Altruism Today

A ground-breaking, year-long investigation by Youth Today has uncovered ample evidence that many youths incarcerated in American juvenile facilities are getting potent anti-psychotic drugs intended for bipolar or schizophrenic patients, even when they have not been diagnosed with either disorder.

The findings are derived from records of state juvenile systems that provided sufficiently detailed information on their use of these anti-psychotics – called “atypicals.” Only 16 states responded to a nationwide survey by Youth Today, meaning that a majority of states either would not or could not demonstrate that they were even monitoring the use of these medications on incarcerated juveniles.

The atypical anti-psychotics were being used to treat a wide variety of diagnoses, including intermittent explosive disorder, oppositional defiant disorder and even the more common attention deficit and hyperactivity disorder.

Critics believe most of these diagnoses are simply a cover for the fact that prisons now use drugs as a substitute for banned physical restraints that once were used on juveniles who aggressively acted out.

“Fifty years ago, we were tying kids up with leather straps, but now that offends people, so instead we drug them,” says Robert Jacobs, a former Florida psychologist and lawyer who now practices psychology in Australia. “We cover it up with some justification that there is some medical reason, which there is not.”

Supporters of prescribing the atypicals believe using the drugs as sedation isn’t necessarily bad.

“It prepares youth so they can respond to treatment,” says LeAdelle Phelps, a former juvenile facility director and adolescent psychologist. “By reducing aggression and by having calming, soothing effects,” the anti-psychotic makes residents “more malleable.”

Others disagree, arguing that the drugs may interfere with attempts at meaningful therapy.

But there have been no studies on widespread use of the atypicals on juvenile offenders. The Government Accountability Office is investigating various state policies for placing foster children on atypicals, which in those cases are paid for by federally matched Medicaid.  

But federal Medicaid money, by statute, cannot fund care for anyone incarcerated for a crime – adult or juvenile. That means funds for medications issued to juvenile inmates come from state sources. 

For more than a year, Youth Today has been working to find out how much states have been spending on anti-psychotic drugs for incarcerated juveniles, and why. 

Atypicals and youth: a primer

Nobody fully knows how anti-psychotic medications do their job, but the consensus is that the drugs can quell psychotic episodes by interacting with neurotransmitters in the brain called Dopamine receptors.

The drug binds with the receptors, which limits the amoung of dopamine that is transmitted. That can quell the hallucinations and voices heard by people suffering from schizophrenia or who have psychotic episodes brought on by bipolar disorder.

But because many of the drugs may also bind with and limit other receptors – such as serotonin and oxytocin – they can numb the overall impulses and actions of most people who take them, whether they have a psychotic disorder or not.

Anti-psychotic drugs have been a part of the psychiatric medical arsenal since the 1950s. The first iteration, haloperidol, often prescribed under the brand name Haldol, has long been used in this country either to treat or sedate institutionalized people. It poses serious downsides pertaining to motor control; Haldol has been known to cause tremors, muscle stiffness and twitching in patients.

The second generation of anti-psychotic drugs – the atypicals – emerged in the late 1990s and early 2000s. The five most frequently used are Abilify (aripiprazole), Geodon (ziprasidone), Seroquel (quetiapine), Risperdal (risperidone) and Zyprexa (olanzapine).

The drugs show significantly lower rates of haloperidol’s motor control side effects. But they have their own set of potential side effects in addition to sedation, including significant weight gain and early onset of diabetes.

Those side effects are magnified for adolescents, says Mark Olfson, professor of clinical psychiatry at Columbia University.

“There is a reasonable body of evidence that adolescents are more sensitive to the metabolic side effects,” Olfson says.

Those risks are augmented further in some juvenile facilities by a lack of time devoted to physical activity.

The Food and Drug Administration approved Abilify for use in adolescent patients with schizophrenia or bipolar mania in 2007. Since then, similar approval has been given for Seroquel, Risperdal and Zyprexa. Geodon has not been approved for treatment of youth. 

But doctors need not wait for FDA approval to prescribe a drug off-label, and when it came to poor children, they certainly did not wait for the FDA to approve atypical anti-psychotics. Ken Kramer, a researcher with the Citizens Commission on Human Rights of Florida, obtained detailed annual Medicaid expenditures for the five most prescribed atypicals in 30 states.

It's time for organizations to embrace employees diagnosed with Asperger's Syndrome.

A very mild form of autism, Asperger's is found in IT departments nationwide; the Silicon Valley area has seen a significantly greater upsurge in autism cases than other parts of the U.S. People with Asperger’s often are capable of contributing to projects with a higher capacity for production and quality than their “normal” counterparts – one fictional example being Chloe from the TV show “24.”

