Guilty of Being Black in America

     Over the years I have witnessed many protests both violent and peaceful.  I have also seen many cities tore up and burning because of social unrest. I was in the middle of a riot once while working some years ago. I was scared, but I made it out of the city after my deliveries that night largely due to a black man I worked with that ran the same route in this predominantly black neighborhood who knew the area well and he instructed me in detail on how, as he put it, “I could get my white ass out of there if something ever did happen.” I am pretty sure my ass would have been in big trouble without some of those instructions that night because people did throw bottles and strike the vehicle I was in with bats and sticks and I was called a honky and other angry words more times that night than I had ever heard before in my life. The smell of tear gas that had been propelled into a building next to a group of people is something I will never forget or the chaos that ensued in that neighborhood because of a an incident that shined a light on racism, unfairness, or perhaps I should say the persistent inequity in treatment between people in this country often by the people who are supposed to protect and serve us all. Unfortunately, behind these incidents there is always dead body with dark skin that cause many of us to cry injustice and to get angry for a little while. For an instant, the people in this country who are in the majority are forced to come face to face with the reality of the hidden racism in this country and indifference shown to people in the minority and some in the majority hate to have their silent racism rubbed in their face. Nevertheless, every time something like this happens most people of all races and creeds hope that this time the death of a brown skinned man or woman because of callous indifference will be the last and some meaningful change occur. Often change in the way of social reforms to attempt to keep what happened from happening again does occur, but what doesn’t change is how we think or how perceive each other and as long as that doesn’t change being guilty of just simply being black in America will continue to occur.

      The question before us is what will make our racism, or our unfairness or indifference to others end? When will these senseless deaths from callous indifference that cause violence to erupt across our nation stop?  It will end the day a white person can look at black person and not see the color of their skin first and when a black person can look a white person and not see the color of their skin first. The day a guy looking at hot girls on the beach doesn’t lean over to his friend and say look at that hot girl over there without having to add the descriptive black or African American to distinguish her from the other hot girls. The day a person gets angry at someone that does not look like them or wear the same skin color and the first thing that pops in their mind is not a derogatory term connected to their skin color or race. The day we realize that there is no such thing as a black problem or white problem, but that it is a problem for all of us. The day when people stop talking about racism because as long as we are talking about racism, we have a race problem. The day people of all races, creeds, colors realize that we are in this thing called life together and that when one of us bleeds we all bleed. The day we as a people stop allowing the psychological chains of slavery to bind us to attitudes, thoughts, and feelings that imbue the very soul of our nation. The day we stop allowing the grotesque ghosts of “Jim Crow” to lynch the hearts and minds of generation after generation people. The day a special fear constructed from our ugly history no longer exists. A fear that forces brown moms and dads to have a special conversation with their children at a certain point in their lives about the white people that could hurt them, especially those who might wear a badge. When that day comes there will be no more senseless deaths from simply being guilty of being black in America. When that day comes, we will have arrived at that elusive but magical place some of us heard about many years ago from a wise man that died trying to get us there, a place called the “promised land.”                 

Can You Imagine?

     Can you imagine being chained in a ship and taken to a strange land against your will?

     Can you imagine you and yours being shackled and sold to farms to work the land?

     Can you imagine being whipped for just saying something or looking the wrong way?

     Can you imagine your wife or daughter being used as brood mares to create more workers?

     Can you imagine your loved ones being categorized just like any other livestock?

     Can you imagine finally acquiring your freedom after a lifetime of imposed servitude?

     Can you imagine a country founded on the ideal of freedom denying it to so many?

     Can you imagine being hated and treated unequally just because you looked different?

     Can you imagine being hunted by people in hoods with bibles and crosses in their hand?

     Can you imagine being in fear for your life just for walking someplace or talking to someone?

     Can you imagine seeing your father or son in a hangman’s noose swinging from a tree?

     Can you imagine not being able to use a bathroom just because you were the wrong color?

     Can you imagine having to scold your child for using one of those bathrooms?

     Can you imagine being told that you cannot ride in a seat in the front of the bus?

     Can you imagine being told there is no vacancy at a motel when you know there is vacancies?

     Can you imagine people not serving you at a restaurant because you were not the right color?

     Can you imagine people crossing the street because they feared walking by you?

     Can you imagine having feelings for someone but not acting on them because of others?  

     Can you imagine being gunned down by those who are supposed to protect and serve?

     Can you imagine being sprawled out on the ground with someone’s knee on your neck, struggling for every breath, asking for your mother, knowing the life is slowly draining from your body and wondering why?

     Can you imagine?

God Make It Stop!

The hearts of our once invisible heroes grow weary fighting a relentless demon.

God make it stop!

They sacrifice all with little to save souls from the consuming darkness surrounding them.

God make it stop!

How many faces of those gasping for life’s last breath will be burned into their memories?

God make it stop!

How many hands will go lifeless in theirs because of a viral monster that yet goes unanswered?

God make it stop!

How often must they gaze into already tear-soaked faces and be the bearers of even worse news?

God make it stop!

How many times will they totally collapse from exhaustion from working extra shifts and hours?

God make it stop!

How many more tears will fall behind their masks for those they could not pull back from death?

God make it stop!

They yearn for a whisper of hope to dull the ventilators symphony of despair and desperation.

God make it stop!

They search for the rainbow beyond a dark ominous cloud that now besieges all humanity.

God make it stop!

           

Written for all the medical professionals working tirelessly through this epidemic.

Who Are We?

Are we a shining beacon of possibility to people everywhere?

Or are we doomed to float endlessly in the sea of our own contempt?

Who are we?

Are we the welcoming light of hope held up on high for all to see?

Or have we succumbed to the darkness of hatred and indifference?

Who are we?

Are we the champion that seeks to set the best example for the rest of the world?

Or have we resigned ourselves to accept the requiem of our national conscience?

Who are we?

Are we capable of finding the greatness within ourselves once again?

Or will we endlessly tumble into the unquieted abyss of our past glory?

Who are we?

Are we doomed to sit in quiet desperation contemplating what once was for eternity?

Or will we once again strive to make our greatness more than an empty slogan on a cap?

Who are we?

How Do We Educate Students With Emotional/Behavioral Disorders?

     What are students with Emotional/Behavioral Disorders also known by the anacronym EBD students? EBD students like many students fall within the special needs category of students and EBD students along with other students with all sorts of disabilities fall into Florida’s ESE or Exceptional Student Education category in public schools. The purpose of ESE is to help each child with a disability progress in school and prepare for life after school. However, even with planning and providing everything special needs students need to learn in school some students do not meet those goals easily and these unique frequently troublesome EBD students are one such group.

     EBD students are children with all sorts of mental, behavioral, and developmental disorders like ADHD, Oppositional Defiant Disorder, Bipolar Disorder, Conduct Disorder, Anxiety Disorder and so on and their numbers are growing. It is estimated that one in seven children between the ages of two and eight has either a mental, behavioral, or developmental disorder (Who Cares About Kelsey). In many cases these children have been abused in unimaginable ways, suffered extreme neglect, and for one reason or another have been shuffled from one foster care home to another numerous times before they even reach school age, but the issues EBD students have can be either biological or environmental or quite often a combination of both. In general education settings EBD students go far beyond being disruptive in class and are routinely either spending their days in ISS (in school suspension) or getting OSS (out of school suspension) and sent home. EBD students often get angry over the littlest slights by others, can get frustrated over the smallest of things, and will occasionally just go into a full-blown tirade or fit. Students with Emotional/Behavioral Disorders (EBD) have been known to throw chairs, flip tables, desks, tear up classrooms, and on occasion hurt other students or those who work with and around them. However, no matter how bad these students behave or what some people might think we must try to educate them because first every child has a right to an education under the law, and second our failure to at least try to educate them and help them toward a better life is just sending them on down to the next stop on the freeway to social failure the criminal justice system (Rutherford, Mathur, & Nelson, 2000). 

     What many people fail to realize is that money spent on education is never a waste even if some things attempted do not work as well as expected because the hard truth is it costs far less to educate young people than it does to incarcerate them and the social costs of doing nothing or not trying is even greater than the economic ones. As a result, people all over the country have tried to figure out the best way to educate these challenging EBD students. Some feel EBD children should be educated in their own school or what is called a self-contained school while others think they should be educated in self-contained classrooms within public schools. Research has shown that specialized Emotional/Behavioral Disorder units, self-contained classrooms, in public schools improve students educational and social skills.

