Category: articles

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.”                 

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.      

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

Glahn, D. C., Bearden, C. E., Caetano, S., Fonseca, M., Najt, P., Hunter, K., & … Soares, J. C. (2005). Declarative memory impairment in pediatric bipolar disorder. Bipolar Disorders, 7(6), 546-554. doi:10.1111/j.1399-5618.2005.00267.x

 

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

McDonough-Ryan, P., DelBello, M., Shear, P. K., Ris, M. D., Soutullo, C., & Strakowski, S. M. (2002). Academic and cognitive abilities in children of parents with bipolar disorder: A test of the nonverbal learning disability model. Journal Of Clinical And Experimental Neuropsychology, 24(3), 280-285. doi:10.1076/jcen.24.3.280.980

 

Dickstein, D. P., Axelson, D., Weissman, A. B., Yen, S., Hunt, J. I., Goldstein, B. I., & … Keller, M. B. (2016). Cognitive flexibility and performance in children and adolescents with threshold and sub-threshold bipolar disorder. European Child & Adolescent Psychiatry, 25(6), 625-638. doi:10.1007/s00787-015-0769-2

 

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.

 

Horn, K., Roessner, V., & Holtmann, M. (2011). Neurocognitive performance in children and adolescents with bipolar disorder: A review. European Child & Adolescent Psychiatry, 20(9), 433-450. doi:10.1007/s00787-011-0209-x

 

Feeny, N. C., Danielson, C. K., Schwartz, L., Youngstrom, E. A., & Findling, R. L. (2006). Cognitive-behavioral therapy for bipolar disorders in adolescents: A pilot study. Bipolar Disorders, 8(5 pt 1), 508-515. doi:10.1111/j.1399-5618.2006.00358.x

 

Shear, P. K., DelBello, M. P., Rosenberg, H. L., & Strakowski, S. M. (2002). Parental reports of executive dysfunction in adolescents with bipolar disorder. Child Neuropsychology, 8(4), 285-295. doi:10.1076/chin.8.4.285.13511

Henin, A., Mick, E., Biederman, J., Fried, R., Wozniak, J., Faraone, S. V., & … Doyle, A. E. (2007). Can bipolar disorder-specific neuropsychological impairments in children be identified?. Journal Of Consulting And Clinical Psychology, 75(2), 210-220. doi:10.1037/0022-006X.75.2.210

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).  Arlington, VA: American Psychiatric Publishing.

 

 

 

 

 

A Prescription for the Death of Generations

A Prescription for The Death of Generations

By Kim E. Morrison

Saint Leo University

PSY-499

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Despite our wars on drugs and the numerous slogans we have used to try and keep people, especially our youth, off illegal drugs, drugs have always been a pervasive part of the American culture. As a matter of fact, one could argue that illegal drugs and those who used and sold them were a culture within culture because in the past not every nook and cranny of America were touched by them in the same way. Yes, you would here about the occasional drug overdose death or here about some dealer or group of people being busted for selling and distributing drugs, but many people in suburban and small-town America could say I am glad we do not have a drug problem here or say my kids would never get addicted to drugs here, so drug abuse and addiction was not something talked about around the dinner table of rural or suburban America. The average American dismissed drugs as being a problem of larger cities. Drugs were something that were sold on seedy street corners by emaciated drug dealers trying to support their own addiction, by gangs in ethnic neighborhoods trying to make a buck by first poisoning people within their own ethnic group and then reaching into other groups to increase their profit and power, by pimps trying to make more money on their prostitutes or as means to increase their production, or the pure for profit drug dealer who is always around to capitalize on the misery of others. A “Sugarman” as they were once called in song, that could be found in the shadows just waiting to take advantage of those desperately needing a fix to fend off the unrelenting agony of withdrawal, those trying to escape personal demons that haunt their every waking hour, and those who live lives of quiet desperation seeking a temporary freedom from the chains of their situation and dilution of the thoughts associated with it.

