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AUTISM FIRST STEPS
AUTISM DAILY NEWSLETTER
Wednesday January 16, 2002
INDEX:
* Drew's story, Part
3: Newly learned coping skills fail on the outside
* Pain in the Gut? Don't Blame Stomach Acid
* Early diagnosis of autism critical, speakers say
* Kids move unevenly along 'ladder' of care
******************************
Drew's story, Part 3: Newly learned coping
skills fail on the outside
BY
JEREMY OLSON
WORLD-HERALD STAFF WRITER
RELATED STORIES
Drew's
story, Part 1: Teen's downward spiral forces difficult decisions 
Drew's
story, Part 2: From treatment center to juvenile jail and back 
Models
for change, Day 3 
Glossary
of terms, Day 3 
In part two, Drew bounced back and
forth between residential treatment and juvenile detention before being
accepted at Cooper Village in Omaha. 
Chess is Drew's favorite game. At Cooper Village in Omaha, he
even played in a tournament. Eventually, Drew was moved to Cooper's group home,
but Medicaid ended the stay a month later, and Drew was sent home.
COOPER VILLAGE - Drew has a reputation when he arrives at this private
treatment facility for boys in July 1998. A reputation for being trouble. For
failing at treatment. For the drug and alcohol problems he has in addition to a
mental disorder. But he also comes here at the age of 13, still an
impressionable child. He feels good about Cooper Village, he tells his mom -
horses roam its rolling, grassy hills north of Omaha. The other places didn't
have horses. His positive attitude helps bring about progress at Cooper.
Doctors stabilize the drug regimen for his disorder, which is either a severe
form of depression or bipolar disorder. A therapist earns Drew's trust.
Following DrewJuly 8, 1998 - Begins residential treatment at Cooper Village,
Omaha.
May 2, 1999 - Transfers to treatment group home at Cooper Village
June 7 - Released from Cooper Village and sent home to Lincoln
Aug. 9 - Rushed to BryanLGH West Medical Center in Lincoln after medication
overdose
Aug. 28 - Rushed to Bryan again after another overdose
Sept. 3 - Sent to Lincoln Regional Center
Oct. 27 - Accepted at Cedars Youth Services Boys Home, Lincoln
March 31, 2000 - Released and sent home
Oct 15 - Arrested and sent to Lancaster County Juvenile Detention Center
Several kids sit around on one free day, watching movies and eating pizza the
staff bought. Staff members let Drew and his friends play tackle football,
though such rough contact is supposed to be against the rules. Staff members
are optimistic about Drew, although wary. Many newcomers have a honeymoon
period that later wears off. Drew does test the limits. He rummages through a
wastebasket and finds some unused pills. He and a friend take them, hoping for
a high. They get caught and confined to quiet rooms. Later, he has a manic
outburst during a group session and has to be physically restrained. His
glasses break in the struggle. When Drew made that kind of mistake in his first
six months in the mental-health system, he was sent to a juvenile-detention
center, suspending his therapy. At Cooper, there are consequences, but not that
kind of disruptive change. A few days later, he gets to play in a chess
tournament at the center. It's his favorite game. With his glasses still
broken, the board is a blur. But that doesn't stop him from whipping opponent
after opponent with moves they never saw coming. His mother and brother taught
him to play, but they can't beat him anymore. Don't worry, he tells defeated
opponents with a sly smile. I do it to everyone. School is still a bore to him,
but by spring 1999 - a year after flunking many of the classes on his schedule
- the 14-year-old's report card shows C's, B's and even an A in writing. Assignment:
Write about a perfect dinner. A perfect dinner to me would have to be
romantic. I am a romantic type person. So if I would have a perfect dinner my
friend ... would have to be with me. There would have to be Marilyn Manson ...
playing softly in the background. We would need roses and the lights would have
to be dim. In conclusion, I like romance and I am not always violent. -
Drew Drew does well enough to move from Cooper's most restrictive setting,
residential care, to a group home - the first major step toward home. His
mother, Pam, comes from Lincoln every weekend to take him shopping or to a
movie, privileges he gained at the group home. She sees progress in Drew but
gets nervous when state Medicaid officials tell her it's time to discharge him.