     In one study that focused on the academic performance of EBD students from elementary age through middle school in self-contained schools that only provided services to EBD students showed that both elementary and secondary age groups scored far below the 25th percentile in math, written expression, and reading and the secondary age group of students were shown to have even lower skills in all math (Lane, Barton-Arwood, Nelson, & Wehby, 2007). Unlike other studies that used only standardized achievement tests, this study used both curriculum-based measures as well as standardized achievement tests to garner their results (Lane, Barton-Arwood, Nelson, & Wehby, 2007). This study was not without some limitations, but the results did confirm the results of previous studies on self-contained schools that reported substandard academic performance as well as finding them deficient in other areas, like socialization (Lane, Barton-Arwood, Nelson, & Wehby, 2007).

    In another study that compared self-contained schools with self-contained classrooms to see if there was any difference in them. The results showed that the students educated in self-contained classrooms scored much higher academically than those educated in self-contained schools and again both standardized and curriculum-based measures were used in garnering the results (Lane, Wehby, Little, & Cooley, 2005).  The students educated in self-contained classrooms had far better skills in math, reading comprehension, oral language, written language, and fluency than students educated in self-contained schools (Lane, Wehby, Little, & Cooley, 2005). However, there seemed to be no difference in socialization skills between the two groups, but the results of these skills were derived from teacher assessments. Researchers strongly believe that there is a difference here that favors those in self-contained classrooms and those differences are going unrecognized simply because teachers are not connected well enough with student peer culture to detect the differences (Lane, Wehby, Little, & Cooley, 2005).

     The researchers from the previous study did a part two of that study where they again compared self-contained classrooms with self-contained schools to see if there was any difference in them, but this time they followed EBD students that had been placed in both of those settings at the start of the study for a year (Lane, Wehby, Little, & Cooley, 2005). The results were like the first study with somethings showing more of a difference and less in others (Lane, Wehby, Little, & Cooley, 2005). One significant change was that EBD students educated in self-contained classrooms in this study showed better scores in relation to social and behavioral aspects, so unlike the previous study the social skills of these EBD students improved (Lane, Wehby, Little, & Cooley, 2005). On the other hand, the social skills of students educated in self-contained schools decreased noticeably (Lane, Wehby, Little, & Cooley, 2005). EBD students in self-contained schools also showed significant decreases in writing scores when compared to students in self-contained classrooms (Lane, Wehby, Little, & Cooley, 2005). Researchers feel that because more severe problem behavior was reported in self-contained schools that this score may be because less time was allocated to academics to make more room for social instruction and anger management therapies (Lane, Wehby, Little, & Cooley, 2005). However, self-contained classrooms are set up in public schools and they have a steady stream of people coming into self-contained classrooms to observe and to pick up students to work with individually to improve their socialization and deal with their anger issues. Despite some improvements the researchers of this study concluded that collectively over the course of an academic year the EBD students in both the self-contained classrooms and self-contained schools made very little progress in some areas (Lane, Wehby, Little, & Cooley, 2005). Researchers also state that their findings, more than anything else, indicate that more support is needed in both settings to show more progress (Lane, Wehby, Little, & Cooley, 2005).  These researchers also realized that there were glaring limitations in both their studies and that more research must be done in this area and all future studies should have a much larger sample (Lane, Wehby, Little, & Cooley, 2005).

      Some are now thinking that inclusion of EBD students back into general education classrooms with support and more teacher education in dealing with EBD students is a better idea. However, a study comparing developmental gains on preschool children with all sorts disabilities, including EBD children, in inclusive settings or general education classrooms, and self-contained classrooms showed mixed or no notable differences in social outcomes between students in general education classrooms and those in self-contained classrooms, so as far as socialization is concerned there is little difference in the settings (Holahan & Costenbader, 2000). The researchers go on to state that children with disabilities do not show positive outcomes or benefit from a social skills standpoint just by being near children without disabilities (Holahan & Costenbader, 2000). As far as developmental growth or functioning is concerned these researchers found that children who are already functioning at a higher level do better in inclusive classrooms and children already functioning at a lower level in these things made higher gains in self-contained classrooms (Holahan & Costenbader, 2000). Even though these researchers were not exclusively studying preschool EBD students, their research seriously challenges the reoccurring notion that one educational setting is better or will produce better results socially or academically than another (Holahan & Costenbader, 2000).

     Better socialization or improving the social skills of EBD students is the whole reason behind the idea for inclusion of EBD students into general education classrooms. One study that focused on the social life of EBD children in self-contained classrooms did detailed interviews of fourteen students educated in a self-contained classroom and fourteen children that were closely matched for comparison educated  in a general education classroom and found that EBD children had little to no chance to engage in integrated school activities and that their social networks in school were comprised of mostly those children and adults who were connected to or a part of special needs education (Panacek & Dunlap, 2003). The overall value of this study as far as reliable information is in the least questionable because not only was the sample size very small, but all the students interviewed for this study came from the same school district and to add to that the students used in the study were all pulled from the free lunch roster, so all those interviewed came from low income families (Panacek & Dunlap, 2003). This and other limitations that the researchers themselves recognized with this study makes this study hard to generalize across a whole population (Panacek & Dunlap, 2003).  The truth, from a person who works with EBD students in a public school, is that EBD children in self-contained classrooms in some public schools do engage integrated activities. Public schools refer to things like gym, chorus, and so on with other students as “specials,” and EBD students can be involved in them, but they often lose those privileges quickly do to their behavior. EBD students also encounter general education students on buses, playgrounds and in line for breakfast and lunch each day, so the premise that EBD students are completely cut off from general education students in public schools or that they never encounter general education students as a group or individually in public school is totally ludicrous. EBD student’s inability to socialize normally with general education students and their frequent antisocial behaviors better explains why their social networks are small, not the self-contained classrooms they are educated in.

     One article or study looked at the outcomes of a three-year project that examined the consultation process and what would be needed to develop or ready staff for the inclusion of EBD students back into general education classes (Shapiro, Miller, Sawka, Gardill, & Handler). Apparently, it is believed by some that inclusion in general education classes is better for EBD students, but they realize that general education teachers and staff need to learn how to deal with and handle EBD students and that consultation will be needed before and after training or developing the staff to make inclusion of these students successful. These researchers tried to ascertain how much consultation would be needed and whether it needed to continue after training and developing staff and how much staff development would be needed (Shapiro, Miller, Sawka, Gardill, & Handler). The results of this study showed that consultation services are critically important for continued staff development and thought it to be a solid strategy to improve the chances that the inclusion of EBD students in general education classes would be effective and successful (Shapiro, Miller, Sawka, Gardill, & Handler). However, researchers found that even with an intensive experience based in service programs to help teach and develop staff to create and implement intervention strategies a large majority of the teams assembled failed to implement the strategies they created and selected (Shapiro, Miller, Sawka, Gardill, & Handler). People in many school districts were uncertain of

how to proceed, their communication broke down, and there was a lack of follow through with interventions (Shapiro, Miller, Sawka, Gardill, & Handler). The researchers concluded that for inclusion of EBD children in general education classes to succeed all school personnel must be provided with intensive training, have a lot of or a significant amount of consultation support, very specific interventions that are accepted by a majority of those involved, and continued collaboration efforts (Shapiro, Miller, Sawka, Gardill, & Handler). Some groups in the study that utilized the training well and did all the things necessary to make this successful and where the EBD students received effective intervention seventy percent of the EBD students maintained or increased their time in general education classes (Shapiro, Miller, Sawka, Gardill, & Handler). The study did show that putting EBD students back into general education classes and having it work out is possible, but for this transition to work, even a little, would not be without a massive effort and cost.          

