleeping medicines and one for attention-deficit disorder. All by the time he was 3.
He was sedated, drooling and overweight from the side effects of the antipsychotic medicine. Although his mother, Brandy Warren, had been at her “wit’s end” when she resorted to the drug treatment, she began to worry about Kyle’s altered personality. “All I had was a medicated little boy,” Ms. Warren said. “I didn’t have my son. It’s like, you’d look into his eyes and you would just see just blankness.”
Today, 6-year-old Kyle is in his fourth week of first grade, scoring high marks on his first tests. He is rambunctious and much thinner. Weaned off the drugs through a program affiliated with Tulane University that is aimed at helping low-income families whose children have mental health problems, Kyle now laughs easily and teases his family.
Ms. Warren and Kyle’s new doctors point to his remarkable progress — and a more common diagnosis for children of attention-deficit hyperactivity disorder — as proof that he should have never been prescribed such powerful drugs in the first place.
Kyle now takes one drug, Vyvanse, for his attention deficit. His mother shared his medical records to help document a public glimpse into a trend that some psychiatric experts say they are finding increasingly worrisome: ready prescription-writing by doctors of more potent drugs to treat extremely young children, even infants, whose conditions rarely require such measures.
More than 500,000 children and adolescents in America are now taking antipsychotic drugs, according to a September 2009 report by the Food and Drug Administration. Their use is growing not only among older teenagers, when schizophrenia is believed to emerge, but also among tens of thousands of preschoolers.
A Columbia University study recently found a doubling of the rate of prescribing antipsychotic drugs for privately insured 2- to 5-year-olds from 2000 to 2007. Only 40 percent of them had received a proper mental health assessment, violating practice standards from the American Academy of Child and Adolescent Psychiatry.
“There are too many children getting on too many of these drugs too soon,” Dr. Mark Olfson, professor of clinical psychiatry and lead researcher in the government-financed study, said.
Such radical treatments are indeed needed, some doctors and experts say, to help young children with severe problems stay safe and in school or day care. In 2006, the F.D.A. did approve treating children as young as 5 with Risperdal if they had autistic disorder and aggressive behavior, self-injury tendencies, tantrums or severe mood swings. Two other drugs, Seroquel from AstraZeneca and Abilify from Bristol-Myers Squibb, are permitted for youths 10 or older with bipolar disorder.
But many doctors say prescribing them for younger and younger children may pose grave risks to development of both their fast-growing brains and their bodies. Doctors can legally prescribe them for off-label use, including in preschoolers, even though research has not shown them to be safe or effective for children. Boys are far more likely to be medicated than girls.
Dr. Ben Vitiello, chief of child and adolescent treatment and preventive research at the National Institute of Mental Health, says conditions in young children are extremely difficult to diagnose properly because of their emotional variability. “This is a recent phenomenon, in large part driven by the misperception that these agents are safe and well tolerated,” he said.
Even the most reluctant prescribers encounter a marketing juggernaut that has made antipsychotics the nation’s top-selling class of drugs by revenue, $14.6 billion last year, with prominent promotions aimed at treating children. In the waiting room of Kyle’s original child psychiatrist, children played with Legos stamped with the word Risperdal, made by Johnson & Johnson. It has since lost its patent on the drug and stopped handing out the toys.
Greg Panico, a company spokesman, said the Legos were not intended for children to play with — only as a promotional item.
Cheaper to Medicate
Dr. Lawrence L. Greenhill, president of the American Academy of Child and Adolescent Psychiatry, concerned about the lack of research, has recommended a national registry to track preschoolers on antipsychotic drugs for the next 10 years. “Psychotherapy is the key to the treatment of preschool children with severe mental disorders, and antipsychotics are adjunctive therapy — not the other way around,” he said.
But it is cheaper to medicate children than to pay for family counseling, a fact highlighted by a Rutgers University study last year that found children from low-income families, like Kyle, were four times as likely as the privately insured to receive antipsychotic medicines.
Texas Medicaid data obtained by The New York Times showed a record $96 million was spent last year on antipsychotic drugs for teenagers and children — including three unidentified infants who were given the drugs before their first birthdays.
In addition, foster care children seem to be medicated more often, prompting a Senate panel in June to ask the Government Accountability Office to investigate such practices.
In the last few years, doctors’ concerns have led some states, like Florida and California, to put in place restrictions on doctors who want to prescribe antipsychotics for young children, requiring a second opinion or prior approval, especially for those on Medicaid. Some states now report that prescriptions are declining as a result.
A study released in July by 16 state Medicaid medical directors, which once had the working title “Too Many, Too Much, Too Young,” recommended that more states require second opinions, outside consultation or other methods to assure proper prescriptions. The F.D.A. has also strengthened warnings about using some of these drugs in treating children.
No Medical Reason
Kyle was rescued from his medicated state through a therapy program called Early Childhood Supports and Services, established in Louisiana through a confluence of like-minded child psychiatrists at Tulane, Louisiana State University and the state. It surrounds troubled children and their parents with social and mental health support services.
Dr. Mary Margaret Gleason, a professor of pediatrics and child psychiatry at Tulane who treated Kyle from ages 3 to 5 as he was weaned off the heavy medications, said there was no valid medical reason to give antipsychotic drugs to the boy, or virtually any other 2-year-old. “It’s disturbing,” she said.
Dr. Gleason says Kyle’s current status proves he probably never had bipolar disorder, autism or psychosis. His doctors now say Kyle’s tantrums arose from family turmoil and language delays, not any of the diagnoses used to justify antipsychotics.
“I will never, ever let my children be put on these drugs again,” said Ms. Warren, 28, choking back tears. “I didn’t realize what I was doing.”