It's June 1999. While he has been at Cooper a full year, he's been in its group
home for only a month. This is the devil's bargain you make, she figures, when
you place your child in state custody. She saw custody relinquishment as her
only option to get Drew the mental-health care he needed. But now, because she
is not his legal guardian, major decisions regarding Drew's treatment are no
longer hers to make. Drew's therapist at Cooper worries that he's not ready to
test his new coping skills and his drug and alcohol sobriety. The only
follow-up program the court orders as Drew heads home is Alcoholics Anonymous.
Pam doesn't see how sitting with a bunch of middle-aged alcoholics will help
Drew. But she's determined to support his return home. So she drives him to the
meetings four times a week. Drew sees the meetings as a way to bum cigarettes.
The therapist advises Pam to keep things stable. But as soon as Drew gets home,
everything changes. He has a new psychiatrist. Drew says the lithium he takes
to prevent depressive or suicidal episodes hurts his stomach. No problem, the
doctor tells him: Stop taking it. That seems rash to Pam, and Drew later seems
more edgy. She's glad when the next appointment comes. "So, how's the
lithium working out for you?" the doctor asks. "You took him off of
it," Pam says in amazement. The doctor runs down a list of alternative
medications. Drew picks one that his Cooper friends told him creates a high.
Drew gets a job with Lincoln's Green Team program for 14- and 15-year-olds
seeking work. He loves cruising around a golf course, changing the holes on the
greens. But it's only a three-week program. Pam hunts for another structured
activity but finds none. She asks the state caseworker about support programs.
The caseworker says the local program administrator should help. Pam calls the
program administrator - who says the caseworker should set things up. Before
June is over, she calls to arrange Drew's special education programs for the
school year. Call back in August, she's told. It's early August, two weeks
after Drew turns 15. He is upset. Home isn't what he remembered. Many of his
friends are no longer around. He wants something to do, partly to get his mom
off his back. His grandma takes him to meet a man who might have work for him
doing repairs at an assisted-living facility. Drew seems nervous while they
wait - his grandma sees him swallow a couple of his pills - and becomes edgy
when he eventually learns that no job is available. He swallows some more pills
on the way home. Later, he bikes over to mow his grandparents' lawn for a
little cash. His grandma, watching from her picture window, thinks he's moving
like a zombie. After he leaves, she calls to warn Pam: Keep an eye on Drew -
something is wrong. Pam rushes upstairs. Drew is unconscious on a sofa, and too
many pills are missing from his bottle. Pam calls her insurance company, and
pleads for coverage of a trip to the emergency room. Then she calls 911. Drew
recovers at a hospital psychiatric ward. Then he visits a new psychiatrist, who
offers new pills. Another change. Pam calls the school district, as told, to
set a meeting. But the administrator misses that one and a makeup meeting.
School will start within days, so Pam gives up and enrolls Drew in regular
classes. This is exactly the last-minute rush she tried to avoid. School
pressures fuel Drew's depression. Within days, he again overdoses on psychotropic
drugs, an effort to numb his emotional pain and stress. This episode ends his
time at home. He is hospitalized at the state's Lincoln Regional Center and
sent to a group home. The day before Christmas, a new psychiatrist authorizes
another medication change. Bad timing, Pam thinks. The holidays are so
stressful. When Drew becomes moody and hostile, the psychiatrist approves yet
another medication change - Drew's fifth in six months. Pam complains to the
state caseworker, who orders no more changes without her consent. School has
become an afterthought. Many times Drew rides the city bus from the group home
to school, then sneaks to his mom's to smoke pot with friends while his mom is
at work. Sometimes he smokes it on the group home roof, sometimes in his room,
cracking open the window to let the smoke out. By February 2000, he is enrolled
in a special education program. But it's too late. His next progress report
shows four F's and three withdrawals. Pam is upset with the group-home staff.
During one school suspension, they let him leave that morning on the bus. She
stops by with fast food one day and finds Drew so stoned that she decides to
confront the staff. Unhappy with the response, she figures she can do better
than this, and persuades the juvenile court judge to let Drew return home for
the summer. She is far less hopeful than she was last summer, after Drew's year
at Cooper Village. Drew's attitude is worse, and he is clearly using drugs. But
Pam tries. She bribes Drew to get a summer job by buying him stereo equipment.