     Unfortunately, there are several things not considered or even mentioned when inclusion is discussed by researchers in these studies. First, is the fact that no one considers the good students in the general education classes with these EBD students. How will it affect their education and safety? If a teacher must focus on one EBD child that is frequently out of control and disrupting the entire class, how will that affect the education of the majority students in that class? Isn’t that teacher losing precious class time that could be more productively spent on the students in the class that behave? If an EBD student hits a student with chair or attacks one of the other students in a way that requires outside medical help or hospitalization, what are you going to say to the parents of that student? How are you going to explain to them that the violence perpetrated on their child was caused by a student with emotional and behavioral issues or better yet asks you why that violent of a student was in their child’s class to begin with? Would having EBD students in general education classes not increase the school’s overall liability? Second, EBD students are often removed from the school they are in and bused to schools that have EBD units or self-contained classrooms. If you were to completely end self-contained classrooms and schools for EBD students and put all the EBD students back in general education classes in the schools they were in and the number of EBD students keeps increasing, schools in some areas will be overburdened with EBD students while other schools would have few. Wouldn’t having a huge number of students in any school that are consistently one or two grades behind effect funding or the quality of the education provided in that school? Third, the EBD students that are in self-contained schools and classrooms now were once included and in general education classrooms and their actions or better yet their inability to socialize and their antisocial behaviors is what resulted in them being evaluated by someone in the school system with a psychology degree and placed in a self-contained classroom in the first place. Since they were evaluated and placed in a self-contained classroom, it is safe to say that the EBD students in self-contained classrooms have the severest of problems or issues and most likely could not be integrated back into general education classes easily. If integration back into a general education setting was attempted for all EBD students, it would not be without a lot of trouble and great cost.

     One reason why research done on EBD students in schools is limited and what research has been done is all over the place and checkered with spotty or inconclusive results is that there is little to no advocacy for EBD children. There is no one out there with any real desire to try and figure out what is best for these children educationally or otherwise because these unlucky children are not disabled in a way that is acceptable to most of us. No these are the crazy kids that have meltdowns over nonsense, wreck things for no reason, and are constantly wanting to punch the living daylights out of anybody that angers or irritates them even slightly. They are the children that many people think need nothing more than a swift kick in the butt to correct their behavior and refuse to accept that they may have a mental disorder because mental illness is something we do not like to talk about. We do not fundraise for mental illness or have a Special Olympics for crazy children, we lock it away and pretend it does not exist. There is no one out there willing to speak up and say what might be best for EBD children or say what type of education or educational setting would be best for EBD students and be able to explain why.  

     The people that would make the strongest advocates for these children, particularly in education, are the people that work with and around EBD students in the schools every day. Special Education Teachers because they work so closely with EBD students would be the most aware of the unique educational needs of these students and their families and that awareness would make them great advocates for all the services necessary to meet the needs of these students and their families (Murry, 2005). Unfortunately, there are barriers that keep or at least inhibit Special Education Teachers and other people that work with these children in schools from advocating effectively on behalf of these children and their families (Murry, 2005). Some of those barriers would be the school bureaucracy itself, time constraints, the threat of losing standing or face because someone is to blame, employment insecurity because many teachers in school systems are on a three year probation, the need to step outside the normal operating routines, opposing perspectives from others within the school system, school wide need versus individual need scenarios, and the possible threat of some type of litigation (Murry, 2005).

     How do we educatestudents with emotional/behavior disorders? Is a question that appears to be a difficult one to answer because not only are the issues and problems surrounding EBD children and their education complex, but there is a serious lacking in the depth of knowledge regarding EBD children and their education. Research on this issue is wrought with many limitations and clear external validity issues not only illustrates that lack of knowledge, but clearly indicates that more research must be done in this area. However, we do know that self-contained classrooms are a far better choice for EBD students both academically and socially than self-contained schools because all the research points in that direction. All the data relating to self-contained schools indicates academic and socialization problems and one study clearly showed a decline in these things in EBD students educated in them. In contrast, EBD students educated in self-contained classrooms showed clear academic increases or higher academic scores than EBD students educated in self-contained schools in both the short term and over a whole school year. Researchers did not find much of an increase in socialization skills between the two settings, but self-contained classrooms scores on this were still better than self-contained schools and some researchers thought the scores on this should be higher for self-contained classrooms and offered a reason as to why the scores of the two settings were closer than they should have been. The findings of another study done on not just EBD students, but all students with disabilities challenged the whole idea that one educational setting would be better than the other for socialization.  Unfortunately, the difference in scores academically and socially between self-contained classrooms and self-contained schools was not enough to keep some people from considering integrating EBD students back into the general education classes they were taken out of because of their antisocial behaviors to improve socialization. However, inclusion of EBD students back into general education classes will be difficult, costly, and present other problems not fully considered or overlooked.    

     In 2006 there were over two million young people in the United States with emotional/behavioral disorders and that number has increased and continues to grow (Who Cares About Kelsey). Students with emotional/behavioral disorders are three times as likely to be arrested before leaving school and often in middle school because the graduation rate for EBD students is far worse than students with other disabilities (Who Cares About Kelsey). After getting out of school EBD students are more than twice as likely as students with other disabilities to wind up living in a correction facility, a half-way house, in a drug rehab center, or on the street and females with emotional/behavioral disorders will become teenage mothers at more than twice the rate of females with other disabilities (Who Cares About Kelsey). The statistics on children and young people with emotional/behavioral disorders are mind numbing now and will certainly get worse if we do not try to educate more of these young people enough to be at least somewhat productive citizens and the economic and social cost will be much, much greater if we make no attempt to try to educate them. It comes down to what people want the government to spend their taxes on. We can spend more on the front end to try an educate these difficult children, or we can spend it on the back end and build more prisons and juvenile detention centers. In either event a good deal of money is going to be spent whether we like it or not.

         Yes, it is imperative more research is done on trying to figure out the best way to educate students with emotional/behaviors disorders or if educating them more than one way is not a better approach to the problem and while doing this we must also consider the impact our fixes or solutions to this problem will have on the education and safety of other children. The research that has been done so far with all the limitations and generalization issues recognized in it really doesn’t tell us a lot other than self-contained classrooms are better than self-contained schools and that there are problems with inclusion and that there are some problems with inclusion researchers are not even considering. Future research on this issue is going to require larger samples, fewer limitations, and better external validity otherwise we will not have achieved anymore than we have and that is not good enough. The clock is ticking, and we know the problem is not going to get better because the number of children with emotional/behavioral disorders is increasing, so the need for answers will become even more important in the future.

     One of the reasons why this early research is not more concise or conclusive is because researchers are going in many directions and looking at many angles on the issue because there are little or no advocates out there for young people and students with emotional/ behavioral disorders, so there is nothing to send researchers in one direction and no one to create a push to find solutions to the problem quicker. The people best suited and most knowledgeable that could advocate for students with emotional/ behavior disorders are the people working closest with these students at schools, but they are afraid to because there are barriers that make it hard to get involved. Another reason is because we are talking about children with mental health issues and mental health is something we do not like to talk about or in some cases even acknowledge it exists. There is such a stigma associated with mental illness that we do not want to hear about mental illness period and God forbid someone in your family has a mental illness and a few people know about it the gossip whispers around you will be lower than dreaded cancer whispers. If you have a child with a mental illness that is violent and has fits of rage, an EBD child, that you cannot not handle, it is even worse because then you must be bad parents for not being able to control your child. Your child doesn’t have a mental illness all he or she needs is a swift kick in the butt that you are not giving them. My point here is the stigma around mental illness and public perceptions must change because along with everything else this stigma effects is one big one called advocacy.                             

References

Holahan, A., & Costenbader, V. (2000). A Comparison of Developmental Gains for Preschool Children with Disabilities in Inclusive and Self-Contained Classrooms. Topics in Early    Childhood Special Education, 20(4), 224-235. doi:10.1177/027112140002000403

Lane, K. L., Barton-Arwood, S. M., Nelson, J. R., & Wehby, J. (2007). Academic Performance of Students with Emotional and Behavioral Disorders Served in a Self-Contained Setting. Journal of Behavioral Education, 17(1), 43-62. doi:10.1007/s10864-007-9050-1

Lane, K. L., Wehby, J. H., Little, M. A., & Cooley, C. (2005). Academic, Social, and Behavioral Profiles of Students with Emotional and Behavioral Disorders Educated in Self-Contained Classrooms and Self-Contained Schools: Part I—Are They More Alike than Different? Behavioral Disorders, 30(4), 349-361. doi:10.1177/019874290503000407

Lane, K. L., Wehby, J. H., Little, M. A., & Cooley, C. (2005). Students Educated in Self-Contained Classrooms and Self-Contained Schools: Part II—How Do They Progress over Time? Behavioral Disorders, 30(4), 363-374. doi:10.1177/019874290503000408

Murry, F. (2005). Effective Advocacy for Students with Emotional/Behavioral Disorders: How High the Cost? EDUCATION AND TREATMENT OF CHILDREN, 28(4)

Panacek, L. J., & Dunlap, G. (2003). The Social Lives of Children with Emotional and Behavioral Disorders in Self-Contained Classrooms: A Descriptive Analysis. Exceptional Children, 69(3), 333-348. doi:10.1177/001440290306900305

