Mar 7, 2013
ELW

Written Testimony on HF 357 – Youth Mental Health Intervention

 

February 13, 2013

Dear Chairman Mullery and Members of the Early Childhood and Youth Development Committee,

As I am unable to attend this hearing in person, I appreciate your willingness to accept this written testimony on the mental health interventions proposed for funding in HF 357.  I am writing as a mother of three, a pediatrician, and a policy analyst for the International Society for Ethical Psychiatry and Psychology and for Education Liberty Watch

While understanding and sharing the desire to help those who struggle with emotional issues, especially in light of the violent incidents involving those suspected to be mentally ill or under treatment for mental illness, for the sake of those this legislation is supposed to help, their families, and the taxpaying public, please beware of unintended consequences.  Because of the uncertainties of psychiatric diagnosis, especially in youth and because of difficulties with psychiatric medication, things could well become worse if the focus of these efforts is strongly on medication as listed as the first item in the proposed interventions funded in this bill on lines 1.16 and 1.17 dealing with antipsychotic medication management

Let me begin with the diagnostic aspect of mental health in general and psychosis in particular.  Here are two of many examples that I could give you of quotes from leaders in psychiatry:

Dr. Dilip Jeste, president of the American Psychiatric Association, in a December 2012 statement[1] on the completion of the new, about to be published edition of the bible of psychiatric diagnosis, the Diagnostic and Statistical Manual (DSM-5), said, “At present, most psychiatric disorders lack validated diagnostic biomarkers, and although considerable advances are being made in the arena of neurobiology, psychiatric diagnoses are still mostly based on clinician assessment.”

In plain English, that means that psychiatric diagnosis is an educated guess.  Dr. Allen Frances, chief editor of the current edition of the DSM put it much more bluntly in a 2010 interview[2]:“…there is no definition of a mental disorder.  It’s bull****.  I mean, you just can’t define it.”

In fact in a December 2012 op-ed published in the Star Tribune, he said:

There are profound economic consequences to where boundaries are set between what is normal and what is considered a mental disorder. Diagnosis of mental illness brings on a cascade of costs, including doctor visits, tests, medications (and treatment for their complications), forensic and prison costs, disability obligations, the siphoning of educational resources and absenteeism.

We are already experiencing an inflation in psychiatric diagnosis and an explosion in the use of expensive, and often unnecessary and harmful, psychotropic drugs.[3]

In his opinion, the new edition of the DSM will increase these already high costs enormously. In Minnesota, the Department of Human Services spends more on antipsychotic medication than any other pharmaceutical class.

Diagnosis is more complicated in children and adolescents.  The World Health Organization said in the 2001 World Health Report, “Childhood and adolescence being developmental phases, it is difficult to draw clear boundaries between phenomena that are part of normal development and others that are abnormal.”

With regard to psychosis in particular, the problems of accurate diagnosis are even more acute.  Committees of psychiatrists involved in creating the DSM-5 revisions had contemplated an entity called “psychosis risk syndrome” to try to identify adolescents and young adults who were at risk for developing the psychotic symptoms of delusions, hallucinations, and paranoia associated with schizophrenia and bipolar disorder.  Proponents of this approach believe that “clinicians have long noted the existence of early indicators which act as a warning that a first psychotic episode may be imminent” and that, “Since delayed treatment for a first psychotic episode can often worsen the outcome, there is a very real need to act on prodromal symptoms as soon as possible.”[4]

Thankfully, for the health and safety of American adolescents and young adults, the psychosis risk syndrome was abandoned for several very important reasons:

 

The same psychiatrists and psychologists that though it was important to treat these preliminary symptoms of psychosis as soon as possible acknowledged  literally in the next sentence of the same article, “Unfortunately, given that the presence of prodromal signs do not invariably result in psychosis, acting prematurely can often do more harm than good.”[5]

The DSM-V committee was ultimately never able to satisfactorily answer issues like “the ethics of false positives,” “ how soon biomedical interventions should begin,” and whether if “prodromal patients deoften attached to mental illness in most societies.”

The reputation of the DSM and psychiatry in general has been battered by the disastrous effects of broadening the diagnostic criteria for bipolar disorder to include children.  This decision was the most regretted by Dr. Frances, the lead editor of the current version of the DSM, volume IV.  That decision led to a 40 fold increase in the diagnosis of bipolar disorder in children, most notably  in African American males and in some children as young as 18 months old.  According to an August 2012 study, prescriptions of antipsychotics for children, including for off-label uses, such as for ADHD, increased seven and a half fold.