He finds one at a pool. But when a boss chews out Drew's friends for playing
recklessly on a nearby playground, Drew threatens the boss. And loses the job.
He later quits a department store job so he can hang out with friends and smoke
pot. When Pam challenges his behavior and his choices, he physically threatens
her. She pours out liquor when she finds it, so Drew hides it. He mixes vodka
into containers of Sunny Delight, knowing his mom never drinks the juice. By
October, her nerves are frayed. She is seeing a therapist and taking
anti-depressants. Drew refuses to take his medications. Counseling programs to
help with home life have ended. One day she finds Drew and two friends on the
front porch, drinking beer and burning a cardboard box. Pam uses a garden hose
on the fire, splashing Drew in the process. In a rage, he chases her into the
house. She runs upstairs and tries to lock herself in her bedroom with an old
skeleton key. He forces open the door and grabs her neck. "I'm going to kill
you!" he yells. His friends pull him away, and they all take off. Police
arrest Drew a few blocks away. He wakes up the next morning back in Lancaster
County's juvenile detention center. He's groggy from the aftereffects of vodka,
beer and marijuana. He's so down that staff members peek in his room every four
minutes as a suicide check. Counselor Michelle Grummert is sorry to see Drew
back. She worked with him two years ago, after his first psychiatric crisis.
She persuades him to start taking his anti-psychotic medications again. But he
remains sad, knowing his fate: the state detention center in Kearney. On
Wednesday: Life is tough for Drew at the state detention center in Kearney. But
Girls and Boys Town offers hope.
http://www.omaha.com/index.php?u_np=0&u_pg=36&u_sid=281595
******************************
Pain in the Gut? Don't Blame Stomach Acid
Library: MED
Keywords: GASTRITIS STOMACH BACTERIA OMEPRAZOLE GASTRIN H.PYLORI
Description: When it comes to cooling the burning pain of gastritis,
reducing the amount of acid in the stomach may seem like a good idea. But two
new studies with laboratory mice, conducted by scientists at the U-M Medical
School, indicate it could be exactly the wrong thing to do. (Gastroenterology,
Jan-2002)
Contact:
Sally Pobojewski, pobo@umich.edu
734-615-6912 or
Kara Gavin, kegavin@umich.edu
734-764-2220
For immediate release
Pain in the gut? Don't blame stomach acid
U-M scientists show why inhibiting acid production could make gastritis worse
ANN ARBOR, Mich. -- When it comes to cooling the burning pain of gastritis or
an inflamed stomach lining, reducing the amount of acid in the stomach may seem
like a good idea. But two new studies with laboratory mice, conducted by Howard
Hughes Medical Institute scientists at the University of Michigan Medical
School, indicate it could be exactly the wrong thing to do.
U-M scientists found that antibiotics were the best way to kill the bacteria
that cause gastritis and eliminate stomach inflammation in their experimental
mice. Mice treated with prescription drugs called proton pump inhibitors or
PPIs, which block acid production, acquired more bacteria and developed more
inflammatory changes in their stomach linings than untreated mice.
"These animal studies indicate that it is the inflammatory response --
triggering the overproduction of hydrochloric acid -- which is the stomach's
primary response to bacterial colonization," says Juanita L. Merchant,
M.D., Ph.D., an HHMI assistant investigator and U-M associate professor of
internal medicine and physiology. "Inflammation of the stomach lining
coincides with production of peptides called cytokines, which stimulate
production of a hormone called gastrin. Gastrin triggers parietal cells in the
stomach lining to produce more hydrochloric acid, which kills off most invading
microbes. If you inhibit gastric acid production, you interfere with the
stomach's natural defense mechanism."
Merchant cautions that without controlled clinical trials, it is impossible to
know whether the results would be exactly the same in humans. She also
emphasizes that a type of bacteria called Helicobacter pylori, the most common
cause of gastritis, was excluded from these studies. Since reduced gastric
acidity does appear to make the mammalian stomach more vulnerable to bacterial
invasion and gastritis, however, Merchant says physicians may want to
re-evaluate the long-term use of omeprazole and other proton-pump-inhibiting
drugs in their patients.