Shapiro, E. S., Miller, D. N., Sawka, K., Gardill, M. C., & Handler, M. W. (1999). Facilitating the Inclusion of Students with EBD into General Education Classrooms. Journal of Emotional and Behavioral Disorders, 7(2), 83-93. doi:10.1177/106342669900700203

Rutherford, R. B., Mathur, S. R., & Nelson, C. M. (2000). Severe Behavior Disorders of

            Children and Youth. Education and Treatment of Children and Educating Students with    Emotional and Behavioral Disabilities in the 21st century: Looking Through Windows, opening doors, 23(3), 203-218

Who Cares About Kelsey. (n.d.). Key statistics. Retrieved from         https://whocaresaboutkelsey.com/docs/educational-materials/key-statistics.pdf?sfvrsn=2

The Time Has Come for Medicare For All

     People must wake up and stop being conned by the insurance and pharmaceutical industry and the people and congressmen or women they have bought to serve their interests. We must also realize that the insurance industry and the pharmaceutical industry are profit driven mechanisms that are not there to help you the average citizen. They do not care about you and your family and they never did. Any commercial for an insurance company whether it be Auto, life, health, or whatever kind of insurance that talks about being a family oriented company or anything of this nature is selling you a bunch of bullshit and they are trying to get you to buy into it and the famous spokesperson they might be using to do this more than likely has stock options or some vested interest above a paycheck in promoting their product. The pharmaceutical industry is just as crooked and as greedy as the insurance industry. They make medicines that can both make you sicker or treat your illness and get those medicines approved with the same speed because they control who tests those medications. Everyday you hear advertisements about lawsuits against a medicine or medical device and the reason why is because the pharmaceutical industry got the laboratories they own or that are in their pocket to say products they need approval for are safe and effective, so they can get it approved by the FDA and start making huge profits on it. Once a pharmaceutical product has been on the market six months or a year, the profits on it is so staggering that they can easily sustain a lawsuit against them for injuries or damages sustained by people who used the product, so all of it including spending millions on lobbyist to protect their interests is simply part of the cost of doing business in America for them. Just in 2018 alone the pharmaceutical industry spent 27.5 million dollars on lobbying to protect their interests. However, their increasing profits do not end there because even on older medicines that have been around that are used to treat certain diseases, like diabetes, asthma, and so on, they keep going up on the price because they know a certain number of people must have them to live and they also know the number people with diseases that require what they call maintenance drugs are growing, so to use the terms a business would use they are capitalizing on the emerging market and that is why something, like common insulin, that had been twenty dollars a prescription years ago when my grandmother took it is now four or five hundred dollars a prescription now. The reason for the increase is pure greed and nothing more. You need it they got it, so now you or your insurance company is going to have to pay for it and your insurance can get off the hook for some of the cost, by putting the burden back on you the average citizen in the form of a copayments, deductibles, and premiums.

     Whether you believe health care should be an individual right or not is irrelevant in the grand scheme of things. Whether Obama Care works for you or not is not relevant either because unless there is a move toward something like Medicare for all problems with our health care system will continue and the greed within it will run unabated.  The truth is Medicare for all can be done and should be done. The infrastructure is already there and we all pay a good amount into it from our paychecks for those on social security or social security disability, so why not pay a little more in taxes to get the rest of us covered by a plan that already exists and works. You will not find and elderly person in America anywhere willing to give up their Medicare card because they know it covers 80% of their medical costs right off the top and if I can pay for someone else to enjoy these benefits what is wrong with me paying a little more in taxes for myself and family. Right now, health care costs the average family of four about 28000.00 year. If you divide that by four, you come to 7000. dollars per year give or take as the number that each person pays in health costs per year, so even if they were to increase the Medicare deduction from your paycheck by another 40.00 per week to accomplish Medicare for all the cost to you the average citizen would only be an additional 2080.00 dollars per year which translates into savings to you of about 5000.00 dollars per year. Medicare for all would also control costs because they would no longer be able to gouge people and their insurance companies for services and prescription drugs like they are doing right now. The Koch brothers, the guys that support Republicans and their bullshit lie machines, had people do a study on this thinking that they could prove that Medicare for all would cost more, but what their study proved was that Medicare for all would save Americans two trillion dollars over a ten-year period. When they do not have the money argument against something that would be good for the average citizen, they then try to get you to believe that our quality of care would be diminished and other absolute bullshit along this plane. Grandma and Grandpa uses Medicare has the quality of their care diminished? Do they have to wait in long lines to receive care?  The answer is no, and neither would any of us. The want to scare you away from things like Medicare for all, with words like socialized medicine, because the insurance industry will not get away with screwing people on insurance premiums, deductibles, copayments and other things they do to increase their profit margin. The pharmaceutical industry will not be able to bilk obnoxious profits out of drugs people desperately need because if we are all paying into the same program and receiving the same benefits from it the government will have to constrain them.  

     The truth is if we want a congress that will work to do something like Medicare for all or any change that will make a significant difference to the average citizen, the first thing we must do is to elect people whether Democrat or Republican that are not in the pockets of the insurance or pharmaceutical industry. We do not have that now and that is why the political will to get things done, especially big things, and achieve real results for average citizens does not exist. What we have is a lot of congressmen and women on both sides of the aisle that are getting fat protecting the interests of big business and taking their money hand over fist and standing there telling us it cannot be done or conning us into believing that something that is in all our best interest is not in our best interest. Comedian George Carlin once stated in a show, “This is one big club and you ain’t in it.” Which is true the average citizen is not in the club, never has been, and never will be. However, we can vote intelligently and remove some of the greediest club members. All we must do is follow the money and not cast a vote for anyone running for congress that is taking money directly or indirectly from the insurance or pharmaceutical industry because they are nothing but paid for puppets for those industries and will do their bidding even when it is in total opposition to the greater good of the majority of the people in this country. The real reason nothing gets done in Washington for the average citizen in this country has nothing to do with the words Democrat or Republican because both political parties are dysfunctional in some sense, but because we the average citizen working more than one job to keep their heads above water, not unlike the homeless, do not have a lobby in Washington, so unlike the insurance and pharmaceutical industry or other corporations we do not have a big fat check to hand someone running for Congress to do our bidding.      

Child Protective Service Facts and Myths

    There are videos, written work, and other stuff all over the internet bashing and making child protective investigators and the service in general look monstrous, but as with many things you see, hear, or read a blending of myth sprinkled with a few truths always gets the attention of people and makes a better story or video presentation. Sometimes these things are even reinforced by people who once worked for child protective services that have a bone to pick, but as someone who did the job for a short time I can tell you that child protective investigators in general have the best of intentions and work hard to keep children safe and if there is problem it is not with the people doing the job as much as it is the system in which they are working.  Child Protective Investigators do have certain protocols they must follow and absolute time frames in which they must accomplish specific things and there is little allowance for deviation in either of them without causing problems somewhere. Nevertheless, stories on internet complaining about or speaking about the horrible mistakes made by Child Protective Services tend to focus or bash Child Protection Investigators themselves as if they were uneducated independent contractors making decisions about scooping up someone’s children and ripping them from their home on their own without consent or approval from anyone above them which is simply not true. The Department of Children and Families is a record keeping machine and every visit to a location, every conversation, every picture, every phone call, and every action a child protective investigator makes is noted and documented in detail with a date and time in their system and every supervisor knows exactly what cases their investigators are working on and where they are in a particular case, so there is nothing done by any individual child protective investigator under some cloak of darkness without someone else knowing about it and if there was they would certainly not be in their position long. My point here is if there is a villain in this anywhere it is not the child protective investigator that speaks to your children unannounced or that comes knocking on your door out of the blue. They are there to investigate allegations related to a child victim or victims that have been made and to determine if there is any basis for those allegations. No children are taken from a home unless all the criteria for what they call present danger is met and that does not happen as often as many like to think and yes mistakes are made, but the determination to remove a child from a home is not done in a vacuum by the investigator alone, nor is it a decision that is based on the feelings of anyone. The reality is Child Protective Investigators do not want to take your child or children because when they do have to shelter a child or children it is the start of a very long day for them and it involves completing a mountain  of paperwork the size of a cheap novel that has to be done that very day because if a child is removed from a home what is known as a shelter hearing must occur by law in front of a judge within twenty-four hours to establish if the investigator had cause to remove the child or children in the first place.