The other huge issue involved with expanding medication treatment of young people with early psychosis is both the lack of effectiveness and severe dangers of these drugs.  In his book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, award winning journalist Robert Whitaker describes one of many studies cited:

In the 1980s, Martin Harrow, a psychologist at the University of Illinois, began a long-term study of 64 newly diagnosed schizophrenia patients. Every few years, he assessed how they were doing. Were they symptomatic? In recovery? Employed? Were they taking antipsychotic medications? The collective fate of the off-med and medicated patients began to diverge after two years, and by the end of 4.5 years, it was the off-medication group that was doing much better. Nearly 40% of the off-med group were “in recovery” and more than 60% were working, whereas only 6% of the medicated patients were “in recovery” and few were working. This divergence in outcomes remained throughout the next ten years, such that at the 15-year follow-up, 40% of those off drugs were in recovery, versus 5% of the medicated group.  Harrow reported at the 2008 annual meeting of the American Psychiatric Association, “I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than those on antipsychotics.” (Emphasis added)[6]

This is not to mention very dangerous effects of these drugs, such as:

 

DEATH – A 2006 study found 45 deaths in children from 2000 to 2004 associated with these drugs, with that likely only representing one to ten percent of the total.[7]

SHORTENED LIFE SPAN – Researchers believe that those diagnosed with mental illness and treated with medications face a 25 year shorter lifespan[8]

SUICIDE & VIOLENCE – Although not as closely associated with violence as the antidepressants like Prozac, antipsychotics all cause akathisia, a severe inner agitation, “which means that persons who take them can’t sit still and feel like they are jumping out of their skin. They behave in an agitated manner which they cannot control and experience unbearable rage, delusions, and disassociation.”[9]  Below is a table of psychiatric drug associated school shootings that have resulted in many deaths just in the US.[10]

# KILLED MEDICATION LOCATION YEAR
1 Zoloft + ADHD Med Huntsville, AL 2011
6 Prozac Northern IL Univ. 2008
33 Psych med found in shooter’s effects Virginia Tech 2007
11 Prozac Red Lake, MN 2005
3 Shooter admits not having medication Appalachian Law School, VA 2005
15 Zoloft/Luvox  Columbine, CO 1999
4 Prozac Salem, OR 1998
9 Ritalin Fayetteville, AK 1998
5 Ritalin West Paducah, KY 1997
3 Prozac Pearl, MS 1997
2 Xanax + Several other drugs South Carolina 1988
2 Anafranil Winetka, IL 1988

BRAIN SHRINKAGE – “Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment.[11]
METABOLIC EFFECTS –  “Children and adolescents seem to have a higher risk than adults for experiencing adverse events such as extrapyramidal symptoms, prolactin elevation, sedation, weight gain, and metabolic effects when taking antipsychotics. “[12] Continue reading »

Mar 6, 2013
ELW

Childcare Unionization Will Hurt BOTH Working Families & Small Businesses

The childcare unionization attempt that was halted by a judge and about which we warned and reported in 2011 and 2012 (see background here and here) has returned with a vengeance in this legislative session under DFL control. Although more properly trying to unionize childcare and home care providers via legislation instead of executive order, this idea has many problems that are outlined below in the written testimony submitted by Education Liberty Watch in the hearing on SF 778, authored by Senator Sandy Pappas that occurred, March 4th in the Senate Local Government Committee.  These include lack of constitutionality, higher costs and decreased access to childcare and home care workers for struggling poor and working families that receive state subsidies, including the early childhood scholarships proposed for a huge expansion this year.  We understand that bills to increase government control over every aspect of our lives are coming at breakneck speed this legislative session, but if you care about small business’ freedom from forced unionization, the quality, cost and availability of childcare and home care, and the right to provide education and care for your family members without government interference, please consider contacting your legislators (House, Senate) and Governor Dayton.   The March 4th hearing will be continued with a vote taken on SF 778 tomorrow, March 6th at 3 PM in Room 15 of the Capital, but the event is ticketed and no testimony will be taken. The House companion bill, HF 950, authored by Rep. Michael Nelson will be heard by the in the House Early Childhood and Youth Development Committee at 5:30 PM, Thursday March 7th, in Room 200 of the State Office Building. Thank you!

Education Liberty Watch’s written testimony prepared by Dr. Karen Effrem for the Senate hearing is linked here and available just  below.

Mar 5, 2013
ELW

Written Testimony Against Childcare Unionization – SF 778

Dear Chairwoman Pappas, Ranking Member Hall, and Members of the Senate State and Local Government Committee,

Thank you for accepting this written testimony and for your concern for families in childcare and the providers that care for them.  I am submitting this testimony as President of Education Liberty Watch, which is also a part of the Childcare Freedom Coalition.

We oppose this legislation for the following reasons:

1)      This bill abrogates the First Amendment right of freedom of assembly  - It will force small businesses that are run predominantly run by women or family members taking care of sick or elderly relatives  to unionize against their will or to pay fair share fees.

2)      Increased costs for working families – Providers will be forced to pass along the increased costs of union dues or fair share fees to their clients or in the case of home care providers caring for their own family members, have to absorb these increased costs when premiums, taxes on medical devices, etc. are increasing, the economy is still struggling and unemployment is still higher than it should be.

3)      Decreased choice, especially for families receiving subsidies – If taking children who receive any kind of childcare subsidy, including the proposed Early Childhood Scholarships, or hiring any kind of homecare provider results in unionization, many of these small business owners will cease to take these children or provide care for these sick people  – analogous to what is happening with  the Affordable Care Act and doctors not being able to afford to care for Medicare and Medicaid patients.

