By JUDY SIEGEL-ITZKOVICH
30/04/2012, Jerusalem Post

Despite visa rejections, three cardiologists lecturing at Dubai conference say they were treated well.

The three Israeli cardiologists who lectured at a Dubai conference of the World Heart Federation a few weeks ago said that they were “treated well” by the United Arab Emirates authorities, even though over a dozen of their peers who were expected to participate but not speak were not given a visa at the last minute.
Prof. Sami Viskin, the director of cardiology at Tel Aviv Sourasky Medical Center, said Sunday that the three cardiologists were allowed to leave the hotel and even given VIP tours of the city by a “friendly escort.”
He added, however, that he objected to the fact that the other Israelis who were invited by the federation were not told until the day before their scheduled departure that the Dubai authorities had not given them a visa.
Sourasky director-general Prof. Gabi Barbash, who also attended, agreed that he and his two colleagues had been treated well by the Dubai authorities.

Last week, The Jerusalem Post quoted Prof. Chaim Lotan, who heads the Israel Heart Society and the cardiology department at Hadassah University Medical Center, as saying that the three cardiologists who were there were “confined to their hotel” and that “their passports were confiscated” while they were there. Lotan did not attend the event because there was an Israeli conference the same week, but he was involved in the arrangements for his colleagues.
Yet Prof. Jacob Pe’er, the chief of ophthalmology at the Hadassah University Medical Center said that in February, there was an international congress in his field in February in which Israelis were “badly treated.”
Pe’er was one of the original organizers as a board member of the International Council of Ophthalmology.
Israel and its flag were not included anywhere. Five Israeli specialists were allowed to attend, but they felt like “thieves.” 

“They were limited in their movements and had guards at all times,” Pe’er said.
He felt so uncomfortable about how Israelis were handled before the conference convened that he canceled his trip and resigned from the International Council of Ophthalmology board.
“I am not willing to cooperate with discrimination against Israelis,” he stated. “International medical and scientific conferences must be open to all; regional ones as in Arab countries are entitled to invite whom they please.”

Posted by Amy Davidson, The New Yorker

March 19, 2012

Three shootings, two guns, one man on a black motorbike, fleeing the scene. The incidents can be tied together with the help of forensics: some of the bullets that killed three children and a rabbi at a Jewish school in Toulouse this morning came from the same .45-calibre gun used the Sunday before last to kill a paratrooper, also in Toulouse, and two more paratroopers last Thursday in Montauban, thirty miles away. The crimes might also be connected, suggestively—although, at the moment, far less than conclusively—by method and possible motive. The children were Jewish; the three soldiers, and a fourth, who is still in a coma, had North African or Caribbean ancestry. (They were all French men; one had served in Afghanistan.) In what sort of rope of hate might they have been looped together?

At the school, the shooter began with a nine-millimetre, but discarded it when it jammed. The adult victim was Rabbi Jonathan Sandler; two of the children were his sons Arye and Gabriel, who were six and three, and the third was an eight-year-old girl named Miriam Monsonego, according to the Times. Miriam’s father was the principal at the school; the BBC reported that he saw her die. Other children were sent running amid gunfire. According to the Guardian, another father told French television, “I saw two people dead in front of the school, an adult and a child… I did not find my son. Apparently he fled when he saw what happened.” The killer rode off on a motorbike.

President Nicolas Sarkozy came to Toulouse and called it a “national tragedy.” Sarkozy is in the middle of a reëlection campaign, and his main rival, François Hollande, came to the city, too. Marine Le Pen, the right-wing National Front candidate, cancelled her campaign events: “I will not comment on how this could touch politics,” she said on French television, according to the Telegraph. “We are waiting, the whole country is waiting impatiently for this serial killer to be found so that all of us can breathe again.” Will she breathe easier, no matter what we learn about why the killer did what he did?

In the earlier incidents, Sergeant Imad Ibn-Ziaten was shot in the head by someone who apparently answered his classified ad about selling a motorcycle; he was thirty. The other victims were Private Mohamed Legouard, who was twenty-six, and Corporal Abel Chennouf, who was twenty-four. There is security-video footage of the second shooting; the killer is a man in dark clothes, perhaps pudgy, with a small scar or tattoo in his face. (He’s wearing a motorcycle helmet, but lifts up the visor slightly around the time he turns over and tries to finish off one of the wounded men.) Corporal Chennouf’s girlfriend is seven months pregnant. One wonders what that child will learn about his or her father and country when arriving for the first day of school, a few years from now.

Photograph by Aksaran/Gamma-Rapho/Getty Images.

Read more http://www.newyorker.com/online/blogs/closeread/2012/03/toulouse-school-shooting.html?printable=true&currentPage=all#ixzz1phlvAWuU

By Emma Teitel , MACLEANS.CA| March 5th, 2012 | 10:15 am

Students boycott Israel, but are blasé about Syria. Why?

Syrian demonstrators. Daniel Etter/Redux

March is upon us, which means the Oscars have been awarded, and that other harbinger of spring is around the corner: Israeli Apartheid Week.

Ordinarily, both events are masterpieces of predictability, with the Academy Awards ushering the usual suspects to the podium (Meryl Streep anyone?), and Israeli Apartheid Week featuring the usual anti-Zionist suspects on megaphones (among them the now famous IAW sub-group, Queers Against Israeli Apartheid, which I’d argue is largely composed of gay Jewish girls who didn’t have fun at summer camp.)

This year the Oscars have come through in predictability, but Israeli Apartheid Week is shaping up quite differently. It’s traditional at Passover seders for the youngest member of Jewish families to ask the “four questions,” which inquire why “this night is different from all other nights.” This year it might be prudent to ask a fifth: why is this Israeli Apartheid Week different from all the others?

The answer is just northeast of Israel, in Syria. In the past 11 months, almost 9,000 civilian protesters and nearly 3,000 anti-government rebels have been murdered by Syrian President Bashar al-Assad’s Ba’ath party dictatorship. Approximately 400 children have been imprisoned and tortured. Meanwhile, Assad’s government claims that 89.4 per cent of Syrians had approved a new constitution that could keep Bashar in power for another 16 years, along with the 12 years he’s already ruled, and the 29 years his father Hafez held power before him.