     The myths about the job Child Protective Investigators do are seemingly limitless, but some of the worse myths and vile misconceptions are those directed at the investigators themselves. One huge myth is the Child Protective Investigators are uneducated and not trained well. I cannot speak of other states, but here in Florida that is pure nonsense. All Child Protective Investigators here have at least a bachelor’s degree in something and all go to training for a month before getting their first case and then they tutored by a senior investigator through their first case and beyond. New CPI’s do not get anywhere near a normal case load for months after they start because it is not a position you can learn fast or on your own. It takes a lot of time to learn and to begin to feel comfortable with what you are doing. They also have special training for certain aspects of their work all along as well. Another myth is that Child Protective Investigators do not care. This is again complete nonsense. As one Senior CPI once said to me, “If this job doesn’t leave you crying in your car at least once, you are not doing it right.”  The job is stressful, but a lot of that is due to nature of the work and what you are dealing with. If you have a child, a grandchild of your own, or have been a child victim, just simply reading some of the allegations, let alone having to interview a child molester or a victim of it, is quite often unsettling and disturbing enough to rattle your soul.  

    People also have the wrong information when it comes to aspects of investigations and often wonder or get angry over certain things Child Protective Investigators do for no reason. For example, many parents get irritated when they find out that a CPI has talked with their children first at their school or something without asking them or informing them they are doing so. The truth is the CPI is perfectly within their rights to talk to children without asking or informing parents first and are within protocol in even asking parents to leave the room when parents are present with them to talk the children individually. If you are under investigation, they are investigators and their victims are children, so it makes logical sense if you think about it to wish to talk to the victim or the potential victim first. The police or local sheriff’s deputy would too be talking to the victim or potential victim of a situation or crime first as well. Another question people often wonder is when a child is talked to at a school or another location by a CPI, doesn’t a witness have to be present? The answer is no, but at schools someone from the school system will often want to sit in on the interview and the CPI will do nothing to stop it because any witness to one of their interviews can be easily be subpoenaed to appear in court as witness if necessary, so this is why some schools prefer not to have their people in the room while a CPI is interviewing a child. One thing you will hear differing points of view on is whether you must let a CPI into your home. Well there is kind of grey area around this issue that often gives rise to constitutional arguments and from a technical aspect a CPI cannot just walk into your home without consent. However, someone with allegations against them refusing to allow a CPI entry into their home is most likely not helping themselves and as soon as the CPI leaves they will be contacting their supervisor and will be returning to your home shortly with the police, so if one were to do this I would advise them to call a lawyer immediately because in all likelihood they just made a bad situation worse by raising suspicions. It does no good to ask the CPI who made that allegation against you either because they are not supposed to reveal that to you and doing so could cost them their job. However, they can and will tell you what allegations were made against you, but even if you can guess who made the allegation(s) against you the CPI cannot really acknowledge that you are right. The truth is sometimes CPI’s do not even know who made the allegation because some are made anonymously. However, there are people in certain positions, like police, nurses, and so on that must automatically notify DCF if children are involved or in the picture.  

     What to do if you are being investigated by child protective services? First, getting angry, yelling, or spouting off about your constitutional rights and not letting them come in your home to do their job is not going to be good thing because even if they are forced to leave they will be back with law enforcement and they will eventually get in your home and get you to cooperate with them, so starting off being adversarial would not be helping your situation at all. As a matter of fact, actions like that will only increase their suspicions that a child in your home may be in real danger. Second, answer all their questions as thoroughly and as truthfully as you possibly can because every question they ask has a purpose even those that sound silly. Some questions a CPI might throw out can be something they already have the answer to just to see if you are going to lie or conceal things. For example, they might ask you if you have a criminal record or if you ever had a DCF case against you before. These are test questions that they already know the answer to because before they even come out to your home they have done a criminal background check on everyone in your household age twelve and older and ran a check to see if you or any family member had a DCF complaint or case on them in the past. They do this prior to going to your home, not for the sole purpose of tricking you, but to ascertain whether they need to bring law enforcement with them.  The CPI will also ask you to take a drug test too and even though you can refuse to take a drug test at the time it may not be a good idea to do that if you have no drugs in your system or only those for which you have prescriptions for. The CPI will ask to see the rooms your children sleep in as well and take pictures of their rooms and other things like a food pantry as well. They will also take pictures of the children. This may seem invasive to you, but it is part of their job and they are following investigation protocol in doing these things. You must keep in mind that a Child Protective Investigator is there to do an investigation based on allegations of something to do with a child and that they are there to determine whether there is what they term present danger or if there is impending danger and both have very specific criteria. No, they are not police, but their investigations are just as important, and they gather evidence as if they might have to go to court whether your case ever reaches a courtroom or not. If you find yourself under investigation by Child Protective Services and a CPI arriving at your door unannounced is a pretty good indication of that, my advice would be to get a pen and paper in your hand to make notes of everything they do or say with the date and time on it. If you have your phone or a tape recorder, record everything that is said between you and the investigator and you should do either of these things each time you speak to someone from Child Protective Services. One of the reasons they have a big advantage in court, should your situation come to that, is because you have nothing to rebuke what they have documented, and I promise you they have documented everything in detail. If your children are taken or you think that they might be or that the investigation against you might arrive in court at some point, contact a family lawyer. Unfortunately, people without the ability to afford representation or the ability to obtain representation are quickly at a disadvantage because you are just another case in a long line of many to any lawyer that may be appointed to you. In either event, the notes or recordings you took during each engagement you have had with Child Protective Services could be of great help to you because this way all the evidence and documentation is not coming from just one side of the aisle.

    Child Protective Services are not the monsters or demons’ people on the internet try to make them out to be. Yes, mistakes are made, occasionally serious ones, but keep in mind that children are of tantamount concern to Child Protective Services and that when you hear in the news that a child died in someone’s custody chances are good that a family court judge somewhere rendered a decision that put the child in harms way, not Child Protective Services, and that is exactly why CPI’s must carefully investigate every case and document everything in detail. The goal of Child Protective Services is to make sure our children are safe and to accomplish this goal by being thorough and by being the least intrusive as possible on families. Unfortunately, there are those times when those stars do not align well and mistakes are made that are hard to impossible to reverse, However, keep in mind that it is not the sole fault of the Child Protective Investigator that knocked on your door in the beginning because if a big mistake has been made realize that your case has been through a lot of other hands long before it got to that point.            

Hey Mama, I Think The Gringos Are Hungry

Hey Mama, I Think The Gringos Are Hungry

“Hola Mama, Creo que los gringos tienen hambre”

By Kim Morrison

 

When I was a teenager many years ago, my family decided that we would get out of the cold weather of upstate New York and travel to Florida in the winter and comeback in the spring. My father sold everything and bought a travel trailer. At that time, we had started to do flea markets along the way to finance our trips back and forth and it seemed to be working, but the thirty-one-foot Rolls International travel trailer proved costly to move down the road and not very convenient for the purpose of setting up and selling at flea markets, so my father sold the travel trailer. We liked traveling down to Florida in the winter, but we wanted to see more of the country and since one of my uncles and his family moved to Arizona we thought we would get something that might possibly make a trip or two across the country. Unfortunately, my family never had much money, so my father, a man of many ideas, who liked to drive and could drive anything got the idea of getting a bus and converting into a camper. The first bus of two my father and I converted into a camper was an old 1960’s model blue Ford school bus. It ran like a champ after our mechanic did some repairs and modifications on it, and it wound up working out well for us because we made several trips down to Florida, out to Arizona, and that old bus even got us out to San Diego, California once.

I reflect on those times now and can say that they were exciting and fun in many ways and quite honestly a learning experience like no other that very few will ever know or understand. However, the trips were not always easy, sometimes we did not make much money at the flea markets we stopped at, so we had to augment our plans a bit and make stops at flea markets we had never been to before. On one trip to Arizona, we left Pensacola, Florida without much money because the flea markets there were awful money wise. However, we had a lot of stuff to sell and quite a few cypress clocks that we were not sure would sell in other parts of the country, but we figured we could at least get to Texas with what we had and hopefully make some money there to continue our journey to Tucson, Arizona. Unfortunately, we had issues with the bus along the way that cost us a little of the money we made, and the weather was not working in our favor, but despite it all we did manage to make it to San Antonio, Texas. When we got there, we had just enough to pay the flea market space rent, so for all intents and purposes we were flat broke, had very little to eat the night before, and had to make money at this little rundown indoor market to not only continue our trip, but to be able to eat the next day. It would be a gross understatement to say that we were nervous about what the next day would bring. We were in a strange place, at a flea market we had never worked before knowing that we never did as well when we setup at indoor markets, a little hungry and knew we would be even more hungry the next day if we did not make any money, but we did have a package of Top Tobacco which always came with rolling papers that we rolled into cigarettes. I am not sure whether rolling them or smoking them eased our tension more, but in either event it seemed to help.