Dr. Edgardo R. Concepcion, the first child psychiatrist to treat Kyle, said he believed the drugs could help bipolar disorder in little children. “It’s not easy to do this and prescribe this heavy medication,” he said in an interview. “But when they come to me, I have no choice. I have to help this family, this mother. I have no choice.”
Ms. Warren conceded that she resorted to medicating Kyle because she was unprepared for parenthood at age 22, living in difficult circumstances, sometimes distracted. “It was complicated,” she said. “Very tense.”
Behavior Problems
Kyle was a healthy baby physically, but he was afraid of some things. He spent hours lining up toys. When upset, he screamed, threw objects, even hit his head on the wall or floor — not uncommon for toddlers, but frightening.
“I’d bring him to the doctor and the doctor would say, ‘You just need to discipline him,’ ” Ms. Warren said. “How can you discipline a 6-month-old?”
When Kyle’s behavior worsened after his brother was born, Ms. Warren turned to a pediatrician, Dr. Martin J. deGravelle.
“Within five minutes of sitting with him, he looked at me and said, ‘He has autism, there’s no doubt about it,’ ” Ms. Warren said.
Dr. deGravelle’s clinic notes say Kyle was hyperactive, prone to tantrums, spoke only three words and “does not interact well with strangers.”
He prescribed Risperdal. At the time, Risperdal was approved by the F.D.A. only for adults with schizophrenia or acute manic episodes. The following year it was approved for certain children, 5 and older, with autism and extremely aggressive behavior. It has never been approved by the F.D.A. for use in children younger than 5, although doctors may legally prescribe for any use they see fit.
“Kyle at the time was very aggressive and easily agitated, so you try to find medication that can make him more easily controlled, because you can’t reason with an 18-month-old,” Dr. deGravelle said in a telephone interview. But Kyle was not autistic — according to several later evaluations, including one that Dr. deGravelle arranged with a neurologist. Kyle did not have the autistic child’s core deficit of social interaction, Dr. Gleason said. Instead, he craved more positive attention from his mother.
“He had trouble communicating,” Dr. Gleason said. “He didn’t have people to listen to him.”
After the neurologist review, the diagnosis changed to “oppositional defiant disorder” and the Risperdal continued.
“Yes, I did ask for it,” Ms. Warren said. “But I was at my wit’s end, and I didn’t know what else to do.”
Dr. deGravelle referred her to Dr. Concepcion, who in turn diagnosed Kyle’s condition as bipolar disorder.
“Some children, when they come to me, the parents are really so frustrated,” Dr. Concepcion said in a phone interview. “Especially the mothers are so scared or desperate in getting help. Their children are really acting psychotic.”
Dr. Concepcion also spoke with Dr. Charles H. Zeanah, a Tulane medical professor, who disagreed with both the diagnosis and the treatment. “I have never seen a preschool child with bipolar disorder in 30 years as a child psychiatrist specializing in early childhood mental health,” Dr. Zeanah said.
More Pills
“It’s a controversial diagnosis, I agree with that,” said Dr. Concepcion. “But if you will commit yourself in giving these children these medicines, you have to have a diagnosis that supports your treatment plan. You can’t just give a nondiagnosis and give them the atypical antipsychotic.”
He also prescribed four more pills.
Kyle’s third birthday photo shows a pink-cheeked boy who had ballooned to 49 pounds. Obesity and diabetes are childhood risks of antipsychotics. Kyle smiles at the camera. He is sedated.
“His shell was there, but he wasn’t there,” Ms. Warren said. “And I didn’t like that.”
Dr. Concepcion referred Kyle to the early childhood support program, which has helped about 3,000 preschoolers from low-income families at risk for mental health problems since 2002.
His speech improved. He threw fewer tantrums. “They started working with us as a family,” said Ms. Warren, who also received parenting advice. “That helps.”
Kyle’s treatment was directed by Dr. Gleason, a Columbia medical graduate who had led a team that wrote 2007 practice guidelines for psychopharmacological treatment of very young children.
“Families sometimes feel the need for a quick fix,” Dr. Gleason said. “That’s often the prescription pad. But I’m concerned that when a child sees someone who prescribes but doesn’t do therapy, they’re closing the door that can make longer-lasting change.”
Off most drugs, Kyle started losing weight and his behavior improved. Ms. Warren’s life also improved. She met a man and they moved into their own house five miles out of Opelousas, a town of 25,000. They were married last Saturday.
At their home recently, Kyle and his brother, Jade, ran and played while their baby sister watched from a playpen. Their clothes were neatly folded in a shared bedroom. They often responded “Yes, ma’am” or “Yes, sir.”
“They’re respectful, but they’re hyper kids,” Ms. Warren said. “Once he came off the medication, he’s Kyle. He’s an intelligent person. He’s loud. He’s funny. He’s smart. He’s bouncy. I mean, there’s never a dull moment. He has a few little behavior issues. But he’s like any other normal 6-year-old.”
Kyle paused to show a reading report card from the end of his kindergarten year, with an A grade.
“Awesome job, Kyle!” his kindergarten teacher wrote.
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no subject
Date: 2010-09-03 11:50 pm (UTC)no subject
Date: 2010-09-04 12:33 am (UTC)Um, this doctor seems to have it backwards. You try to come up with the correct diagnosis that actually seems to fit what's going on with the kid, and if medication is appropriate to that diagnosis, you give it. But you shouldn't try to make your diagnosis fit whatever medication you want to give him/her. That's just nuts.
no subject
Date: 2010-09-04 03:34 am (UTC)no subject
Date: 2010-09-04 12:00 pm (UTC)My concern isn't that Dr. Concepcion is putting down the diagnosis that will allow the treatment, it's the choice of treatment.