You’d think that anyone committed to the cause of justice in the Middle East would put the atrocities in Syria at the top of their to-do list. But the Canadian organizers of Israeli Apartheid Week—loudly devoted to ending oppression and achieving social justice for all—won’t be talking about Syria this year. Instead, they’ll spend March 5-9 railing exclusively against the “Zionist regime” at a university campus near you. Events will include slam poetry renditions, hip-hop shows, and an apartheid poster contest with a top prize of $400.

You could accurately call this tunnel vision activism. Most hopes for mainstream credibility IAW activists might have in their criticism of Israel tends to be destroyed by their singular abhorrence of the Jewish state. No country deserves a free pass because its crimes don’t add up to its neighbour’s, but to boycott one injustice and ignore the far bloodier one next door isn’t just odd: it’s a clear statement that those at the helm of Israeli Apartheid Week hate Israel more than they hate oppression itself.

This is a reality noted by even the anti-Zionist darling and American intellectual Norman Finkelstein, in an interview at Imperial College this month. Finkelstein, who has long been a supporter of the BDS movement, named for its focus on punishing Israel through boycotts, divestments, and sanctions, now claims, scathingly, that the BDS is doomed to irrelevancy by its gross “disingenuousness” on the subject of whether or not Israel should exist to begin with. “I support the BDS,” he says, “[but] their goal has to include the recognition of Israel, or it’s a non-starter.” Finkelstein is right. If you want to uproot a country’s policies, you should make it explicitly clear that you don’t want to uproot the country itself. Unless, of course, you do.

That the folks behind Israeli Apartheid Week wouldn’t mind if the country disappeared is evident in their blasé response to terrorism against Israelis. The movement’s promotional video features a series of cartoon slides about the conflict, one of which reads: “When a people fight the occupier / It is not terrorism / It is resistance.” But there is nothing noble or necessary about blowing up innocent civilians at a falafel stand. Such terrorism is not resistance. It’s murder—something IAW leaders have accused Israel of time and time again.

Hypocrisy aside, the movement’s reluctance to recognize the Jewish state’s right to exist (they claim to be “agnostic” about Israel’s existence), coupled with its failure to stand up for any other oppressed or occupied peoples, is an open invitation for Jews to cry anti-Semitism. Anti-Zionism is not anti-Semitism, anti-Zionists argue, but Israel’s unique distinction in their ideology as the very worst place in the entire world has most Jews begging to differ. In my final year of university, a friend of mine—who we’ll call Sandy Cohen—wanted to organize a non-aligned event to run alongside Israeli Apartheid Week, to educate uninformed students about the conflict from a neutral standpoint. Organizers of Israeli Apartheid Week were less than pleased with the idea—they were having a party, and she was trying to crash it. One organizer even compared her to a Nazi and claimed that, like “all Zionists,” she had a knack for “twisting her words.” Not once did Cohen declare herself a Zionist. The only thing her detractor knew about her was her name—which is, undeniably, Jewish.

If all people who criticized Israel were anti-Semites, I’d be an anti-Semite. But it’s this kind of nastiness and hypocrisy that makes you wonder if the week isn’t an indictment of so-called Israeli apartheid, but rather a morbid celebration of a problem none of the protesters really wants solved. Haaretz columnist Bradley Burston argues that peace isn’t the product of “freedom for one people at the expense of another, but freedom and independence for both.” Until the Israeli Apartheid Movement acknowledges this, it will remain nothing more than a thinly veiled anti-Semitic frosh week for the far, far left.

by Alan M. Dershowitz
February 27, 2012 at 4:59 pm

http://www.stonegateinstitute.org/2896/should-harvard-sponsor-a-one-sided-conference

In order to assess whether Harvard is acting properly in relation to the upcoming student-sponsored conference entitled: Israel/Palestine and the One-State Solution, I propose the following thought experiment. Ask yourself what Harvard would do if a group of right wing students and faculty decided to convene a conference on the topic, Are the Palestinians Really a People?, and invited as speakers only hard right academics who answered that question in the negative? Would the Provost office at Harvard help fund such a conference? Would the Kennedy School at Harvard grant such conference legitimacy by hosting it? Would Harvard’s Carr Center For Human Rights Policy or Weatherhead Center for International Affairs support such a conference? Would distinguished Harvard professors agree to speak at it?

If the answers to those questions are clearly "yes", then Harvard cannot be faulted for its role in the forthcoming anti-Israel hate fest. It would mean that in the name of academic and speech freedom Harvard will host a conference on nearly any kooky idea of the hard right or hard left. If the answer is "no", then the single standard of academic freedom would demand reconsideration of the Harvard Provost’s decision to help fund the anti-Israel hate fest and the decision of the Kennedy School to lend its premises to this event. If Harvard were to decide to host the anti-Israel hate fest but not the anti Palestinian one, that would reveal either an anti Israel or pro hard left bias unbecoming a great university.

To be fair, the dean of the Kennedy School did issue a statement that his school "in no way endorses or supports the apparent position" of the conference, and that he hopes the "final shape of the conference will be significantly more balanced." But the question remains, would he have done no more than that if an anti-Palestinian conference were being hosted on his premises and supported by "centers" associated with the Kennedy School?

I believe Harvard would probably pass the "neutrality test," but I hope the issue is never directly put to Harvard, because it would be obnoxious for there to be a conference here on the subject of whether the Palestinians are a real people. They are, and so are the Israelis. The quest for a Palestinian state is a legitimate one, as is the need to preserve Israel as the nation state of the Jewish people.

The participant is the Harvard conference will deny that there is any parallel between the subject of their conference and the subject of my hypothetical one. They will claim that the "one state solution" is a serious academic subject, whereas the question "are the Palestinians really a people?" is not. This is a pure rationalization. The question regarding the Palestinians was raised by a candidate for President of the United States and has been the subject of debate and controversy in the media and in academic writings. Both subjects are essentially political in nature and both have similarly phony academic veneers. Both conferences would be unacademically one-sided in their selection of speakers. Moreover, a great university committed to free speech and academic freedom does not get to pick and choose which political issues it deems sufficiently "correct" to warrant its imprimatur.