The next morning, we carried our stuff into the flea market and began setting up our tables with the hope of having a good sale day.  Everybody in the place seem to be able speak Spanish, but us which was not unusual when you consider where we were. The people setup next to us with mostly used items were a very friendly Mexican family that could speak no English at all. We did not know whether they were legal or illegal immigrants and quite frankly it did not matter to us because we were all there for the same reason and that was to make some money. Our Mexican neighbors were cooking something on an electric hot plate that smelled so good that it was making me hungrier than I already was, but the best we could relay to them through gesture is that what they were cooking smelled good. After we got all our stuff setup and already begun our day, one of the children of our Mexican neighbors again through gesture held out and offered us a few breakfast tacos they had made. We assumed they were breakfast tacos because it was still breakfast time. We gladly accepted because by that time we were hungry and still had not sold anything. We thanked them numerous times and wondered if they did not somehow know or could tell that we were hungry because we did hear the word gringos a few times. However, this kind gesture from folks that could not understand us any better than we could understand them came as shock. These simple tacos were made of refried beans with bits of fried egg and bacon wrapped in a soft tortilla shell, but still to this day they were the best damn tacos I have ever had because they were the result of a pure act of kindness from strangers who could not speak our language, but somehow knew that we were hungry.

We did not make much money that day, but we were not hungry anymore and in better spirits thanks to an overt act of kindness shown to us by strangers who spoke a different language from us. We did make enough to eat later and the next day the cypress clocks we brought from Florida that we thought might not sell anywhere else took off and we wound up selling most of them right there the next day and made enough money to continue our trip to Arizona where we wound up selling the rest of them. We never returned to San Antonio, Texas, but my family and I never forgot that a single act of kindness by strangers, a gesture that transcended both cultural and language barriers, an act of goodwill that clearly illustrates that good people do come in all colors, shapes, sizes, ethnicities, and faiths. Yes, mama the gringos were hungry that day and sometimes a simple breakfast taco is far, far more than just what is under the tortilla shell.

An Unspeakable Truth

First, this piece is not politically motivated or a referendum on anything currently going on.     Second, I want to state unequivocally that I do not claim or presume to be an expert on women’s trauma or sex abuse related issues. This is just one good man’s opinion on not all that women go through when they are sexually abused or assaulted, but on the truth that women, no matter how tough they are or how hard they try, never forget or even get by these horrific events in their life without issues no matter how much time passes. My opinion comes from being an active listener and the ability to garner trust with many people extremely quickly which is one of the reasons why I switched from mass communications in college to psychology. In the different positions I have held I have had countless conversations with women young and old and some on occasion have told me some very personal things or details of things that happened to them that they have never told anyone else. The fact that some of them told me about their rape, molestation, or sex abuse I still to this day find surprising because I can tell you these are things women do not like to share with anyone period and none have ever done so with me without either a tear entering their eyes or their voice cracking on, at least, the high points of the horrible event they were recanting to me. In my opinion, the idea that any woman who was a victim of any kind of sexual abuse wanting to speak about what happened to them in any kind of public forum, let alone testify about it a hearing, for profit or any kind of contrived purpose is utterly ludicrous. Sexual abuse and things of that nature that women at any age have endured are what I call unspeakable truths and if you are lucky enough to have heard one of these intensely personal stories from any woman of any age please realize that she only told you because she trusted you, for whatever reason, absolutely implicitly.

Over the years I have heard a few stories from women which include everything from violent rape to sexual abuse that were sometimes so gut wrenching or shocking to me that they left me stunned and without words which is a hard thing to imagine because I write, so I usually always have words. Despite that I write, I have never written a story based entirely on any sexual abuse or rape any woman has ever told me about and I never will because what was told to me was in confidence and I hold those kinds confidences more dear and near than a Catholic Priest holds a confession. I learned quickly from these women that their stories are known by a very select few people and in one case I am certain no one knew what happened to her when she was a young teen, not even her father or mother. Just imagine having some type of sexual abuse happen to you when you are a young woman or in your teenage years and never disclosing any portion of it to another living soul until many years later just simply because you felt no one would ever believe you, not even those closest to you. Imagine holding on to a terrible secret for years that may have eaten away at your self-esteem to a point that this one life incident has redefined your feelings of self-worth. Imagine trying to tell people what happened to you knowing full well that they will either not believe you or make you feel like you did something to cause what happened to you. Imagine asking yourself over and again “why me,” or “why did this happen to me” as if you were somehow selected to be raped or sexually abused. Imagine feeling so dirty, sullied, or fouled by an experience like this that no matter what you do you cannot physically or psychologically wash it away. Imagine constantly feeling like you have had something taken from you that you and only you had a right to give. Imagine taking anxiety medication for half your life to eliminate the memories, nightmares, or unrelenting moments of fear and emotions that just well up inside of you out of the blue because of single horrible event in your life that you had no control over. Imagine being haunted by a memory of some vile act done to you ten, twenty, or forty years ago and doing your best to live with it, live around it, to move on, to grow as a person personally and intellectually despite of it, but still, no matter how far you have come, never being able put the memory or memories of what happened to you to sleep permanently, an incident that almost certainly altered you or your life in some way whether you realize it or not. Now, imagine garnering the courage to publicly tell your story and after going through it all having some man say, “Well it was a longtime ago and after all boys will be boys.”  Yes, boys will be boys, but good boys know better and a truly good man or men should damn well know better.

Bipolar Disorder: Childhood’s Most Under-recognized Disorder

Abstract

Bipolar Disorder is one of the most under-recognized and misdiagnosed disorders in children and adolescents. One goal of this paper is to attempt explain why Bipolar Disorder is difficult to diagnose in children and how it is often misdiagnosed or missed in them completely. The second goal of this paper is to look at some of the promising research being done to make Bipolar Disorder easier to diagnose and separate from other childhood disorders that might occur with this disorder or share similar symptoms with it. In addition, we will look at a psychosocial treatment with pharmacotherapy that may help attain a remission of Bipolar Disorder in children.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Childhood’s Most Underrecognized Disorder

Why Bipolar Disorder in young children and adolescents is underrecognized and often misdiagnosed? The short answer here would simply be that the research on Bipolar Disorder in young children and teenagers is still being done and many questions have not yet been fully answered. One reason for this is because most of the research you will find on Bipolar Disorder in children and adolescents has been done only within the last twenty years, so in a sense research on Bipolar Disorder in children is still in its infancy. The slow start here may be because for a longtime psychiatrists, psychologists, and others in related fields were under the assumption that young children and teenagers could not either get Bipolar Disorder or that the worst or most obvious symptoms of this disorder would not appear until adulthood. Why intelligent people might have been in this mindset could stem from the fact that they know people can carry genes of medical disorders, like Huntington’s Disease, but never show symptoms of it until adulthood, so why could this not be true for some mental disorders too.

Why is bipolar disorder in children misdiagnosed or goes unrecognized?

Even with the great research that has already been done Bipolar Disorder in children and teenagers it is very difficult diagnose because children who have it will often have anxiety, depressive, and many other disorders cooccurring with it (American Psychiatric Association, 2013). Attention Deficit Hyperactivity Disorder is often misdiagnosed as Bipolar Disorder in children because symptoms overlap (American Psychiatric Association, 2013).  Rapid speech, racing thoughts, distractibility, and less need for sleep at night are symptoms seen in children with ADHD as well as children with Bipolar Disorder going through a manic period. Certain personality disorders are also shared by both these disorders (American Psychiatric Association, 2013). Unlike the adult version, Bipolar Disorder in children is more continuous. Children have

long-periods of rapid cycling and can shift from mania and depression several times a day. These shifts can be quite subtle in children. A child with Bipolar Disorder having a depressive episode may simply appear irritable and moody and a child having a manic episode may appear overly happy, silly, or goofy to the extreme (American Psychiatric Association, 2013).  Diagnosing a child with Bipolar Disorder would require you to talk to the child, interview family, teachers, and anyone else that deals with them on a regular basis, observe the child in different settings, look at medical records to see if a drug or condition is not causing the symptoms and even after doing all that and possibly more the child may not meet all the criteria for a Bipolar I or II diagnosis according to the DSM-V, but with enough symptoms a diagnosis of “Unspecified Bipolar and Related Disorder” might be possible (American Psychiatric Association, 2013).  In a sense, Bipolar Disorder in a young child or teenager is like a fiendish little gremlin that can look like other disorders, that has an evil kinship with Attention Deficit Hyperactive Disorder, that can present itself in different ways in different children, and one that can wreak as much havoc in a child’s mind as it can in an adult mind if not more, not to mention the stress it can put on families and relationships in general.