Unfortunately, the demon of drug abuse and addiction that we once believed would remain in the dark corners of American life has stepped out of the shadows into a new seemingly respectable form that is leaving no age, ethnic demographic, or socioeconomic group untouched by its consuming grip.  America is in the throngs of what many are now calling an opioid epidemic that shows no signs of abating. An epidemic not fueled by illegal drugs, but by legal prescriptions drugs and the dealers are not on dingy street corners, but in fine offices wearing white coats and stethoscopes armed with nothing, but prescription pads and the best of intentions for patients in pain. As a result, prescription drug abuse, addiction, and dependence has become a repugnant addition to the drug problem in America that not only could be eliminated, but must be before we witness the death of more generations.

In less than a decade studies trying to ascertain the extent and depth of this problem as well as find viable solutions to this problem have yielded some mindboggling heart wrenching statistics and clearly explains why everyone is calling this an epidemic. Just from late 1999 to 2011 opioid overdose deaths in the United States quadrupled (Cheatle, 2015). In 2012 drug overdoses was the leading cause of deaths, surpassing automobile accidents (Barry et al., 2015).  By 2016 nearly two people per day were dying of opioid overdoses (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017). In just one month in 2008 they found that 4.7 million adolescents and adults in this country were misusing prescription opioids which represents about 2% of the entire U.S. Population (Cleland, Rosenblum, Fong, & Maxwell, 2011). The number for those seeking treatment for addiction in the period from 1999-to 2008 skyrocketed. The increase for heroin addiction was 69%, but the increase in those seeking treatment for prescription opioids jumped up twenty-fold to 1, 896% (Cleland, Rosenblum, Fong, & Maxwell, 2011). The number of prescribed opioids from 1999-2012 increased to 400% which is enough to supply every adult in the United States with a one-month twenty-four-hour supply of narcotics (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017). In 2012 opioid pain relievers were directly involved in 470,000 hospital emergency department visits and the economic costs associated with opioids which included medical, productivity, and crime came to 50 billion dollars (Barry et al., 2015). One of the most heartbreaking of these statistics was that there has been a 400% increase in Neonatal Abstinence Syndrome just between 2000-2012. What this means in simple terms is that a baby is born addicted to drugs approximately every twenty to thirty minutes in the United States and some figures put it at every fifteen to twenty minutes (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017).

In 2006 the Prescription Opioid Addiction Treatment Study, POATS, was launched in response to the epidemic level trends of prescription opioid abuse and addiction in this country, and the burgeoning number of people seeking treatment to drug programs for addiction (Weiss et al., 2010). These continuing studies have proved informative on many aspects of the opioid problem. They found that people who can no longer acquire prescription drugs will try to obtain and use heroin in place of it. As a result, along with the prescription opioid epidemic, there has been an uptick in heroin use in this country as well (Weiss et al., 2010). POATS has studied treatments for opioid drug addiction and dependence and found that there may be different outcomes for pure heroin addicts versus those who are addicted to prescription opioids and the fact that many people have used more than one drug complicates everything, including studying the problem because it makes it harder to define study groups. As a result, the statistics and figures obtained on the opioid epidemic may be conservative, so this epidemic may be even worse than the data shows. Researchers considering these factors and others have suggested that treatment programs should be tailored toward the individual and their specific drug use pattern to be more effective (Weiss et al., 2010).  Another issue related to the opioid epidemic that researchers have discovered is that some portions of rural America, even when adjusting for density, have the highest rates of opioid poisoning and death. Kentucky, Oklahoma, West Virginia, and Alaska have been hit the hardest by the opioid epidemic with all having rates of poisoning and death from opioids not only greater than more populous areas, but far above the national average (Keyes, Cerdá, Brady, Havens, & Galea, 2014). The trouble is there is very little empirical data to explain why this is occurring in these areas. However, some researchers have suggested that these high rates are related to the extreme poverty levels in these states and the tight kinship between people there because statistics have shown that 70% of those who report non-medical use of prescription opioids state that they received them from friends and relatives (Keyes, Cerdá, Brady, Havens, & Galea, 2014).

