It's me again with another message of hope. August 28, 2005 10-year-old Blake Randall is learning to manage multiple mental illnesses through medication and a treatment program that provides intensive services while allowing him to remain at home. Mail Tribune / Bob Pennell -------------------------------------------------------------------------------- Mental health overhaul Oregon’s care system for disturbed children shifts focus to families By JONEL ALECCIA Mail Tribune As the mother of a mentally ill 10-year-old, Laura Randall knows all about blame. Just last month, a man in a tourist gift store offered unsolicited parenting advice when her son, Blake, became overwhelmed by summer crowds. "He has a tendency to cover his ears and start screaming and banging his head," Randall said. "The man said, ‘That boy just needs a good ass-whipping.’ I’m not a violent person, but I just wanted to deck that guy." Such judgment from strangers is bad enough, the Central Point woman said. They don’t understand the daily challenges of caring for a child diagnosed with nearly a dozen psychiatric disorders. But she and other parents of mentally ill kids said they’ve encountered similar, if more subtle, reproach from the very experts — therapists, doctors, treatment providers — hired to help. Advertisement For years, parents say they’ve been left out of policy decisions, sidelined from treatment plans or — worse — regarded as the source of their children’s illness. "There have been times when I felt like I was being blamed by everybody," said Randall, 34, whose son was kicked out of two Central Point elementary schools last year after violent rages. Starting this fall, that’s supposed to change. After years of planning, Oregon’s mental health system for children is implementing an overhaul aimed at increasing parent involvement while also providing flexible services to help keep kids in their own communities. "We’re saying that the goal is to keep them ‘at home, in school, out of trouble and with friends,’" said Maureen Graham, Jackson County program manager for outpatient services. "The focus is on what can we do to enable that to happen — and let’s make sure the family is at the center of the process." At stake is $45 million in state funds and vital services for 105,000 children and adolescents who require at least moderate mental health care and some 7,300 who suffer from serious mental illness. In Southern Oregon, Blake Randall is among more than 1,700 moderately to severely mentally ill young people expected to benefit from the shift. A smiling boy in a Yu-Gi-Oh! shirt, Blake offers visitors lemonade and a chance to hold his long-haired guinea pigs, Angela and Little Bit. At home, there’s no sign of the fourth-grader who threatened last year to kill two little girls with a gun (he didn’t actually have one), or the boy who erupted into a violent rage that culminated when he smashed a principal’s finger. But then Blake’s mother brings out plastic trays filled with dozens of multi-hued pills. "I’ll show you what I have to do to keep track of this. We have meds at breakfast, 4 p.m. and bedtime," she said. "You have to make sure the meds he takes for one thing don’t affect anything else." The multiple medications help control the effects of Blake’s illnesses, first diagnosed when he was a toddler. The list includes bi-polar disorder, Asperger’s syndrome, obsessive- compulsive disorder, oppositional defiance disorder, hyperactivity and attention deficit disorder, sensory integration dysfunction and pervasive developmental disabilities, among others. Without the drugs, Blake easily can become violent, destructive and full of rage, his mother acknowledged. Even with medication, the boy’s behavior has been dangerous enough to warrant a brief stint in residential psychiatric care and referrals for hospitalization. "Had he been older and not developmentally delayed, they would have recommended it (hospitalization)," Randall said. Under the new system, however, Blake is finding help close to home. This fall, he expects to return to a program run by the Southern Oregon Child Study and Treatment Center in Ashland. At SOCSTC, Blake receives individualized counseling, education and other services during the day. At night, he sleeps in his own room. "I’ve been very good at SOCSTC," Blake said. "I’ve improved. I get two stars every day — and that’s the max!" At the same time, Randall has been increasingly involved in treatment decisions about her son. "Now that he’s at SOCSTC, I feel like I’m being listened to more," she said. "You know, he is really a very loving, thoughtful little guy." Randall’s optimism is a good sign, according to local treatment providers and administrators backing the change. Even the experts acknowledge that the children’s mental health system has focused too rigidly on treating symptoms instead of understanding individuals. And, they add, families often have been regarded as part of the problem, not the solution. "As we know more about brain function, we know that these illnesses can be due to genetics, drugs or trauma the child has suffered," Graham said. "There’s less focus on the pathology of the family." Instead, treatment providers are developing a flexible, responsive menu of options for mentally ill kids — and a new focus on their families. At the Southern Oregon Adolescent Study and Treatment Center in Grants Pass, a residential program, staff members have shifted their philosophy