Statistics, general facts, and genetic connection

Sadly, there is nothing humorous about the facts we do know about Bipolar Disorder in general. Bipolar Disorder is a chronic debilitating condition that affects one percent of the world’s population and is the greatest cause for medical disability worldwide (American Psychiatric Association, 2013). People with Bipolar Disorder have high mortality rates with about one third attempting suicide once in their lifetime and one fourth completing their suicide (American Psychiatric Association, 2013). Bipolar Disorder also has a very strong genetic link because there is a ten-fold chance of it being passed on from one generation to the next, so the

closer the kinship to someone with it the more likely the disorder will be passed on. We also know that thirty percent of adults with the disorder show severe impairment in work role functioning. Cognitive tests done on both adults and children with Bipolar Disorder show that they do poorly on them (American Psychiatric Association, 2013). Unquestionably, the need for more study on Bipolar Disorder is clear and the fact that much less research has been done on childhood onset Bipolar Disorder than on adult onset strongly suggests an even greater need to learn more about this complex dreadful disorder in children.

Promising research in childhood Bipolar Disorder goes in many directions

The goal of many researchers investigating Bipolar Disorder in children is to increase their knowledge in general and to gain a better understanding of the cognitive changes in children, so they can find ways to more easily distinguish it from other symptomatically closely related childhood disorders, like ADHD because just like any other disorder or condition earlier diagnosis improves outcomes. Other research relating how stress plays a role in childhood Bipolar Disorder and of course other research utilizes what has been learned thus far to look at innovative treatments that go beyond pharmacotherapy.

Research toward earlier diagnosis

In one study they looked at individual subcomponents related to executive cognition to advance knowledge on this disorder and they found that adults and children do show similar deficits in cognition in executive functions (Bearden et al., 2007). The researchers admitted that more longitudinal studies need to be done, but the promise of the research in this area is that it may someday be able to develop a test to better distinguish Bipolar Disorder from other childhood disorders, like ADHD, which would allow childhood Bipolar Disorder to be diagnosed earlier (Bearden et al., 2007).  In another study seeking a greater understanding of the cognitive functions in childhood Bipolar Disorder with a focus on being able to design a specific treatment to improve impairment and academic performance they hypothesized that children with Bipolar Disorder I and II with full on mania or hypomania would have certain deficits, including those in learning (Dickstein et al., 2016). Their thought was that these cognitive differences might be used to develop some type of markers both biologically and behaviorally which might result in better and earlier diagnosis of Bipolar Disorder as well as some treatment approaches in children and adolescents with Bipolar Disorder (Dickstein et al., 2016). One example of a treatment or aid is computer assisted cognitive remediation (Dickstein et al., 2016).

Study centered on a treatment idea

A study centered on a treatment idea was done to acquire some preliminary information on the feasibility and possible efficacy of a manualized cognitive behavioral treatment for teens or adolescents with Bipolar Disorder (Feeny, Danielson, Schwartz, Youngstrom, & Findling, 2006). The study was successful to some extent in that they did find that it was feasible to use individually delivered cognitive -behavioral therapy with pharmacological treatment (Feeny, Danielson, Schwartz, Youngstrom, & Findling, 2006). The treatment showed promise because improvement in teens with Bipolar Disorder was clearly shown. In addition, teens in both manic and depressive periods shown improvement, so treatments in this direction have the potential to be quite effective (Feeny, Danielson, Schwartz, Youngstrom, & Findling, 2006). Researchers did suggest that more randomized studies on this are needed to be done, but they were successful enough to illustrate the potential of cognitive behavioral treatments for children with Bipolar Disorder (Feeny, Danielson, Schwartz, Youngstrom, & Findling, 2006).

 

 

Why Bipolar Disorder in children looks a lot like ADHD

Continuing the search for a marker to identify Bipolar Disorder in children earlier, a study that centered on impaired verbal declarative memory in children was done (Glahn et al., 2005). Since this is considered a marker for Bipolar Disorder in adults, researchers were trying to find out if children suffered from exactly the same type impairments here (Glahn et al., 2005). Their results did show that these impairments are common to both adults and children with this disorder and that comparable brain systems are compromised (Glahn et al., 2005). This study takes early steps in examining memory and learning processes more specifically in children with Bipolar Disorder I and appears to be in line with or according to the diagnosis in the DSM-5 (Glahn et al., 2005). Again, research in any direction like this could bring about earlier diagnosis of Bipolar Disorder in children and may help distinguish it more clearly from other disorders. One disorder that Bipolar Disorder shows a clear comorbidity with is ADHD, so with a focus on that researchers in another study tried to find out if a unique pattern of neuropsychological deficits is characterized in children with Bipolar Disorder (Henin et al., 2007). They did this by examining whether children with Bipolar Disorder and those with ADHD displayed neuropsychological deficits and whether those deficits were more severe in one disorder than the other (Henin et al., 2007). Their results showed that the neuropsychological performance in children with Bipolar Disorder is very similar to children with ADHD alone (Henin et al., 2007). This research clearly illustrates why Bipolar Disorder in children is difficult to diagnose early and easy to misdiagnose. The work done here directly relates to the evaluation and treatment of Bipolar Disorder in children (Henin et al.,2007). Unfortunately, you cannot treat a disorder until you can clearly distinguish it from another and this study showed some clear parallels between Bipolar Disorder in Children and in children with Attention Deficit/Hyperactive Disorder.

Education plan for children with Bipolar Disorder that takes their cognitive difficulties and deficits into account    

Another study that was simply an in-depth review of the current literature on the neurocognitive impairments in children, under eighteen, with Bipolar Disorder found that children with Bipolar Disorder show deficits in a wide range of cognitive areas (Horn, Roessner, & Holtmann, 2011). Their results revealed a consistent pattern in impairments in verbal memory and in working memory (Horn, Roessner, & Holtmann, 2011). The researchers thought here was that these deficits needed to be incorporated into an individual treatment program, so the underlying goal of this review was toward identifying neurocognitive tests for evaluating these impairments in juvenile Bipolar Disorder in clinical practice (Horn, Roessner, & Holtmann, 2011). In concert with other studies they did find that there were no differences found between the deficits or impairments found in adults and children with the disorder (Horn, Roessner, & Holtmann, 2011). However, the researchers felt these deficits in children with Bipolar Disorder did need to be incorporated into an individual and school’s educational plans because they thought children might benefit from a treatment approach that takes their cognitive difficulties or deficits into account with some focus on teaching them skills to deal with the mood and neuropsychological issues (Horn, Roessner, & Holtmann, 2011). In addition to trying to garner a better understanding of the cognitive impairments in children with Bipolar Disorder studies down these avenues gives us practical insights and applications at clinical levels (Horn, Roessner, & Holtmann, 2011).

Negative effects of life events on children with Bipolar Disorder

A study that took an entirely different approach by focusing on how life events might influence child and adolescent Bipolar Disorder did find that children with Bipolar Disorder experience significantly high rates of life stress compared to children with other mental disorders (Johnson & McMurrich, 2006). Teenagers with psychopathology are more than likely to report two types of stressors failure and being misunderstood (Johnson & McMurrich, 2006). Their findings did show that negative life events are tied or associated with the course of teen or adolescent bipolar disorder and that the effects of life events are entangled or wrapped up with emergent symptoms of the disorder and family difficulties (Johnson & McMurrich, 2006). A question other studies in this area will need to work on is how these life events might make symptoms of childhood bipolar disorder worse. This study indicates an even greater need for early diagnosis of Bipolar Disorder in children, so clinicians can get in front of any external issues that might make the symptoms their patients present with worse.

Do parents with Bipolar Disorder pass learning issues down to their healthy children?         