Together with Yana Zavros, Ph.D., an HHMI post-doctoral fellow, Merchant and
colleagues compared stomach cells from normal mice with those from a strain of
transgenic mice, developed at U-M, that lack the gene for producing gastrin.
Their goal was to understand the feedback relationship between bacteria,
pro-inflammatory factors, hormones and acid secretion in the stomach. Results
are published in the January 2002 issues of Gastroenterology and The American
Journal of Physiology.
Mice in the U-M studies contracted gastritis just like people do -- from eating
food or drinking water contaminated with bacteria. While 75 percent of people
with gastritis test positive for Helicobacter pylori, many other species of
bacteria can trigger inflammatory changes, too, and often co-exist with
Helicobacter. No matter what type of bacteria causes the problem, it is a
serious medical condition. If untreated, chronic gastritis can lead to peptic
ulcers and stomach cancer.
H. pylori is the only bacterial organism in the stomach that cannot be killed
by hydrochloric acid. Since Merchant wanted to study the relationship between
other bacteria and gastric acid, she needed to exclude the presence of H.
pylori. U-M scientists cultured and analyzed bacteria from stomach washings of
all normal and gastrin-deficient mice to confirm the absence of Helicobacter.
Major types of bacteria identified included Lactobacillus, Enterobacter and
Staphylococcus.
U-M scientists treated infected gastrin-deficient mice and normal control mice
with antibiotics for 20 days. Other mice were treated for two months with a
proton-pump-inhibiting drug called omeprazole or with a combination of
omeprazole and antibiotics. At the end of the treatment period, researchers
compared cell changes and bacterial counts from the stomach linings of all
mice.
Major findings from the U-M studies include:
-- Stomach cell samples from both the transgenic gastrin-deficient mice and the
normal mice whose ability to produce gastric acid was inhibited by omeprazole
all showed significant inflammatory changes -- including more immune cells
called lymphocytes -- and greater numbers of bacteria.
-- Gastritis that developed in mice on omeprazole resolved after 20 days of
antibiotic treatment, despite continued omeprazole treatment and low stomach
acidity.
-- The number of acid-producing parietal cells and gastrin-secreting G-cells in
the stomach increased in all mice with abnormally low levels of hydrochloric acid.
Elevated numbers of parietal and G-cells correlated with the presence of
inflammation, not with stomach acidity.
-- Elevated levels of gastrin during chronic inflammation suppressed production
of a growth hormone called somatostatin, which inhibits parietal and G-cell
function. When the inflammation subsided following antibiotic treatment,
gastrin levels returned to normal releasing the hormonal brake inhibiting
somatostatin.
"Our findings show that changes observed in gastrin-deficient mice are caused
by inflammation triggered by an overgrowth of many bacterial species,"
Zavros explains. "An abnormally low level of acidity in the stomach is the
factor initiating all these events."
"The bottom-line message is that a two-week course of antibiotics to treat
the inflammation is essential for a successful cure," Merchant adds.
"Once you get rid of the inflammation, the gastric acid levels should
return to normal. It is crucial to take antibiotics for the entire two weeks
exactly as your physician has prescribed, however. People often stop taking
their medication early or skip doses, which helps the bacteria to develop
antibiotic resistance."
In addition to the Howard Hughes Medical Institute, this research was supported
by the National Institutes of Health. Linda C. Samuelson, Ph.D., an associate
professor of physiology in the Medical School, developed the strain of
transgenic mice used in the experiments. Former U-M post-doctoral fellows
Gabriele Rieder, Ph.D., and Amy Ferguson, Ph.D., collaborated in the study.
Gastroenterology 122:119-133, 2002 -- text available at:
http://www.gastrojournal.org/cgi/content/full/122/1/119
Am J Physiol Gastrointest Liver Physiol 282:G175-G183, 2002
A press release from the Howard Hughes Medical Institute is available at
http://www.hhmi.org/merchant.htm
http://www.newswise.com/articles/2002/1/GASTRIN.MHS.html
******************************
Early diagnosis of autism critical, speakers say
By
Steve Reeves
Staff Writer
Bryna
Siegel, a professor at Langley Porter Psychiatric Institute at the University
of California in San Francisco, speaks about autism to the audience at a
conference Friday at Bryant Conference Center. Photo by Jason Getz. The
Tuscaloosa News.