The only real difference between the two subjects is that if Harvard were to sponsor a one-sided conference against a Palestinian state, there would be massive protests, especially by some of the very academics who are willingly lending their imprimatur to the anti-Israel hate fest. But the charge of hypocrisy has never stopped these professors from applying a double standard against Israel. They should not be stopped from speaking—that would be censorship and a denial of academic freedom. But they should be shamed for participating in an unacademic one-sided hate conference, and for their hypocrisy in doing so in the name of academic freedom, when they would never tolerate a comparable hate conference against a Palestinian state or the Palestinian people.

Let there be no doubt that the call for a single state solution is a euphemism for ending the existence of Israel as the nation state of the Jewish people. The major proponents of this ruse acknowledge—indeed proclaim—that this is their true goal. Tony Judt, who was the academic godfather of the "one state" ploy, saw it as an alternative to Israel as the nation-state of the Jewish people, which he believed was a mistake. Many of those speaking at the Harvard conference are on record opposing the existence of Israel. Leon Weiselteir was right when he observed that the one state gambit is not "the alternative for Israel. It is the alternative to Israel."

The "one state" solution failed in the former Yugoslavia. It failed in India. And it would fail in the Mid East. That’s why most Palestinians and nearly all Israelis are against it. They favor a two state solution, as does most of the rest of the world.

Many of the speakers at this conference will rail against "a Jewish State." But they will not protest the Palestinian Constitution which establishes Islam as the only "official religion" and requires that "the principles of Islamic Sharia shall be the main source of legislation." Moreover, it establishes Arabic as the sole "official language" of Palestine. Israel, in contrast, treats Judaism, Islam and Christianity equally, does not base its laws (except regarding family matters of Jews) on Jewish law, and has three official languages—Hebrew, Arabic and English (with Russian constituting the 4th unofficial language and (Ethiopian) Amharic a 5th, manifesting its extensive ethnic diversity).

As this conference goes forward, and as the massive casualties mount in Syria, the resounding silence about the victims of the Assad brutality by those speakers ,who use the G word (genocide) every time Israel acts in defense of its citizens, speaks louder than their hypocritical words. The extremists who will be speaking at this hate fest are so obsessed with Israel’s imperfections that they ignore—indeed enable—the most serious human rights violations that are occurring throughout the world. That is the real shame of the double standard that is represented by this hateful conference.

First Posted: 1/5/12 , Huffington Post 

We here at HuffPost High School knew it all along (not to brag, or anything), but now there’s the research to back it up — a new study by the American Psychological Association recently found that blogging may have psychological benefits for teens.

The study, which surveyed 161 high school students in Israel, examined the teens’ self-esteem levels and daily social activities and behaviors after a 10-week blogging experiment. The researchers found that the teens who blogged — as compared to those who did nothing or kept a private diary — displayed greater improvements in self-esteem, social ease, and emotional well-being. The bloggers who wrote specifically about their social difficulties and those whose posts were open to comments showed the most improvement.

Although research on teens and social media usage have shown mixed results for the effect of social networking on well-being, with blogging, the generally encouraging comments on the blog posts may be a contributing factor in the teen bloggers’ lessened social anxiety and increased well-being.

The study’s co-author said, “Although cyberbullying and online abuse are extensive and broad, we noted that almost all responses to our participants’ blog messages were supportive and positive in nature… We weren’t surprised, as we frequently see positive social expressions online in terms of generosity, support and advice.”

Do you think blogging is good for teens? Have you found that comments on personal blog posts are generally positive? Share your thoughts in the comments below.

This story is taken from Sacbee / PR Newswire

Society for Integrative and Comparative Biology to Convene Annual Meeting

Published Thursday, Dec. 29, 2011

CHARLESTON, S.C., Dec. 29, 2011 — Scientists will present research on marine biodiversity, climate change, animal behavior, and rapid evolutionary changes

CHARLESTON, S.C., Dec. 29, 2011 /PRNewswire-USNewswire/ — The Society for Integrative and Comparative Biology, one of the oldest and most prestigious interdisciplinary biological organizations, will hold its annual meeting at the Charleston Area Convention Center in Charleston, SC, from Jan. 3 to Jan. 7, 2012.  More than 1500 scientists will present the latest research on animal ecology, evolution, physiology, neurobiology, and biomechanics, offering journalists a rich assortment of news and feature possibilities.

Experts from a wide array of different disciplines will convene at the meeting to discuss topics relevant to marine biodiversity, climate change, animal behavior and neurobiology, and rapid evolutionary changes.  In addition to presentations of the latest research, the conference will include events with societal implications, such as a special lecture on evolution, education, and creationism over the past decades. 

This year, the SICB highlights three society-wide symposia:

• The Impacts of Developmental Plasticity on Evolutionary Innovation and Diversification
• Novel Methods for the Analysis of Animal Movement
• Dispersal of Marine Organisms

The Impacts of Developmental Plasticity on Evolutionary Innovation and DiversificationEcologists, evolutionary biologists, physiologists, and developmental geneticists discuss Developmental Plasticity—how animals grow differently, from zygote to adult, due to changes in their environment.  For example, young male dung beetles with access to plentiful food supplies grow large horns to fight other males, allowing for eased access to females.  Conversely, male beetles with limited food do not grow horns and instead develop alternative ways to access females.  Scientists think that such plasticity helps organisms to evolve rapidly and also promotes the formation of new species.  But no one fully understands what sorts of environmental changes promote plasticity, or what genetic and physiological changes actually cause animals to grow differently. 

Novel Methods for the Analysis of Animal Movement Scientists consider new ways to understand animal and cell movements, including cell movements in the earliest stages of embryo formation, insect flight, insect migration, and whales turning and diving.  Experts in genetics, biomechanics, and ecology will present computational approaches that rely on data from microscopy, high-speed video, and radar and satellite imaging. 