Oklahoma, one the rural states hit the hardest by this epidemic, was among the first to begin initiating statewide policies to combat the epidemic at the pharmacy benefit or payer level. This was prompted by the fact that the costs associated with abuse and dependence diagnosis among Medicaid patients was much higher than for other patients. The policies which included quantity limits on certain drugs, pharmacy lock in programs on patients thought likely to misuse due to their medical utilization history, prior authorizations for specific drugs, step therapy program which basically requires that a physician use designated products for the first step before you go on to other steps, and other restrictions were perceived as prevention methods with the goal of reducing potential abuse and costs (Keast, Nesser, & Farmer, 2014).  In the short term the strategies created by Oklahoma Medicaid, MOK, seemed to achieve some results. The CDC, Centers for Disease Control and, the NIH-NIDA, The National Institutes of Health- National Institute on Drug Abuse are now funding research to determine not just the impact of these policies, but any policies like them and the consequences from them (Keast, Nesser, & Farmer, 2014). There are a few problems with dealing with this issue on the costs side of it alone. One, it doesn’t address the problem of those already addicted to prescription opioids and two, it seems logical that just doing these cost related measures alone is sure to cause an uptick in illegal drug use, particularly heroin, so the idea of the groups above studying these measures make sense on a lot of levels.

In 2009, to find some balance between the potential effects of prescription opioids without reducing legitimate access to opioids for pain relief the FDA proposed a Risk Evaluation and Mitigation Strategy, REMS, to look at the risks and benefits of opioid medications and describe requirements and procedures to reduce the misuse and abuse of these types of medications (LING, MOONEY, & HILLHOUSE, 2011). The idea here is to put some type of restriction or create or make some arrangements controlling prescribing practices in ways that might reduce or lessen opportunities to misuse opioids (LING, MOONEY, & HILLHOUSE, 2011). Patient education on these medications would be a part of REMS as well and that is necessary because research shows that 80% of the people fail to understand just how easy it is to become addicted to prescription opioid pain relievers (Barry et al., 2015). There are some great ideas here as well because 78% of the people surveyed on this issue say doctors are responsible for a solution to this problem (Barry et al., 2015). However, once again these solutions do not address the problem of those already addicted or the 70% of the people who report non-medical use of prescription opioids that state that they got them from friends and family (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017).

Every idea some states and the federal government have come up with so far to do something about the opioid epidemic in America deserves merit, but what has been done so far to address this problem is tantamount to a group of men urinating on a forest fire with the hope of keeping it from spreading.  What is needed to effectively solve this problem is a full-throated approach toward every angle of the opioid epidemic and to do this you would need to get everybody that is directly involved in, connected to, or touched by this massively growing social problem to generate ideas and workable solutions to the problem. This would include bringing people together from the medical community, the police, drug enforcement, emergency medical personnel, policy makers from the state and federal level, clinicians, doctors and pain management specialists, drug rehab and treatment center specialists and counselors, people from state Medicaid agencies, health insurance providers and other payors, pharmacists, drug manufacturers and distributors, psychiatrists, psychologists from every discipline, family members of addicts, and former drug addicts themselves because no one understands the problem of drug addiction better than those who have been intimate with this demon. To some great extent the Clinton Foundation and the Johns Hopkins Bloomberg School of Public Health have done exactly this very thing and have come up with recommendations that would greatly reduce this problem if not eliminate it entirely. First, mandate prescriber registration and optimize Prescription Drug Monitoring Programs, PDMP’S, in all states. These programs if optimized would be highly effective in reducing drug abuse and diversion. Their purpose is to monitor, collect, and analyze electronic data collected from and submitted by dispensing pharmacies and prescribing physicians. This data can also be used for research for public education, and abuse prevention (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative).  Second, the Centers for Disease Control has had guidelines on prescribing opioids to people with chronic pain for some time, so the next obvious step is to work with medical boards to pass policies that reflect these guidelines (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017). Third, expand drug take back programs and provide clear guidelines on safe disposal and storage of prescription opioids (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017). Forth, work with drug manufactures to look at innovative packaging and in creating prescription opioids that are more difficult to abuse (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017). The have already shown that they can reformulate oxycodone, so it can used without being abused. The savings in costs and in lives alone with be worth researching this more and doing it to other opioid medications (Kirson et al., 2014). Fifth, work to obtain funding to build more drug addiction treatment centers in those rural areas or any other areas where addictions rates are high (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017). Sixth, work with developers to reformulate Naloxone, Narcan, the drugs that can reverse opioid or opiate drug overdose, so they can be used by non-medical professionals to prevent drug overdose deaths and work to get them distributed to schools, clinics, all first responders, and any where else they might be needed (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017). Naxolone, Narcan, should be easy to utilize and as easily available as epi pens because it could prevent a death and give someone another chance at life. Seventh, work to create more public awareness on the opioid epidemic issue and work to avoid and end stigmatizing language with relation to drug users, treatment, and everything else associated with it (Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative, 2017).