A new book, Asperger's On The Job, by Rudy Simone (Future Horizons/Available now), a business consultant with Asperger's, contends that too many managers and co-workers try to force those with the syndrome to conform to office environments and routines. Instead, they need to find ways to adapt procedures, interactions and the overall environment to the needs of these employees – allowing valuable source of unique talents to be discovered. For more information about the book and getting the most out of workers with Asperger’s,

 click here.

FOR America’s children the education system is often literally a lottery. That is the main message of a new documentary about America’s schools, “Waiting for ‘Superman’.” Made by the team that gave us “An Inconvenient Truth”, and supported with the sort of marketing budget that other documentary makers can only dream of, it is intended to create a surge in public support for education reform at least as great as the clamour to do something about climate change generated (for a while) by Al Gore’s eco-disaster flick.

The timing could hardly be better. The “jobless recovery” is finally bringing home to Americans the fact that too many of those who go through its schools are incapable of earning a decent living in an increasingly competitive global economy. The number of jobs advertised but not being filled is increasing even as the unemployment rate stays resolutely high. And despite its depressing enumeration of the failure of so many schools, particularly in poorer urban areas, its miserable ending, and the bleakness of its title, the movie also has a message of hope: there are good schools and teachers in America, whose methods could make its education system as good as any in the world if only they were allowed to.

That truth, recognised by anyone who has spent even a few hours in, say, a KIPP charter school, is an inconvenient one to the teachers’ unions, which the film rightly identifies as a big chunk of kryptonite standing in the way of a dramatic rescue for the children of America. For example, the film features efforts to reform the school system in Washington, DC, led by Adrian Fenty, the mayor, and Michelle Rhee, his combative schools chief, including a scene where Ms Rhee’s offer to double salaries for teachers in exchange for them giving up tenure and accepting “merit pay” (performance-related wages) is rejected by the unions. Right on cue for the launch of the film, Mr Fenty has just lost his local Democratic Party primary to a more union-friendly rival, so Ms Rhee may well be leaving. The $1m spent during the campaign by the American Federation of Teachers played a crucial role in Mr Fenty’s defeat.

The teachers’ unions have resolutely opposed efforts to pay good teachers more than mediocre ones, to fire the worst performers, and to shut down schools that consistently fail to deliver a decent education. This, coupled with underfunding in poor areas, has resulted in a shortage of good schools; so the few that are worth getting into are hugely oversubscribed, with places allocated by the public lotteries which provide the grim climax to the movie. Ms Rhee upset the unions by refusing to accept all this, closing dozens of schools and firing 1,000 teachers, including the head of her own children’s school.

Hey, teachers! Leave them kids alone

Perhaps the most important thing about “Waiting for Superman” is that it is liberal, Al Gore-friendly types who are highlighting the fact that the teachers’ unions are putting their worst-performing members before the interests of America’s children. Class(room) war may be about to break out within the Democrats. Teachers’ union members are a vocal group within the party; but its rising stars—such as Cory Booker, the mayor of Newark, who has just persuaded Mark Zuckerberg, the founder of Facebook, to donate $100m to improve the city’s schools—are making school reform a priority.

To be fair, the unions are not all bad. As Bill Gates has pointed out, they are taking part in an initiative funded by his foundation to develop new measures of teacher performance, which could be the basis for a form of merit pay. Moreover, he notes, reform cannot succeed without the support of the majority of teachers. Even so, the fact is that the teachers’ unions are the primary obstacle to reform—which presents leading Democrats, and above all, Barack Obama, with a crucial test: will they be willing to confront a core part of their membership in the interests of America’s children? Mr Obama has gone further than many expected in pushing school reform, not least by setting up the Race to the Top competition for additional money. If he has any doubt as to which side he ought to be on, he need only ask that bellwether of public opinion, his old friend Oprah Winfrey. She recently invited Ms Rhee onto her show, where the audience gave her a standing ovation.

Volunteer USA joins schools and other nonprofits to observe National Literacy Day in September. So what better way to celebrate literacy and learning then by giving away free books!

Thanks to a donation from the Dollar General Literacy Foundation, we’ve created a contest for schools, classrooms, libraries and other nonprofit groups to each win FREE books.

The books are great for children between the ages of 4 -8. The five titles include “Monkey and Me,” “Diego’s Wolf Pup Rescue,” “Duck for President,” “When Dinosaurs Came with Everything” and “Romeo and Lou Blast Off.”

Contest Details: On our Facebook page, we want to hear why your school library, classroom or nonprofit really needs the books, what makes you stand out above the rest? Post your idea on our wall by September 30. The first 100 nonprofit folks to post will win 10 free books to add to their libraries.