      This research study was an investigation into the intellectual functions and academic performance or achievement abilities in healthy children of parents with Bipolar Disorder to see if these children exhibited any nonverbal learning disabilities (NLD) (McDonough-Ryan et al., 2002). The results of this study did show that children with parents who have Bipolar Disorder do demonstrate cognitive abnormalities and academic weaknesses relative to those children with healthy parents. However, the actual pattern of deficits is not consistent with NLD (McDonough-Ryan et al., 2002). This study was done to see if there was any cognitive link to parents with Bipolar Disorder in healthy children (McDonough-Ryan et al., 2002). This look at healthy children of parents with Bipolar Disorder is a different approach toward finding a way to diagnose Bipolar Disorder in children earlier. If you look at those children who have not inherited the disorder from their parents, you might be able to figure out a marker in those children who might inherit the disorder or in those who might inherit the disorder in the future.

A look at executive functioning in children with Bipolar Disorder through parental reports.

     The study looks at executive functioning in teens or adolescents with Bipolar Disorder who are in a manic or mixed mood state by garnering or collecting data from their caregivers (Shear, DelBello, Rosenberg, & Strakowski, 2002). From the information they gathered they studied their performance on those tasks related to or mediated by executive functions by utilizing a behavior rating inventory of executive function (Shear, DelBello, Rosenberg, & Strakowski, 2002). When compared to the results of healthy teens, they showed significant elevation through all measured functional domains, even among those children who had Bipolar Disorder, but not ADHD (Shear, DelBello, Rosenberg, & Strakowski, 2002). The thought behind this study was to study well-defined adolescent cases with Bipolar Disorder to perform everyday activities that are believed to be related to or dependent on executive functions (Shear, DelBello, Rosenberg, & Strakowski, 2002). These results taken together suggest that the functional deficits measured by the brief behavior rating inventory of executive functions in the sample of teens with Bipolar Disorder might potentially affect not only their current psychosocial functions, but long-term outcomes (Shear, DelBello, Rosenberg, & Strakowski, 2002). Researchers in this study, like many, were hunting for a way to diagnose Bipolar Disorder in children earlier and a way to distinguish it more clearly from other disorders. The difference is researchers in this study focused on the manic and mixed moods of this disorder alone.

A comparison of the dysfunction between type 1 Bipolar Disorder and II in children

     The goal of this study was to determine phenotypic cognitive profiles of patients with Bipolar Disorder. In other words, a composite of characteristics in patients with Bipolar Disorder (Schenkel, West, Jacobs, Sweeney, & Pavuluri, 2012). To do this they studied both type I and II Bipolar Disorder and compared them both with healthy people (Schenkel, West, Jacobs, Sweeney, & Pavuluri, 2012). They found that patients with type I Bipolar Disorder performed more poorly compared to healthy people on all domains they looked at, but they also found the type I Bipolar Disorder patients to be far worse off than those with type II Bipolar Disorder (Schenkel, West, Jacobs, Sweeney, & Pavuluri, 2012). Findings like these could move us closer to creating or developing effective cognitive interventions tailored to the distinct types or sub types of Bipolar Disorder in children (Schenkel, West, Jacobs, Sweeney, & Pavuluri, 2012). The researchers proved their hypothesis in finding that children with type I Bipolar Disorder showed more severe and wide spread cognitive dysfunction and the results indicated that the most notable deficits in all groups were in verbal learning and memory (Schenkel, West, Jacobs, Sweeney, & Pavuluri, 2012). Researchers here felt that any treatment should target these areas (Schenkel, West, Jacobs, Sweeney, & Pavuluri, 2012). This kind of research is an attempt to try to define Bipolar Disorder by looking at the characteristics of it and trying to create a profile from the information.

A child and family based or focused Cognitive Behavior Therapy

     This study was a report of a group adaption of child and family based or focused Cognitive Behavior Therapy (CFFT-CBT), nicknamed Rainbow (West et al., 2009). The object of the study was to find out if this therapy was feasible and acceptable to families and if the treatment resulted in any significant improvement (West et al., 2009). The treatment resulted in significant improvement in manic symptoms, but not in depressive symptoms and in the psychosocial function post treatments (West et al., 2009). One great outcome, but not necessary for the success of the study was that parents reported being able to cope with their child’s illness much better (West et al., 2009). This is important because any kind of mental illness puts an unusual amount of stress on families. This group psychosocial treatment with pharmacotherapy might help bring about or attain remission of symptoms (West et al., 2009). This is just the beginning, but this is a crucial area for research because the need for psychosocial treatments for bipolar disorder to be used in conjunction with pharmacotherapy may help to combat the chronic and devastating course of this disorder (West et al., 2009). Any integrated treatment that has the potential to not only improve the quality of the lives of patients but reduce the public health burden must be considered (West et al., 2009). Discovery of more treatments for this disorder are critical, so more studies in this direction are just as important as those that search for a way to diagnose it earlier or distinguish it better from other disorders.

Conclusion

     The research on pediatric Bipolar Disorder discussed in this paper of what has been done and is being done to understand, diagnose earlier, and to treat this devastating disorder in children represents just a few grains of sand in a beach of information yet to be discovered and learned from research on childhood Bipolar Disorder. The research on Bipolar Disorder in children thus far is inspiring and dynamic in nature for it goes in many directions and that must never stop because the need to unmask this gremlin of a disorder in children and make it easier to identify and distinguish from the other childhood disorders it hides among or shares clear comorbidity with like ADHD is critical to recognizing it sooner and avoiding misdiagnosis. If this can be achieved, Bipolar Disorder in children could be treated sooner and sooner is always better than later as far as outcomes are concerned.

To illustrate the issue of not being able to identify Bipolar Disorder in children easer or more clearly consider how devastating it might be for a mother to have been told by one psychologist or psychiatrist that her child has ADHD only to find out from another a few years later that her child has Bipolar Disorder or vice a versa. If you were the mother or even a father in this scenario, would you not be wondering how a psychiatrist or psychologist could make such a huge error in diagnosis. Unfortunately, what they would not know and would not ever understand no matter how clearly it was explained is how a mistake like this could be made. The sad truth is according to just the information discussed here this mistake could be made very easily by a psychiatrist or psychologist. One might argue that it was a rush to judgement or to a diagnosis, but that may or may not be the case. A psychiatrist or psychologist could have interviewed parents, teachers, and others that deal with the child on a regular basis, obtained medical records on the child, looked at school records, observed the child at multiple times in multiple locations, interviewed the child, considered some potential environmental factors and from all accounts did the homework necessary to make a diagnosis and still make a mistake. Yes, everything does have to fit the criteria in the DSM-V to make a diagnosis of Bipolar Disorder but finding that the symptoms in the child you studied also somewhat matches ADHD with another disorder can still leave you without a clear diagnosis of either or leave with just enough symptoms to contemplate a diagnosis of Unspecified Bipolar and Related Disorder. People always like to use the phrase “the devils in the details,” but when it comes to diagnosing Bipolar Disorder in children the devil is in a huge complex forest of details that can make it look like other disorders, be hidden among other disorders, function in concert with other disorders, and that has a close kinship, as far as symptoms are concerned, with ADHD which is a disorder that is diagnosed in children with such great regularity that it would make even the wisest psychologist or psychiatrist pause to consider it. Hopefully someday research on Bipolar Disorder in children will clear this forest a little for psychiatrists and psychologists, but until then Bipolar Disorder in children will remain either under-recognized or occasionally misdiagnosed in children.

 

References

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Bearden, C. E., Glahn, D. C., Caetano, S., Olvera, R. L., Fonseca, M., Najt, P., & … Soares, J. C. (2007). Evidence for disruption in prefrontal cortical functions in juvenile bipolar disorder. Bipolar Disorders, 9(Suppl1), 145-159. doi:10.1111/j.1399-5618.2007.00453.x

 

Johnson, S. L., & McMurrich, S. (2006). Life events and juvenile bipolar disorder: Conceptual issues and early findings. Development And Psychopathology, 18(4), 1169-1179. doi:10.1017/S0954579406060561

 

Schenkel, L. S., West, A. E., Jacobs, R., Sweeney, J. A., & Pavuluri, M. N. (2012). Cognitive dysfunction is worse among pediatric patients with bipolar disorder type I than type II. Journal Of Child Psychology And Psychiatry, 53(7), 775-781. doi:10.1111/j.1469-7610.2011.02519.x

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West, A. E., Jacobs, R. H., Westerholm, R., Lee, A., Carbray, J., Heidenreich, J., & Pavuluri, M. N. (2009). Child and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: Pilot study of group treatment format. Journal Of The Canadian Academy Of Child And Adolescent Psychiatry / Journal De L’académie Canadienne De Psychiatrie De L’enfant Et De L’adolescent, 18(3), 239-246.

 

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