Dispersal of Marine OrganismsA diverse group of scientists talk on patterns of marine animal dispersal throughout the oceans. To explain the diversity and ecology of ocean species, these researchers will examine how tiny larval organisms can find suitable habitats in which to live. These methods of movement can include  swimming or crawling, drifting with ocean currents, or hitching a ride on larger animals on drifting seaweed, or on boats.  This symposium assembles an interdisciplinary group of outstanding young and established speakers to address dispersal in marine organisms in order to foster integration and cross-talk among different disciplines and to identify gaps in scientific knowledge and areas for future research.

SOURCE Society for Integrative and Comparative Biology

Study: Autistic Children Have More Brain Cells

By Alice Park Wednesday, November 9, 2011

There’s growing evidence that the brains of autistic children are very different from the brains of other youngsters. Now a new study that found an excess of brain cells in children with autism comes closer to pinpointing the origins of the condition: in utero versus in toddlerhood.

In research reported in the Journal of the American Medical Association (JAMA), scientists at the University of California, San Diego, found that autistic children have about 67% more nerve cells in a part of the brain known as the prefrontal cortex than children without autism. The prefrontal cortex is involved in processing social skills, communication, cognitive functions and language — all areas in which autistic children often show abnormal development.

Lead researcher Eric Courchesne studied the brains of seven autistic boys between the ages of 2 and 16 after their death and compared his analysis to the brains of six unaffected boys who died at similar ages. The excess of neurons was a bit of a surprise since in most cases, deficits in social skills — like the ones autistic children typically have — are linked to less, not more, nerve tissue.

“When we think of the inability to handle complicated information, we usually think of too little in the way of connections or brain cells,” he says. “But this is just the opposite.”

MORE: Risk of Autism Is Five Times Higher in Low-Birthweight Babies

Functionally, however, the autistic children may have been suffering from a dearth of proper nerve connections since the overabundance of neurons may have led to difficulty in their ability to connect and communicate with each other. That situation, says Courchesne, could "lead to pathways that slow down or prevent normal active interaction between different regions of the brain.”

Social interaction and communication, for example, require that nerves from distant portions of the brain link up. Think of too many nerves like an overgrown forest that could choke some of these critical neural bridges.

Equally significant is the fact that the excess of neurons in the prefrontal cortex aren’t formed after birth, but during early development, in utero. That suggests that the changes responsible for autism are occurring much earlier than scientists had thought.

MORE: Could the Way We Mate and Marry Boost Rates of Autism?

“Knowing that we have a specific type of defect that occurs very early in development really helps us to focus and sharpen the next steps in research to determine what caused the excess,” says Courchesne. And hopefully find new treatments that can help children and their families cope better with the symptoms of autism.

Find this article at:
http://healthland.time.com/2011/11/09/study-autistic-children-have-too-many-brain-neurons/

© 2011 Time Inc. All rights reserved

Read more: http://healthland.time.com/2011/11/09/study-autistic-children-have-too-many-brain-neurons/print/#ixzz1dDWRdOxS

http://www.sciencedaily.com/releases/2011/10/
     111020024329.htm

IQ, the standard measure of intelligence, can increase or fall significantly during our teenage years, according to research funded by the Wellcome Trust, and these changes are associated with changes to the structure of our brains. The findings may have implications for testing and streaming of children during their school years. (Credit: © lightpoet / Fotolia)

ScienceDaily (Oct. 20, 2011) — IQ, the standard measure of intelligence, can increase or fall significantly during our teenage years, according to research funded by the Wellcome Trust, and these changes are associated with changes to the structure of our brains. The findings may have implications for testing and streaming of children during their school years.

Across our lifetime, our intellectual ability is considered to be stable, with intelligence quotient (IQ) scores taken at one point in time used to predict educational achievement and employment prospects later in life. However, in a study published October 20 in the journal Nature, researchers at the Wellcome Trust Centre for Neuroimaging at UCL (University College London) and the Centre for Educational Neuroscience show for the first time that, in fact, our IQ is not constant.

The researchers, led by Professor Cathy Price, tested 33 healthy adolescents in 2004 when they were between the ages of 12 and 16 years. They then repeated the tests four years later when the same subjects were between 15 and 20 years old. On both occasions, the researchers took structural brain scans of the subjects using magnetic resonance imaging (MRI).

Professor Price and colleagues found significant changes in the IQ scores measured in 2008 compared to the 2004 scores. Some subjects had improved their performance relative to people of a similar age by as much as 20 points on the standardised IQ scale; in other cases, however, performance had fallen by a similar amount.

To test whether these changes were meaningful, the researchers analysed the MRI scans to see whether there was a correlation with changes in the structure of the subjects’ brains.

"We found a considerable amount of change in how our subjects performed on the IQ tests in 2008 compared to four years earlier," explains Sue Ramsden, first author of the study. "Some subjects performed markedly better but some performed considerably worse. We found a clear correlation between this change in performance and changes in the structure of their brains and so can say with some certainty that these changes in IQ are real."

The researchers measured each subject’s verbal IQ, which includes measurements of language, arithmetic, general knowledge and memory, and their non-verbal IQ, such as identifying the missing elements of a picture or solving visual puzzles. They found a clear correlation with particular regions of the brain.

An increase in verbal IQ score correlated with an increase in the density of grey matter — the nerve cells where the processing takes place — in an area of the left motor cortex of the brain that is activated when articulating speech. Similarly, an increase in non-verbal IQ score correlated with an increase in the density of grey matter in the anterior cerebellum, which is associated with movements of the hand. However, an increase in verbal IQ did not necessarily go hand-in-hand with an increase in non-verbal IQ.

According to Professor Price, a Wellcome Trust Senior Research Fellow, it is not clear why IQ should have changed so much and why some people’s performance improved while others’ declined. It is possible that the differences are due to some of the subjects being early or late developers, but it is equally possible that education had a role in changing IQ, and this has implications for how schoolchildren are assessed.

"We have a tendency to assess children and determine their course of education relatively early in life, but here we have shown that their intelligence is likely to be still developing," says Professor Price. "We have to be careful not to write off poorer performers at an early stage when in fact their IQ may improve significantly given a few more years.