Dear Mr. and Mrs. not my children, not in my neighborhood please be advised that the opioid epidemic in America is a lot closer than you think if it isn’t already at your door. The time for national complacency on this issue has long past. We can no longer afford to declare another meaningless war on this problem and try to incarcerate it away or simply just say no to the problem with our eyes closed wishing and hoping that drug abuse and addiction goes away. What we must do is call this opioid epidemic what it is and that is a national health crisis. A crisis that is shattering and destroying families and communities in every corner of our country, costing our country billions upon billions of dollars, and taking human lives at a staggering rate of one every twelve hours of every day. We can no longer afford to say not my clowns, not my circus because we are all in this clown car of hell and it is headed for a cliff. We can no longer just nibble at the edges of this massive social problem. There are no quick fixes for what we are facing, no single approach that will even begin to put a dent in it. What is needed are real solutions to solve this issue and we will not get them if all the voices, even those remotely connected to this issue, are not heard and our approach to it is not a multifaceted effort with every idea considered and utilized if good and every possible consequence of the actions taken thought through. The opioid epidemic has already cost us a couple of generations and it is poised to insure the death and destruction of more generations if concrete action is not taken now.

Our mission will not be considered complete if teenagers who were prescribed pain medications for injuries are getting addicted to them and when they cannot get them are searching for illegal alternatives before the sickness and agony of withdrawal begins to kick in.  Our job will not be done if mothers and fathers or grandfathers and grandmothers in chronic pain from injuries or illness are getting addicted to prescribed pain medications and requiring rehab to free them from addiction. We will not have done enough if young people of any age are able to buy prescription drugs like oxycontin from neighborhood drug dealers under street names like hillbilly heroin, kickers, and killers. Our task will not be over if people addicted to prescription opioids are replacing them with heroin or a lethal cocktail of opiates and benzodiazepines and dropping dead from overdoses in homes and streets across our country. We will not have done all we could if one person dies of an opioid overdose just because there was no access to Naloxone, Narcan, to reverse it. This will not be over if distraught parents with tearsoaked eyes and a hole in their heart are still picking out little pink and blue coffins for children who could not be helped before the relentless grip of drug addiction drained the light of life from their eyes. If one infant somewhere in our country lays in a neonatal intensive care unit (NICU) inconsolable, screaming an agonizing shrill, twitching, seizing or shaking like a tuning fork involuntarily as he or she awaits a nurse to administer a baby sized dose of methadone or morphine to fend off the painful agonizing sickening effects of narcotics withdrawal our job is not done, our mission will not be complete.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference

 

 

Ford, J. A., & Lacerenza, C. (2010). The Relationship Between Source of Diversion and Prescription Drug Misuse, Abuse, and Dependence. Substance Use & Misuse, 46(6), 819-827. doi:10.3109/10826084.2010.538461

 

Cheatle, M. D. (2015). Prescription Opioid Misuse, Abuse, Morbidity, and Mortality: Balancing Effective Pain Management and Safety. Pain Medicine, 16(suppl 1), S3-S8. doi:10.1111/pme.12904

 

Cleland, C. M., Rosenblum, A., Fong, C., & Maxwell, C. (2011). Age differences in heroin and prescription opioid abuse among enrolees into opioid treatment programs. Substance Abuse Treatment, Prevention, and Policy, 6(1), 11. doi:10.1186/1747-597x-6-11

 

LING, W., MOONEY, L., & HILLHOUSE, M. (2011). Prescription opioid abuse, pain and addiction: Clinical issues and implications. Drug and Alcohol Review, 30(3), 300-305. doi:10.1111/j.1465-3362.2010.00271.x

 

 

 

 

Weiss, R. D., Potter, J. S., Copersino, M. L., Prather, K., Jacobs, P., Provost, S., … Ling, W. (2010). Conducting Clinical Research with Prescription Opioid Dependence: Defining the Population. The American Journal on Addictions, 19(2), 141-146. doi:10.1111/j.1521-0391.2009.00017.x

 