about handling clients. "We’re learning how to respond to need, instead of just providing service," said Bob Lieberman, the agency’s executive director. That might mean sending a violent, out-of-control kid into foster care for a night or two, but then providing his parents with intensive counseling and other services to help after the crisis has passed. That model acknowledges that families with problems are still primary caregivers for their kids, Lieberman said. "We’re recognizing that the more you deal with the parents, no matter what they might have done, the better it is for their kid," he added. Even very stable families will benefit from the new emphasis, said Caren Caldwell, 53, of Ashland. Her 18-year-old adopted son started psychological treatment at age 4, but wasn’t diagnosed with Asperger’s syndrome (a form of autism) until age 15. "I’ve had some good experiences and some nightmare experiences with people who thought they knew my son better than I did," Caldwell said. "There’s this assumption on the part of the professionals that if only you were doing it right, he’d be fine." Caldwell’s son spent time at Lieberman’s residential agency, as well as at the Oregon State Hospital in Salem. Only recently, however, has he begun to flourish in an individualized program that allows him to live at home. In a small room at Ashland High School, the young man has help studying math and improving his strong computer skills. "We quit trying to make him fit into some normal child mode," said Caldwell. "Now, he’s shown such improvement and growth." Caldwell has shared her experience and expertise by joining a local board supervising the system change. If there’s one message she stresses to providers and fellow parents, it’s that no two mentally ill kids — and no two families — are alike. "That is so important. It’s so individual," she said. "You can’t put them all in the same box." CARING FOR MENTALLY ILL CHILDREN Here’s an overview of current Oregon programs to treat mentally ill children: Psychiatric residential treatment: Ten programs around the state now provide services for children who need specialized, restricted environments. About 315 beds serve more than 1,000 children and adolescents a year at an average daily rate of $270. Psychiatric day treatment: Nonresidential services are offered through 20 programs around Oregon. Children live at home or in foster care and come to the program for a combination of mental health and education services. Programs generally operate on a school calendar for 230 days of service at about four or five hours a day. Some 321 available slots serve 650 children a year at an average daily rate of $140. Reach reporter JoNel Aleccia at 776-4465, or e-mail jaleccia@mailtribune.com. See here Moms and Dads, it wasn't your fault so if anyone tries to tell you how to deal with your kid, tell them to kiss a part of your anatomy where the sun don't shine. The message of hope here is so intense. Here is a mother whose child has 12 different diagnosed mental illness co occurring and now, with some resources and other carring people at her side, Blake is getting not 1, but 2 stars every day and like the little guy said, " and thats the max " Sincerly, Bill Vanderbilt

Hello Arildaha No need to thank me my friend. That fact that maybe tommorrow some little kid will have a nice day because we cared, is more than enough thanks for anything we can do today. sincerly, Bill

Hi Girls. In case you were wondering how I decided which of you I would post this under, I just went eenie meenie miney moe. catch a burgler by the toe and if he hollars let him go. eenie meeni miney moe .y,o,u, out goes you. Webtrack in Mental Health - October 2005 | Other articles (October 2005) Treatment costs for children with ADHD Jensen PS, Garcia JA, Glied S, et al. Cost-effectiveness of ADHD treatments: findings from the multimodal treatment study of children with ADHD. Am J Psychiatry 2005;162:1628-1638. Attention-deficit hyperactivity disorder (ADHD) is the most common behavioural disorder in children. In addition, it is not uncommon that children with ADHD also suffer from other problems like anxiety, depression or conduct disorder. Treating the disorder with medication, behavioural therapy or a combination of both methods reduces the children's difficulties and symptoms. Untreated the disorder could last into adulthood and result in violent and risky behaviour, criminal acts and substance abuse. The cost-effectiveness of a number of treatment options is studied in this article. The costs for ADHD treatment were comparable with the costs for many other chronic illnesses. Within the three different treatment options the costs varied. Medical treatment was the least expensive. The costs for behavioural treatment were five times higher. Combined treatment was the most expensive. For children with ADHD the medication treatment was the most cost-effective. A combined medical and behavioural treatment showed the best cost-effectiveness for some children with an additional diagnosis of anxiety, depression or conduct disorder. This study concludes that for children diagnosed with ADHD alone, routine treatment with medication can be recommended. But if they suffer from additional behavioural or mood disorders the treatment should be adapted to the special needs of the child in order to achieve better results. A combination of medication and behavioural treatment can be preferable in these cases.