"It’s analogous to fitness.A teenager who is athletically fit at 14 could be less fit at 18 if they stopped exercising. Conversely, an unfit teenager can become much fitter with exercise."

Other studies from the Wellcome Trust Centre for Neuroimaging and other research groups have provided strong evidence that the structure of the brain remains ‘plastic’ even throughout adult life. For example, Professor Price showed recently that guerrillas in Columbia who had learned to read as adults had a higher density of grey matter in several areas of the left hemisphere of the brain than those who had not learned to read. Professor Eleanor Maguire, also from the Wellcome Trust Centre, showed that part of a brain structure called the hippocampus, which plays an important part in memory and navigation, has greater volume in licensed London taxi drivers.

"The question is, if our brain structure can change throughout our adult lives, can our IQ also change?" adds Professor Price. "My guess is yes. There is plenty of evidence to suggest that our brains can adapt and their structure changes, even in adulthood."

"This interesting study highlights how ‘plastic’ the human brain is," said Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust. "It will be interesting to see whether structural changes as we grow and develop extend beyond IQ to other cognitive functions. This study challenges us to think about these observations and how they may be applied to gain insight into what might happen when individuals succumb to mental health disorders."

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The above story is reprinted from materials provided by Wellcome Trust.

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Journal Reference:

1. Sue Ramsden, Fiona M. Richardson, Goulven Josse, Michael S. C. Thomas, Caroline Ellis, Clare Shakeshaft, Mohamed L. Seghier, Cathy J. Price. Verbal and non-verbal intelligence changes in the teenage brain. Nature, 2011; DOI: 10.1038/nature10514

Wellcome Trust (2011, October 20). Brain scans support findings that IQ can rise or fall significantly during adolescence. ScienceDaily. Retrieved October 25, 2011, from http://www.sciencedaily.com­ /releases/2011/10/111020024329.htm

Model special-needs park sparks overseas interest

 By Abigail Klein Leichman, Israel 21C 
October 11, 2011

Ecuador relies on Israeli expertise to plan 200 accessible, inclusive playgrounds based on Friendship Park in Ra’anana.

Photo courtesy of Beit Issie Shapiro

Friendship Park, Ra’anana.

Anybody can install a few playground swings adapted for children with physical disabilities. But that is not Israel’s vision of accessible play areas. Though they have only started taking off in the past six years, Israeli parks for children with special needs combine carefully planned physical layout with just as carefully planned companion programs geared to educating the community about acceptance and integration.

So remarkable is this formula that it has inspired the vice president of Ecuador, himself a paraplegic, to seek guidance from Israel in building 200 similar parks in his home country. Uruguay also is following Israel’s lead in this area.

"The physical and social part of the park go together strongly," says occupational therapist Michele Shapiro, a specialist in sensory therapy at Beit Issie Shapiro (BIS), an organization providing services to children with special needs, promoting research and training and changing attitudes toward people with disabilities.

Photo courtesy of Beit Issie Shapiro

Ecuadorian Vice President Lenin Moreno Garces visits Beit Issie Shapiro in Ra’anana.

"The education, programming and community outreach are what make the park successful," she tells ISRAEL21c. "Otherwise, it becomes a white elephant."

Shapiro headed the design team responsible for Israel’s first accessible and inclusive playground, built on a nine-acre area within the large Ra’anana City Park with the help of the municipality, Jewish National Fund-UK and Keren Kayemeth LeIsrael. This location lets children with and without special needs enjoy the facilities together.

Park Chaverim (Friendship Park) includes paths, swings and carousels that can accommodate a wheelchair, as well as adaptations for children (or accompanying adults) with hearing and sight impairments. Educational activities and community events foster tolerance and inclusive attitudes for children age three to 17 and their families.

Volunteers and staff from BIS help facilitate everyday interactions — and also assure kids with disabilities get first priority on the equipment, which is popular with all children.

Photo courtesy of Beit Issie Shapiro

Friendship Park, Ra’anana.

"Without any social intervention in the park and the schools, families of children with disabilities won’t enjoy the park as they should and you also won’t effect change," BIS Project Director Ronen Cohen tells ISRAEL21c.
Parents of children with disabilities rarely frequent playgrounds, he says. "After their kids come home from special education classes, they’re going from one therapy or another, they’re very tired, they have other kids to raise, and above all they are concerned about the way the community looks at them. That’s why they asked us to be there and welcome them when they come to the park."

Visitors from Ecuador

Since Friendship Park opened in 2005, BIS has given hundreds of tours to municipal officials from across Israel, and consults on the construction of similar parks.

Yet the July 2011 visit of Ecuadorian Vice President Lenin Moreno Garces stands out in Cohen’s mind. Israeli President Shimon Peres and the Foreign Ministry coordinated the tour for the wheelchair-bound Garces, accompanied by his family and a VIP entourage.

"We got the feeling it was really touching for him," says Cohen. "He took a lot of pictures and asked a lot of questions that politicians who come here usually don’t ask, and we explained all the details and the very clear vision behind the park as a place that provides inclusion."

A few weeks later, Ecuadorian Ambassador to Israel Guillermo Bassante contacted BIS and said the vice president wants to build some 200 Friendship Parks, in each city in Ecuador.

"It’s pretty amazing just as a statement, and also it’s a very ambitious thing to do," says Cohen. "I said we will be happy to give all the help we can. I recommended to begin with two or three parks as a pilot and to appoint a professional liaison for us to deal with."

In addition, the Israeli embassy in Uruguay initiated contact last year between the South American country and BIS in order to build a Friendship Park there.

Families come from all over

Years of planning preceded the establishment of Friendship Park, which quickly became a model for Israel and beyond.

The concept began with BIS founder Naomi Stuchiner. Once she had raised the necessary money, she and community social workers organized "think tanks" of parents, adults with special needs and therapists. They sought advice from the National Insurance Institute, organizations working with people with various disabilities and parents all over the world.

"When we had our answers, we put up a park that would have equipment suitable for children with any disability and also for typical children plus parents or grandparents with motor problems," Shapiro says.