Barry, C. L., Kennedy-Hendricks, A., Gollust, S. E., Niederdeppe, J., Bachhuber, M. A., Webster, D. W., & McGinty, E. E. (2015). Understanding Americans’ views on opioid pain reliever abuse. Addiction, 111(1), 85-93. doi:10.1111/add.13077

 

Keast, S. L., Nesser, N., & Farmer, K. (2014). Strategies aimed at controlling misuse and abuse of opioid prescription medications in a state Medicaid program: a policymaker’s perspective. The American Journal of Drug and Alcohol Abuse, 41(1), 1-6. doi:10.3109/00952990.2014.988339

 

Keyes, K. M., Cerdá, M., Brady, J. E., Havens, J. R., & Galea, S. (2014). Understanding the Rural–Urban Differences in Nonmedical Prescription Opioid Use and Abuse in the United States. American Journal of Public Health, 104(2), e52-e59. doi:10.2105/ajph.2013.301709

 

 

 

 

 

Kirson, N. Y., Shei, A., White, A. G., Birnbaum, H. G., Ben-Joseph, R., Rossiter, L. F., & Michna, E. (2014). Societal Economic Benefits Associated with an Extended-Release Opioid with Abuse-Deterrent Technology in the United States. Pain Medicine, 15(9), 1450-1454. doi:10.1111/pme.12489

 

 

Jeffery, D. D., May, L., Luckey, B., Balison, B. M., & Klette, K. L. (2014). Use and Abuse of Prescribed Opioids, Central Nervous System Depressants, and Stimulants Among U.S. Active Duty Military Personnel in FY 2010. Military Medicine, 179(10), 1141-1148. doi:10.7205/milmed-d-14-00002

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Secondary References

 

Johns Hopkins Bloomberg School of Public Health, and the Clinton Foundation, Clinton Health Matters Initiative. (2017). THE OPIOID EPIDEMIC from Evidence to Impact. Retrieved from https://www.jhsph.edu/events/2017/americas-opioid-epidemic/report/2017-JohnsHopkins-Opioid-digital.pdf

 

A special thanks to all those recovering from drug addiction that I transported to Operation Par Inc and other drug addiction treatment centers over the course of several years in my position as a Non-Emergency Medical Transport driver because without the many casual conversations I had with you over that time the parts of this paper where I did not point directly to a peer reviewed or secondary reference would not have been possible. I truly hope you are all living large and free from the chains of drug addiction.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A School Bus Drivers Worst Nightmare

From a statistical standpoint a school bus, with, or without seat belts, is the safest vehicle your child will ever ride into, and that includes your own car. However, statistics are meaningless to the parents of those children who have become victims, or casualties of school bus, or school bus stop related accidents. When these accidents occur, people always wonder why? How could this have happened? Could it have been prevented? The truth is every bus procedure, and rule regarding the safe transportation of your child could be followed letter perfectly, and still something at any place, or at any time could just simply go wrong.

However, there are things that other drivers, and parents can do to make the bus trip for all our children a little safer. First, do not follow a school bus to close because in case you haven’t noticed our big yellow vehicles make frequent stops. Please take notice of the lights across the top of the bus in front, and back. The amber lights means caution we are on approach to a bus stop. When the bus is stopped the red lights come on, and the stop arms extend out. Some drivers apparently think our amber lights means speed up to get around the school bus before the red lights come on because this extremely dangerous practice is witnessed all to frequently. Another extremely dangerous practice done by drivers is running through our stop arms completely. Another, less frequently observed driver error, is getting ahead of us to beat us to a turn the instant they see our directional signal come on. Do not ever do this period. School bus stops are usually placed a few hundred feet away from street corners. There may be children somewhere near the corner your getting ready to careen around, and you will most certainly hit them if they are in, or near the edge of the road. Drivers must keep two things in mind here. First, regardless of the number of rules there are, children don’t always do what they are told to do. Two, rural roads, paved, or unpaved, never have shoulders, so expect children to be very close to the road in these areas.