4)      Politically unpopular across a wide spectrum – This is not popular even among Democrats!! KSTP/Survey USA poll from 2011: “Should daycare workers in the state of Minnesota form labor unions and be considered as public employees?” 68% or survey respondents said no, with only 19% in favor of the idea. Opposition was the majority opinion across all noted demographics, including political affiliation. 73% of Republicans opposed the plan as well as 60% of Democrats and 70% of independents. (See the poll results at Survey USA, especially Question 3 at http://www.surveyusa.com/client/PollReport.aspx?g=98e06008-a002-4bda-b2dc-d5093903734a). Many states that have had unionization laws have repealed them.  Governor Jerry Brown, a Democrat governor of the, or one of the most liberal states in the nation, vetoed a childcare unionization bill.  When Minnesota House Democrats had the opportunity to vote to amend the unionization vote legislation into a bill, even Democrat legislators voted overwhelmingly against it. The vote on that was 16 in favor (all DFL members) to 114 opposed. (See House Journal, page 9336 at http://www.house.leg.state.mn.us/cco/journals/2011-12/J0428112.htm#9336)

5)      This could lead to teacher evaluations for preschool teachers and providers – As with unionized teachers dealing with the Common Core standards and their evaluations based on those standards and test results in K-12, even pro union childcare providers may not like all of the bureaucracy and loss of autonomy from being turned into teachers and assessors of young children having to teach, assess and be rated by one set of government mandated standards  as the use of Parent Aware spreads across the state.

Thank you again for your consideration of our views in this important issue.

Feb 22, 2013
ELW

Studies on the Effectiveness of All Day Kindergarten after 2000

Proponents of All-Day Kindergarten say that the overwhelming preponderance of studies since the 1970′s and 1980′s show a positive benefit of all day kindergarten.  Yet here are quotes from two large studies done after the year 2000, done by the federal government and the Rand Corporation, neither being conservative standard bearers, and a meta analysis of many studies that show there is fade out of any benefits, decrease in positive attitude towards school, and actual harm to math ability:

A meta-analysis found that attending full-day (or all-day) kindergarten had a positive association with academic achievement (compared to half-day kindergarten) equal to about one quarter standard deviation at the end of the kindergarten year. But the association disappeared by third grade. Reasons for this fade-out are discussed. Social development measures revealed mixed results. Evidence regarding child independence was inconclusive. Evidence was suggestive of a small positive association between full-day kindergarten and attendance and a more substantial positive association with the child’s self-confidence and ability to work and play with others. However, children may not have as positive an attitude toward school in full-day versus half-day kindergarten and may experience more behavior problems. In general, the research on full-day kindergarten would benefit from future studies that allow strong causal inferences and that include more nonacademic outcomes. The authors suggest that full-day kindergarten should be available to all children but not necessarily universally prescribed.   Harris Cooper, Ashley Batts Allen, Erika A. Patall and Amy L. Dent – Effects of Full-Day Kindergarten on Academic Achievement and Social Development – REVIEW OF EDUCATIONAL RESEARCH 2010 80: 34 DOI: 10.3102/0034654309359185  http://rer.sagepub.com/content/80/1/34 3/24/10

We found that both academic and nonacademic school readiness skills at entry to kindergarten were significantly related to eventual reading and mathematics achievement in fifth grade. Controlling for nonacademic readiness skills at kindergarten entry eliminated the black-white achievement gap in reading at the fifth grade, while attending a full-day kindergarten was unrelated to reading performance. Attendance in a full-day kindergarten program was not related to achievement in mathematics in fifth grade except when nonacademic school readiness factors were included in the model. When those factors were considered, full-day attendance was negatively related to math achievement. In other words, after controlling for nonacademic readiness at kindergarten, children who had attended a full-day program at kindergarten showed poorer mathematics performance in fifth grade than did children who had attended a part-day kindergarten program. This finding raises the possibility that earlier studies may have failed to find relationships between full-day kindergarten and outcomes because they omitted important information relating to nonacademic dimensions of readiness. Future studies should explore whether the inclusion of such variables changes interpretations about the effectiveness of full-day programs. Le, et al – School Readiness, Full-Day Kindergarten, and Student Achievement: An Empirical Investigation – Rand Corporation, http://www.aecf.org/upload/publicationfiles/ec3624j67.pdf, 2006

“In terms of Kindergarten program type, there is little meaningful difference in the level of children’s end-of-year reading and mathematics knowledge.” (Amy Rathburn, Jerry West, and Elvira Germino-Hausken, “From Kindergarten Through Third Grade: Children’s Beginning School Experiences,” U.S Department of Education, National Center for Education Statistics, NCES 2004-007, August 2004, 33, available at nces.ed.gov/pubs2004/2004007.pdf)

“This report did not detect any substantive differences in children’s third-grade achievement relative to the type of kindergarten program (full-day vs. half-day) they attended.” (Rathburn, et.al)

“Third-grade reading, mathematics, and science achievement did not differ substantively by children’s sex or kindergarten program type.” (Rathburn, et. al.)

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