"We organized it in segments as if you’re looking at a watch with a piece of equipment on each ‘number,’ each of a different color to help children with visual problems to define where they are going." Audible water elements between certain areas help children with sight impairments to orient themselves.

For this first venture, they purchased tried and tested European equipment. Israeli companies are now making the specialized apparatus for the Friendship Parks that BIS has been helping to set up in several other Israeli cities since 2009 with assistance from the National Insurance Institute, Israeli Lottery and the Shalem Fund, among others. Building a park costs about $100,000, and the funders’ ideal is to include community programming.

"Not all of them have the social side yet, and those don’t do as well as ours," says Shapiro. "Families come from all over to use our playground. There’s also a lake and petting zoo in the larger park, so all the kids in a family can enjoy it."

Special Issue: Focus on ADHD

ADHD & ODD: Confronting the Challenges of Disruptive Behavior

By CHRISTOPHER K. PETERS, MD
University of Louisville | September 9, 2009

Dr Peters is director of training in child and adolescent psychiatry and assistant professor in the division of child and adolescent psychiatry at the University of Louisville.

ABSTRACT: Disruptive behavior is the most common mental health problem seen by pediatricians. Although attention-deficit/ hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are both considered disruptive behavior disorders—and although about half of children with ADHD also meet the diagnostic criteria for ODD—the 2 disorders are distinct, having different etiologies and responding to different types of treatment. ADHD is generally viewed as a neurobiologically mediated problem, while ODD appears to have a stronger link to environmental risk factors and psycho- social stressors. Thus, when assessing for possible ODD in a child with disruptive behavior it is important to carefully investigate any psychosocial factors that may underlie the oppositional behavior. Treatment of ADHD clearly involves medication therapy. The 2 principal types of evidence-based treatments for children with ODD are individual therapy with a focus on problem-solving and social skills and parent management training. The latter is especially important; moreover, the provision of needed external regulation of behavior in the home has substantial benefits in the treatment of both ADHD and ODD.

A significant portion of children with attention-deficit/hyperactivity disorder (ADHD) first receive the diagnosis and subsequent treatment from their primary care pediatrician. Children with ADHD who present primarily with symptoms of inattention are often managed successfully by primary care clinicians. However, ADHD is often accompanied by symptoms such as hostility, defiance, and aggression. In fact, disruptive behaviors are the most common mental health problem seen by pediatricians,¹ and properly diagnosing and treating these problem behaviors is often a challenge.
In this article I address the diagnostic challenges posed by oppositional behavior in children with ADHD. I discuss approaches to evaluation and treatment that have proved particularly successful in these patients, and I provide tips on when referral may be warranted.
THE NATURE OF THE DISRUPTIVE DISORDERS

Disruptive behavior in children is not just a contemporary concern, as evidenced in this comment by Socrates: "Our youth now love luxury. They have bad manners and contempt for authority and disrespect for their elders. Children nowadays are tyrants."² The group of disorders that are currently classified by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, as disruptive behavior disorders include ADHD (all 3 of its subtypes—inattentive, hyperactive-impulsive, and combined), oppositional defiant disorder (ODD), conduct disorder (CD; both of childhood and adolescent onset), and disruptive behavior disorder not otherwise specified.³ These diagnoses share primary features of poor self-regulation and associated interpersonal difficulties. Although the diagnoses share "externalizing" symptoms, there are differences in how they are conceptualized. (Externalizing symptoms are negative behaviors that a patient displays as a means of managing internal distress; examples are fighting or running away.)
ADHD is generally viewed as a neurobiologically mediated problem that requires pharmacological treatment as a primary evidence-based intervention.⁴ ADHD is diagnosed in 3% to 7% of school-aged children3 and when untreated can be associated with significant morbidity (delinquency, drug use, poor academic success, increase in injuries). A number of diagnoses commonly occur comorbidly with ADHD: ODD, anxiety disorders, depressive disorders, learning disorders, and substance use disorders.
While the data for the neurobiological dysfunction in persons with ADHD have mounted, with links to the monoamine neurotransmitter systems and dysfunction in the prefrontal cortex now well established, there is a dearth of data demonstrating a clear role for neurobiological dysfunction in ODD and CD. Some studies cite information on the relationship between serotonergic dysfunction and impulsivity and aggression, while others point to the existence of an abnormality of arousal in the autonomic nervous system as evidence of catecholamine dysfunction. Nonetheless, ODD and CD remain less well understood from a biological standpoint and appear to have a stronger link to environmental risk factors and psychosocial stressors.
Despite these etiological differences, ADHD often involves more than its core features of attention deficits, impulsivity, and hyperactivity. Clinicians routinely see children whose parents are challenged by their child’s tantrum behaviors, poor frustration tolerance, and defiance.³ These behaviors are often best understood as resulting from biological vulnerabilities of the child that may be exacerbated by problematic family/parental responses. Understanding the relationship between oppositional and inattentive behaviors has critical importance for management decisions.
Although CD has been more systematically studied, the focus in this article will not be on children with this more serious disorder, who, by definition, intrude on the basic rights of others, break laws, and commit crimes. Instead, I have chosen to focus on ODD in order to help primary care clinicians better understand and intervene with children before severe conduct problems develop.