Parents you have a responsibility to help us keep your children safe as well. First, please tell your children to stay out of the road while waiting for the bus, and please tell your children not to ever run, or even walk toward the bus while it is still moving toward the bus stop. Anyone of these actions could be a stage setter for a most horrible tragedy. When a child runs toward our bus, it forces us to make a quicker less safe stop. Even if your child gets on and off the bus right in front of your door, please do not let them dash for the bus until it is completely stopped because we will still stop short out of reflex to prevent them from running into one our many blind spots. If your child must cross the street to board the bus, tell them look for traffic then look at their bus driver, and wait for his, or her nod before they proceed across the street because from our vantage point in the bus we can see things that you, or your child may not notice. Second, please tell your children never to run back to the bus after they exit. Most elementary bus drivers are on guard for “run backs” because this is something small children are more likely to do than high school students, but the consequences for either could be lethal. Keep in mind that once the students exit the bus, and are clear of the bus from all visible points. The bus driver is preparing the bus to continue to the next stop by putting the bus back in gear, releasing the parking brake, and shutting off the red bus stop lights. If a child runs back for something, and the driver doesn’t see them in time because of a distraction inside, or outside the bus, the child could be hit, and killed. Third, tell your children not to reach for their friends in the windows after they get off the bus. If they were to get their hands caught in the window even momentarily, they could fall, and wind up being crushed by the rear wheels before we could stop the bus. Fourth, tell your children not to stick their heads, hands, arms, or hair out the window while the bus is moving down the road. This action is commonly seen, but extremely dangerous, and potentially deadly. If your child had their head out the window of a school bus traveling at the common residential speed of thirty miles per hour, and was struck flush by a tree limb only one inch in diameter, the impact could literally crush your child’s head. It is not uncommon to see a School Bus breeze by things very close. Sometimes traffic, or road conditions forces us to make tighter turns, or come closer to things than we prefer. We do watch for children popping their heads out the window, but we can’t see everything all the time.

These are just a few of the many challenges school bus drivers face each, and every day. I don’t think parents, teachers, or administrators can quite grasp what it is really like driving down the road with forty to seventy children behind you with no one to watch them except yourself through a mirror that you can only scan in intervals in a vehicle that is large enough, and heavy enough to literally go through a house. After thinking about this, it kind of makes you wonder how we do it every school day, and make it look way easier than it really is. The answer rests in what it takes to make a good bus driver. In my opinion, a good school bus driver is one part training, one part ability, and two parts caring. You can be trained, you can acquire ability, but the minute you stop caring you need to consider a career change before you really screw up, and hurt somebody. I have been a school bus driver for Citrus County for several years now, and I like my job despite the negatives. I transport children to, and from Citrus Springs Middle School, and Citrus Springs Elementary School, and I care about each, and every child I transport even the little darlings I have to frequently write disciplinary referrals on. The mere thought of just witnessing one of the kids from my bus getting seriously injured on the bus, or at a bus stop literally scares me. Some might say that I care more than the parameters of my job requires. I could not disagree with that more. For it is this level of caring that instills the fear that keeps me on guard, and ever vigilant in my goal to make every trip as safe as I can for all the children that ride my bus.

Like most bus drivers, I do my job knowing full well that I am never more than a   heartbeat, or distraction away from catastrophe. Regardless of my training, my ability, or how much I care for the children that ride my bus, I still need the help of everyone to prevent my worst nightmare, and that is having too kneel down beside the broken body of a child who once affectionately, or respectively called me “Mr. Kim.”

Hey Stop Calling Him Retard Joe You Guys

School Bus drivers always have stories to tell and most of them come directly from the children who once our rode our buses. This one is no exception, but it is also a fine example of how kids themselves through laughter can overcome what we have all come to call bullying. Many years ago I had a student on my bus that was slow and he talked a bit funny because of it. The other students used to tease and pick on him constantly by calling him “retard Joe.”  I would yell at them often for picking on this kid, but as hard as I tried these little wise guys always found a way to get a “retard Joe” remark or two in during just about every trip. One special day, Joe finally had it up to the top with their crap and decided to take matters in his own hands. Out of the blue Joe stands up from the front seat and turns to all the students seated behind him and yells: “I not wetarded! I just stupid!”  Well the whole bus load of students just roared into a laughter, so loud that I am certain it was heard a half a block away. What made matters worse is I started laughing so hard myself that I had tears in my eyes and had to pull the bus over just to regain my composure.  At that point, I looked back at Joe and he was standing there behind his seat looking at me as if to be asking why is everybody laughing? I guess it suddenly hit him in that instant why what he had said made everybody laugh because he began to laugh even louder than the rest of us. I don’t know if the laughter erased all of Joe’s pain from being picked on, but I can tell you that not one of those students ever called him “retard Joe” again from that point on.  Some of the same students that once picked on Joe went out of their way to talk to him and the kid they once called “retard Joe” became Jojo to all of them.  The moral of this story is never underestimate anybody because even someone who is a few fries short of happy meal can have a moment of stunning brilliance and teach us all a life lesson.