TUSCALOOSA
| The University of Alabama served as host to a conference on autism Friday,
giving medical and education professionals new information about the disorder
and ways to diagnose it earlier.About 300 people packed an auditorium at Bryant
Conference Center to hear a variety of speakers give presentations on new
treatment techniques, early detection and medical advances. Organizers said the
large turnout underscores the hunger for information about autism, which is
often misunderstood by the public and sometimes ignored by medical
researchers."There has been very little professional training or
conferences about autism in the state of Alabama," said Laura Klinger, a
UA psychology professor who, along with her husband Mark, has been conducting
extensive autism research at the university. She is also director of UA’s
Pervasive Development Disorders Clinic.Klinger said the conference focused
primarily on diagnosing autism in children 5 and younger because early intervention
is critical."We know that the earlier we can identify autism, the earlier
we can intervene and the more chance that treatment will be
successful."About one in 500 children is born with autism, a brain
disorder that is characterized by delays in language development, difficulty in
social interaction and obsessive behaviors. About 75 percent of those with
autism also have some form of mental retardation. Researchers don’t know for
sure what causes autism.Phillip Young, a former president of the Autism Society
of Alabama, said he believes people are becoming more aware of autism and
developing an interest in learning how to diagnose it."Autism is an
under-studied, under-funded developmental disability that is just now beginning
to attract the attention of researchers," said Young, whose 15-year-old
son has the disorder. "The hope is there will be more autism centers being
developed and more research being done."Call the Autism Society of Alabama
at (877) 4AUTISM or visit the group’s Web site at www.autism-alabama.org.Reach Steve
Reeves at steve.reeves@tuscaloosanews.com or 345-0505, Ext. 343.
http://www.tuscaloosanews.com/news/stories/15108newsstorypage.html
******************************
Kids move unevenly along 'ladder' of care
BY
JEREMY OLSON
COPYRIGHT © 2002 OMAHA WORLD-HERALD
RELATED STORIES
Nebraska's
attempt at managed care has fallen short 
Meddling
key in home-based therapy 
Few parents would dream of moving their healthy children to seven different
day cares or schools or homes in two years.
Brent, 15, undergoes home-based therapy as part of an innovative
program to keep kids from being shifted around.
Yet that is what can happen in Nebraska, not with well-adjusted children but
with mentally ill children, who have a much harder time accepting change. One
child with mental and developmental disorders, DaVaughn, went through four
treatment foster homes and three stays at adolescent psychiatric hospitals in
two years - before he was 9 years old. DaVaughn's case isn't isolated. In
Nebraska and Iowa, children with behavioral disorders or problems who are in
state custody are typically moved more than other state wards. Some of these
children, already struggling with hefty emotional problems, feel so unwanted
they develop anxiety or attachment disorders that discourage their success,
said Ann Schumacher, operations director for Alegent Health System's behavioral
health services. "How would it feel to be 10, 11, 15 and know that nobody
wants you?" she said. "That even the state can't find a place for
you?" The problems lie in a system designed like a ladder, from strict
inpatient treatment to less intensive forms of care. Children are supposed to
step down incrementally, but some rungs of the ladder are too weak. More midlevel
programs are needed, between intense hospital care and office visits. A lack of
money and coordination among the caregivers and funding agencies, however, has
prevented such programs from developing or expanding. The result: Children get
stuck too long at the highest levels or start too low on the ladder and
bounce around, making minimal progress. Up to $6.5 million in private and
public money is wasted in Nebraska each year on children while they wait to
move to the next treatment level, according to the Nebraska Association of
Behavioral Health Organizations. Transfers from high-intensity residential
treatment to lower-intensity group or foster homes are delayed 45 to 65 days
on average. And nearly $3 million in Medicaid money was spent last year to
treat Nebraska children at out-of-state centers, often because local
alternatives were unavailable. This inefficient treatment system plays out in
various ways: 
Treatment
facilities frequently reject or try to transfer children with multiple
problems. DaVaughn's mental-health disorders, developmental problems and a
reputation for hitting, kicking and name-calling make him appear too risky for
many treatment facilities. He stayed six months at a psychiatric hospital,
where the average stay is six days, and occupied an emergency bed that then
wasn't available for other children who needed it. Long-term treatment
facilities resisted taking someone so young with such complex problems.