DIAGNOSING ODD IN CHILDREN WITH ADHD
Although some of the criteria for the diagnosis of ODD were established somewhat arbitrarily, the current ODD diagnostic criteria (Table 1) are the best method we have for identifying children who have additional difficulty with self-regulation. Between 40% and 70% of children with ADHD also meet the diagnostic criteria for ODD or CD.^4-6 In a study of preschoolers with ADHD, just over 50% were found to also have a diagnosis of ODD.⁷ To put these figures in perspective, consider that in a group of school-aged children who may or may not have ADHD, the prevalence of ODD may be between 1% and 16%,⁸ or with strict application of diagnostic criteria, between 2% and 3%.⁹

The comorbidity of ODD and ADHD seems to be bidirectional.
The clear overlap of symptoms blurs somewhat the lines of distinction between the 2 disorders and raises a number of questions for the clinician. Where does one disorder begin and the other end? Is it possible that ODD is a by-product of severe ADHD? Is there a common pathway to the evolution of disruptive behavior diagnoses? Is it possible to improve ODD symptoms simply by treating a child’s ADHD?
For primary care clinicians, the importance of identifying co-occurring disorders, such as ODD and ADHD, lies in the possibility of earlier intervention, which has a greater likelihood of having an impact than does the treatment of a more enduring pathology, which may develop if intervention is not timely.
Criteria for an ODD diagnosis.
The diagnosis of ODD requires that a child display several symptoms of antagonism and hostility, have impairment in daily function, and have symptoms/behaviors in excess of what would be expected for a developmentally matched peer—all for more than 6 months.³
The symptoms should not be better accounted for by another mental illness (eg, psychotic disorder in a paranoid child who refuses to eat, or separation anxiety disorder in a child who refuses to attend school)—nor should oppositionality and defiance be symptoms of a biologically mediated illness (eg, autism, schizophrenia).¹⁰
The ODD diagnosis from a developmental perspective.
Consideration of how children acquire self-regulation in the course of normal development can help one to better understand how disruptive behavior evolves. Toddlers, in an effort to develop some independence, display expected poor self-regulation at times (hence the expression "terrible twos"). This is a normal developmental process that assists with the acquisition of new skills for self-soothing and managing unpleasant mood states. We do not consider a diagnosis of ODD in a child who is in this developmental phase. However, if, as the child ages, he or she fails to assimilate new skills and continues to have tantrums and external expressions of emotional instability, defiance, and hostility, then it is appropriate for the family to seek assistance.
RISK FACTORS FOR ODD
A multitude of factors may affect the development of certain disorders. A child may have certain vulnerabilities that contribute to the development of a disorder—or strengths that protect against it. The risk factors and protective factors associated with ODD are summarized in Table 2.

The cases featured in this article (Case 1, Case 2, Case 3) indicate different pathways to the same end: they show how different environmental factors impinging on children with individual differences all can fuel the evolution of ODD. These cases provide a springboard for a discussion of family interactional factors that may contribute to the evolution and maintenance of disruptive behavior.
TJ’s mother (see Case 1), because of her own guilt about her failed marriage, had become an indulgent parent. She failed to maintain boundaries, limits, and expectations because of her discomfort "to see her child in distress." TJ’s internal working model of the world was thus one that reinforced immediate gratification; his acquisition of frustration tolerance and self-soothing had been thwarted. ADHD symptoms contributed to his oppositionality and defiance, probably because he needed more structure and limits to contain his impulses.

AT’s situation (see Case 2) illustrates several common reactions of parents who have exhausted their efforts to attempt to manage disruptive behavior. AT’s parents were more comfortable using authoritative approaches to effect change, and once these methods failed, they were at a loss about what to do. Her father’s frustration and sense of powerlessness were evidenced by his comment that "my father would have beat me if I acted this way, but we can’t treat kids like that anymore." AT’s parents did not err on the side of indulgence; rather, they lacked an awareness of the power of positive reinforcement and praise. Their anxiety about losing control led to their reactive, harsh parenting stance.

JS and his siblings (see Case 3) illustrate the challenges a chaotic home presents for the children who live there. Their mother’s consultation with a psychiatrist seemed to be a turning point. When she received a diagnosis of ADHD and began treatment, her parenting improved. The home became a more predictable environment, and the increased structure was associated with calming of all the children’s disruptive behavior.

These cases suggest that children’s disruptive behavior (ADHD and ODD) can arise via different pathways. However, these different paths of development share a common interactional end point: the need for familial environments that provide external regulation of behavior

EVALUATION OF A CHILD WITH DISRUPTIVE BEHAVIOR
When assessing children who exhibit negative behavior, it is important to try to understand the context of the symptoms. It would be helpful if there were a biological test or a psychological test that was reliable and valid for diagnosing any of the disruptive disorders. However, the reality is that the most important aspect of the evaluation process is the psychiatric examination. Table 3 proposes an outline for an assessment focused on understanding a child’s disruptive behavior.

When meeting with families who are dealing with severely disruptive behavior, you may find it challenging to take the time necessary to fully understand the depth and breadth of a problem. Our health care system favors rapid assessment and quick interventions; however, at times like this, these are not what is needed. When assessing younger children, it may be prudent to meet with the parents without the child to obtain additional information. Conversely, it may be important in older children or adolescents to meet separately with them to establish rapport before meeting with their parents. After the interview process, a physical examination is indicated to rule out medical causes of disruptive behavior, however rare these may be (Table 4).

Simple assessments, such as vision and hearing tests, can sometimes obviate unnecessary interventions. In older children and adolescents, it is important to assess for substance use, as well as any severe sleep-related difficulties. Exploring the influence of language and cultural factors, when appropriate, may also lead to understandable explanations for behavioral difficulties. ADHD, ODD—or both? Because so many children and adolescents with ADHD receive a diagnosis of ODD, it can be difficult to determine how distinctly separate these 2 disorders are. Newcorn and Halperin⁶ discuss the challenge of differentiating ADHD from ODD and CD because of considerable symptom overlap; however, they suggest that there is evidence that ADHD and ODD/CD do not represent variations of a single entity. Still, several studies reviewed by these researchers suggest that children with ADHD are at increased risk for the development of ODD and CD. The assessment of a child with ADHD must therefore include a careful assessment of risk factors and protective factors related to ODD and CD (see Table 2). Not only does this process result in a more accurate diagnosis, it provides a starting point for interventions.

Evaluating underlying psychosocial factors.
Although biological vulnerabilities may underlie certain disruptive symptoms (eg, aggression, impulsivity), there is currently no evidence for a unifying, valid biological explanation of the origin of oppositional and defiant behaviors.¹¹ This reality underscores the importance of a careful investigation of the psycho- social factors that underlie oppositional behavior (Table 5), as exemplified in the cases presented here.