Unfortunately, even well-meaning people will call people like Jojo “special” without realizing that what makes them unique is their ability to laugh at themselves, not the fact that they are slow.  It should be painful for all of us to watch someone, like Jojo, being picked on by others, but what we too often fail to recognize is that when we see this kind of thing happening we could in fact be witnessing the slow destruction of a genuinely good hearted person and in this day and age that is a Goddamned shame. Jojo has been out of school for years now, but old Mr. “K” still talks to him on Facebook once in a while and he writes exactly like he speaks.

From Pretty Pink Bows To Baby Bassinets

Well little girl you are in high water now and the sand is moving swiftly under your feet. You never expected to get pregnant at fifteen and now you are scared, confused, heartbroken, and you are lashing out at everybody because you do not know who to trust at this point in time. You do not know if even those closest to you are offering you wise words of advice, deliberate words of coercion, or self-serving suggestions. Unfortunately, not even the most well intentioned person can answer the intensely personal questions that are in front of you now, but that will not stop them from trying because even the most intelligent people in your life are often too arrogant in their own beliefs to realize that attempting to answer these kinds of questions for you is kind of like a cowboy trying to rope the wind. However, many will still try because they care about you in some way and many out of concern for you will think they have all your best interests at heart. Yes little girl there is a world of folks out there just chock full of good and bad intentions, yet few understand that the road to perdition can be paved just as well with either. You never intended to get pregnant, but you did just the same and now you are at a crossroad in your young life that even adult women have a hard time dealing with. However, despite your tender age, you are going to have to wipe the tears from your big beautiful blue eyes, find some big girl panties to put on, and sit down and render your first real adult decision on an issue that will alter the very course of your life and the lives of others, no matter what you decide.

Stop saying to yourself why me, why now because it is you and it is now. Stop thinking that you are too young to make this decision because you thought you were old enough to make the decision that put you in this situation to begin with and now you have to deal with the consequences of that choice. Stop wondering what to do and thinking that your prince charming is going to walk back into your life and make this decision easier for you because he is just as worried, scared and confused as you are right now, so chances are real good that there will be no glass slipper in your story Cinderella. You can wish and hope all you want for the fairytale solution to appear in one hand, but it is all but certain that the other hand is going to get full first and you are not going to like the aroma. Some would say that you are a little girl making an adult decision, but the reality is you tossed away the little girl card the moment a real baby with real needs appeared in your dollhouse. No sweetie you are a big girl now whether you like it or not or you are ready for it or not and the situation you are dealing with is as real and emotional as it gets. Do not be over whelmed by all the advice people have offered you, but consider it all when you make your decision and pay no attention to the religious nonsense some folks like to spew because it is designed more to make you feel guilty or to scare you than to help you. The people around you, like it or not, are going to have to support your decision because it is yours to make and yours alone. Nobody can hold your hand on this one because regardless of what others might think, right or wrong, you are the one that is going to have to live with the decision you make here. This is a solitary walk on the beach moment for you and during that walk you are going to have to explore not just what is rattling around in your head, but what is down deep in your little heart because the best decisions you will ever make in your life or for your life must always come from both. One of life’s most challenging tasks is constantly trying to find the harmony between one’s head and one’s heart. Blessed are those rare few times one can turn the chaos and discordance of life into a beautiful symphony.