Hi Lisa I just found a very interesting article about some research being done on Autism and related illnesses. There is a glimmer of hope here and I wanted to share it with you and anyone else who reads this forum. Robotic toys may one day diagnose autism Wednesday, October 26, 2005 By Lee Gomes, The Wall Street Journal Autism is a heart-rending mental illness that has become entwined with a contentious social issue. While neither is conducive to easy solutions, some Yale University researchers are hopeful that the clever use of technology might prove helpful to both. Though there is a range of manifestations of autism, the disease is generally regarded as involving impaired social skills. Autistic persons, for example, usually can't engage in normal conversations. The cause isn't known; most researchers believe it involves brain biochemistry, and the only current treatment, often only minimally effective, is behavioral. The recent sharp increase in reported cases of autism has created a controversy. Is there actually now more of the disease? Or is it simply better understood, and thus more commonly diagnosed? Are the numbers further swelled by parents demanding an autism diagnosis for troubled children, bringing with it a chance at better access to social services? Brian Scassellati is a robotics researcher in Yale's computer-science department, and is part of an interdisciplinary group on campus that includes doctors and others. Part of his contribution has been to build very simple robotic heads -- more like smart toys -- then to watch how different children, autistic and nonautistic, respond to them. These devices can be programmed to monitor where the child is, or whether the child has said anything, and then to say something appropriate. In other cases, the robot head will spout things randomly. Prof. Scassellati said that with three year olds, nonautistic children will continue to interact with a robot that is responding appropriately, but will quickly tire of one that isn't. Autistic children, however, show no such preference, and will be equally fascinated by each. It turns out, he says, that there are a number of other ways that autistic children respond differently around technology. One of the most striking, and potentially most useful in terms of diagnostics, involves eye gaze, which can be tracked with special machines. Nonautistic children shown a movie of two people talking will usually go back and forth, looking at the eyes of each speaker. Autistic children, though, consistently look at other things, like necks and hands. Using a film showing a child playing, nonautistic children fix their gaze on the child, while autistic children commonly stare at the empty basketball court in the background. The group at Yale, as well as groups at other autism research centers using technology, are attempting to quantify those differences, with the goal of developing objective diagnostic tests. Currently, diagnoses are made by doctors after interacting with children; Prof. Scassellati says different doctors often will come to different conclusions, if only because the child is in different moods when examined by each physician. It's not known how early autism can be detected. Prof. Scassellati says one of his goals is to develop a gaze-based diagnostic approach that would work with children as early as one. Current autism tests involve social skills, and so can't be given until a child is two or three and capable of some basic interactions. Yet, as with most diseases, the earlier the diagnosis, the better the chance for effective treatment. A standardized set of diagnostic tests might shed light on the question of whether the disease really is on the rise. Prof. Scassellati says his group's work so far is devoted entirely to diagnosing autism -- not to treating it. (Even with that more modest goal, the results aren't in yet.) But he and others can't help but think of the ways that robots might be useful one day in actually treating the disease. That would mean taking on some of the behavior-based conditioning that, in the absence of a solid medical explanation for autism, is now state of the art. Working with autistic children can be exhausting, notes Prof. Scassellati, but machines don't tire. "It is hard to focus on eye contact if the kid is standing a centimeter away from you," as autistic children do, he says. "But that would be very easy for a robot to do." Researchers at Yale, and many other places, are designing robots and tools such as videogames to teach socializing skills to autistic children. The robot maker's standard tool kit by now has all the technologies needed for a computer-controlled machine to interact with a child for a period of time. The machines are no panacea. With human teachers, autistic children often don't apply something learned in one situation to a related situation. Prof. Scassellati says it's not yet known if things will be any different with robots. Considering the pressure some parents place on doctors to get an autism diagnosis, one wonders if parents could somehow "coach" a child into acting a certain way during a automated test. Prof. Scassellati says no. "These are very basic social abilities that we are looking at. If you have them, it's hard to hide them. And if you don't have them, it's easy to notice they are missing."

Hi Lisa. A while back I met a couple of ladies who had children with Autism and I promised them that I would gather all of the information that I could find and post it so they could read it. Unfortunately though, I haven't heard from them in a long time. Maybe they were on LaNell's forum. I don't go to LaNells forums anymore so maybe you could just post this for me on one of her forums. You don't have to mention my name or anything. I just want these ladies to get this information. Thank You in advance my friend.