Finally, a facility in York, Neb., agreed to take him. But the distance from his
Omaha home hurt his mother's ability to meet court-ordered requirements to take
part in his treatment. Shelters
are poorly equipped to fill the system's gaps. Shelters, especially in
rural areas, house a hodgepodge of young children and teen-agers. At
times, abuse victims and abusers are under the same roof. Corey, a 12-year-old
from Sidney, Neb., was placed in a shelter in Alliance, Neb., until a spot
opened in a treatment facility for his depression. These shelters are designed
to hold children for a few days and no more than 30 days. He stayed five
months, until another child kicked him and broke his nose. Corey was moved to
another shelter, but it took another month to place him in treatment. The state
last fall started limiting payment for shelter stays to 30 days, but providers
worry that children will simply be moved from shelter to shelter. Children
are rushed along before parents and caregivers believe they are ready.
Nichole, a 12-year-old from Lincoln, had made no measurable progress with
treatment for her depression when the state's Medicaid manager decided to move
her into a lower treatment level that cost half as much. Her mother thought
Nichole needed more intensive help, not less. But she was told to move Nichole
as instructed or lose health coverage. Children
are moved when the quality of care is challenged. Brothers Quentin and
Mariano were removed from a therapeutic foster home in western Nebraska. Their
caseworker contended the foster parents weren't addressing the boys'
aggressiveness and were ignoring requirements to take them to mental-health
counseling. The private foster-care agency convinced the caseworker's
supervisors that the boys, ages 12 and 10, should stay in the home and reported
that they had dramatically improved. The county judge for the case disagreed.
He ordered the move and said he no longer had confidence in the foster parents
because it appeared they had fabricated reports of the boys' improvements in
order to maintain payments from the state. A broader range of treatment programs
and better-trained caregivers could address these problems. Caregivers find it
hard to start new programs, though, because they are struggling to keep
employees. In 2000, 47 percent of children's mental-health treatment facilities
in Nebraska ceased or reduced services, according to one survey. Staff
turnover at treatment centers is as high as 35 percent because the pay is low
while the education requirements and stress are high, the survey showed. Most
workers leave after one to three years. The state tried to ease the financial
pressures by increasing Medicaid pay rates. But that backfired. ValueOptions,
the private manager of the Medicaid program, started denying more care, saying
the state used outdated information that underestimated how much funding was
needed. Steve Curtiss, Nebraska Health and Human Services' director of finance
and support, said 2-year-old data on the demand for services was used to
compute the rates. He said that is a common practice. Attempts to create new
programs haven't always worked. Uta Halee/Cooper Village of Omaha launched a
program providing daytime treatment and sending kids home at night. The program
was trimmed after it lost $1.5 million in two years. Denis McCarville, the Uta
Halee president, called it a casualty of this ladder-based system that
doesn't adjust well to a new level of care. Judges, probation officers,
caseworkers and others didn't know about the new program or didn't know when it
was appropriate for children. Nebraska's system is based largely on treating
children in crisis, McCarville said. A day-treatment program is most effective
for children whose problems are identified earlier. But early intervention is
difficult. It's also impeded by a funding system that favors crisis-level
treatment programs. Several sources fund mental-health care: the joint
state-federal Medicaid program, state child welfare, state and county
mental-health programs, special education and private insurance. Each carries
its own rules and restrictions. Medicaid, for example, funds very little for
children beyond specific therapies. It generally won't pay for support services
for families, even if such services are key to treating the children. "The
creative program they need is just not on (Medicaid's) spreadsheet of the appropriate
levels of care," Denise Herz said. She is a professor at the University of
Nebraska at Omaha who studied the mental-health needs of juvenile delinquents
and their families. Some believe it is time to dismantle the ladder-based
system and create one centered around community-based programs that treat
children closer to home. The ladder-based system creates a pass-along
mentality. "It's unpatient-focused," said Ted DeLaet, a psychologist
and a consultant working on reforms to the state's system. "If a kid reaches
his treatment goals at one place, you pack him up and move him someplace
else."
http://www.omaha.com/index.php?u_np=0&u_pg=36&u_sid=281671
******************************
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