Listen Up Kid

Never let anyone tell you that you can’t learn. Never allow people to make excuses for you. You can break the wall. You can make it through. Yes it may look impossible, but you can persevere. The biggest dreams are crafted from the smallest threads of hope. Keep trying, keep pushing along, and prove to the world that you can overcome. Don’t let people tell you that you can’t make it. Don’t allow them to group you. Don’t allow them to define you by their standard. Show them that you too deserve to be at the table. Learn to despise hope-sucking phrases like “working poor.” These devices are designed by over educated people to categorize people into groups, so they can find reason for or excuse for future failure. Calling you “working poor” now, means they expect you to fail later. Do not let them win. Try to prove them wrong at every turn. Learn everything you can. Read every book you can find. Show them that you are equal to any task. Take pride in yourself and your own individual accomplishments, no matter how small. Don’t expect a nod of approval or a pat on the back from anybody for anything you accomplish or achieve. The approval of others may be heartwarming, but these pleasantries are incidental, and nonessential to your ultimate success. Your success as a human being rests entirely on your own self-approval.

Now, I am not saying that you should walk around telling everybody you meet how great you are. Self-approval does not mean being a conceited self-absorbed jackass. Self-approval simply means that you internally value yourself enough to recognize that you deserve to be in the game in the first place. The first step toward self-approval is self-respect. People with no respect for their selves live self-destructive ineffective unfulfilled lives. Doing drugs or drinking until you are within inches of alcohol poisoning on a regular basis shows a stunning lack of self-respect, not to mention a gross lack of courage. People who respect themselves don’t need to hang with the so-called cool crowd because they already are cool even if they don’t realize it. It is cool to stand firm against the unrelenting wind of peer pressure. It is cool to stay the course despite all the lures that attract you to do otherwise. It is cool to be individual in your thinking, and actions. What isn’t cool is waking up out of a self-afflicted drug, or alcohol coma after ten, or twenty years only to discover that you have flushed a good portion of your life down the crapper. Self-respect is the antidote to self-destruction. People who don’t respect themselves are destructive to the people around them as well because in order to respect anything or anyone else one must first learn to respect one’s self.

The second step toward self-approval is except no excuses.  The only thing worse than someone else finding excuse for your behavior, and/or failure is your own pitiful attempts at doing the same thing. Win, lose, or draw, don’t make, or accept any excuses for yourself. One of the many ways people try to excuse themselves is by saying they had a tough childhood for one reason, or another. Waa! Waa! Welcome to the club of millions you big dumb baby. Cry a river, build a bridge, and then get over it. Self-reflection is a psychological “Marlboro” addictive, and dangerous to your mental health. Replaying stupid painful crap in your head that you were too young to stop or do anything about then will not help the person you see in the mirror now. Leave those ugly old dogs on the porch where they belong and get on down the road. Think future, not past, you are the Captain Kirk of your own Enterprise tell Scotty to beam you up from planet self pity before there is no intelligent life left in you.

The third step toward self-approval is you must never accept, or settle for less from, or for yourself if there is even the faintest chance that you may regret it later. Your life isn’t a garage sale item; you can’t start out asking a dollar then settle for fifty cents and then later have the gall to wonder why your life didn’t turn out the way you had wanted it to. Life may indeed be like a box of chocolates and you might not know what you’re going to get inside each morsel, but settling for the crappy discount chocolates in the ugly box when a super sized box of Whitman’s is well within reach is just plain stupid. Do not make Forrest Gump like decisions with your life; no one is really that lucky. Fear people who frequently use words like destiny or destined because they are psychotic nimrods with reverse Chicken Little disorder. Instead of waiting for the sky to fall on their heads these lunatics are waiting for something positive to simply fall into their laps. Don’t wait your life away, the only two things people are truly destined to do are pay taxes and die. Destiny is nothing but a dressed and sexed version of the word chance, but chance favors only the individual who is prepared to take one.

Every person is endowed with a gift that is unique to him or her. Life is the journey that each of us takes to figure out what that gift is and how to use it. Some people are successful at their tasks, and some are not, but we all take the ride just the same. The successful are those who took their chance, those who attempted the impossible, those who tried to rope the wind; those who, despite all the obstacles that life through at their feet, dared to dream their dream, not someone else’s. Most people falsely measure success by the fortune or fame one attains when what is truly important is whether or not you had the intestinal fortitude to step up, and take a shot at your dream in the first place. If you try, win, lose, or draw at least you will have the ride of your life to remember and that is far, far better then spending even a single moment of your life wondering “What If…?” Regardless of what others might tell you along your journey, the most important thing in life is not just the number of breaths you have in it, but the number of times it leaves you breathless.