The developmental aspects of separation-individuation are often awry in patients with ODD. The 2 periods when developmentally appropriate interpersonal antagonism is most commonly seen are the toddler years and early adolescence. An assessment must thus consider the question of whether, in some patients who present with the chief complaint of oppositionality and defiance, the behavior represents normal development. The diagnosis of ODD rests on the clinician’s determination of impairment and his or her own perception of how developmentally deviant the behavior has become.
To test or not to test?
Although the clinical interview is at the core of an evaluation for disruptive behavior, psychological testing is a valuable supplement that is designed to support clinical judgment.¹² Psychological testing can be helpful in sorting out diagnoses.
The most commonly used psychological measures in the primary care outpatient setting are rating scales. These are filled out by older patients, patients’ parents, and patients’ teachers. The Conners Rating Scales and Vanderbilt Rating Scales, which are used to evaluate for ADHD, also assess oppositional and conduct-related difficulties. The scales can be scored quickly and help with sifting through the differential diagnosis.
Further assessment is typically done when requested by a clinician having difficulty in distinguishing between multiple conditions, especially if learning difficulties are involved. When making a request for psychological testing, it is important to be specific about the nature and purpose of the assessment being sought. For example, asking for help with the differential diagnosis is different from asking, "Can you assist with evaluating for the presence of a reading disorder in this child, who has ADHD, combined type?"
Helpful components of a psychological assessment of a child with a disruptive behavior disorder may include the child behavior checklist, a learning evaluation, and projective tests (eg, Rorschach test, thematic apperception test) to evaluate for sources of oppositional behavior.

TREATING ADHD WITH COMORBID ODD
After a thorough assessment establishes the presence of ODD as a comorbid diagnosis in a child with ADHD, the next questions are "what to do?"and "what to treat first?"
Treatment of ADHD.
Recommendations for the treatment of ADHD clearly involve medication treatment, usually starting with the psychostimulants.⁴ There are also nonstimulants that can be used, such as the FDA-approved atomoxetine(Drug information on atomoxetine), as well as off-label uses of a2-agonists (guanfacine, clonidine(Drug information on clonidine)), tricyclic antidepressants (eg, imipramine(Drug information on imipramine)), and bupropion.
Whatever the initial choice, there is usually appropriate apprehension on the part of parents and some physicians about using psychoactive agents in children. There has been increasing scrutiny of the true value of medication in childhood psychiatric disorders.¹³ However, the NIMH Multimodal Treatment Study of Children with ADHD (MTA) provided strong reinforcement of the need for medication to adequately treat ADHD.
It is with this realization that clinicians treat ADHD with medication while at the same time enlisting psychosocial therapies to address a patient’s oppositional-defiant behavior. The MTA established that combining psychostimulant treatment with psychosocial interventions (ie, behavioral therapy) was helpful when treating ADHD with comorbid disorders.⁴ The combination of medication treatment and behavior therapy may have led to less decompensation when medication was not taken, as well as contributing to the use of lower doses of psychostimulants.¹⁴ Although oppositional and defiant behaviors may improve as a child’s ADHD responds to medication, the expectation that "just"medication can be used to treat the majority of children with ADHD does not acknowledge the common co-occurrence of psychosocially mediated symptoms that require psychosocial treatments.
Treatment of comorbid ODD.
When addressing the additional concerns of disruptive behavior, it is important to look beyond medication. When ADHD and ODD co-occur in the same child, a biopsychosocial etiology is implied, necessitating a multimodal treatment approach.
The primary care pediatrician plays a critical role in the inauguration of psychotherapeutic interventions. Referring a child for psychiatric consultation and/or psychotherapy invariably taps into the family’s attitudes about mental health issues. The pediatrician’s attitudes and beliefs can be powerful contributors to the perception that patients and their parents have regarding mental health care.
Be especially careful not to blame the families dealing with the disruptive behaviors. Focusing on the interventions instead may improve the likelihood of their following through with a referral. To achieve this nonblaming attitude, it is helpful to keep in mind that the problematic behaviors are interactional in nature: "problematic parenting can be elicited by a ‘difficult’ child and, at the same time, can create problems for a child."¹⁵
Given this interactional model, it is not surprising that the 2 types of evidence-based treatments for patients with ODD are individual therapy with a cognitive behavioral focus on problem-solving skills and parental intervention in the form of parent management training (PMT).
Establishing a relationship with a child and adolescent psychiatrist can facilitate treatment planning. Such a person can direct the pediatrician to therapists who are versed in both family and individual therapies.
Parent management training.
While the chief goal in working with disruptive children is to enhance their own self-confidence in their ability to manage impulses and negative emotions, this can seldom be achieved without working with the child’s family. The first step therapists typically take in working with the families of children with disruptive behavior who have been referred to them is to pursue PMT. PMT is one of the most substantiated interventions in child mental health.^8,16,17 As psychopharmacological interventions are to ADHD, so PMT is to ODD. The goal of PMT is to help parents establish a more focused approach to consistency and predictability, which promotes pro- social behavior in their child. Without a positive relationship with or attachment to the child, it becomes very difficult to establish lasting change in negative behavior. PMT teaches ways to reward children (eg, surprise rewards after desired behavior, anticipated rewards). Parents learn to value praise and their relationship with their child as powerful tools for managing disruptive behavior. Finding opportunities for the parent and child to interact in healthier ways can inject much needed positive energy into a relationship that probably has been composed solely of negative interactions.
Parents are taught about limit setting, active ignoring, consequences, and communication, as well as uses of  "time outs."
Webster-Stratton and Hancock state that "consistent limit setting and predictable responses from parents help give children a sense of stability and security . . . children who feel a sense of security regarding the limits of their environment have less need to constantly test it."¹⁸ It is important to remind parents that all children test parents’ rules and that, by upholding the rules, parents play a significant role in helping their child develop self-regulation. Parents should be reminded that much of effective limit setting is simply a matter of acquiring and practicing skills, a process not so different from that of learning a sport or a musical instrument.
It is important to discuss with parents the need for appropriate expectations regarding the timeline of their child’s response (weeks to months). Parents also need to be aware that symptoms of disruptive behavior tend to increase when the family system is changing. For example, as parents change their approach to handling inappropriate behavior, the child may become defiant to test their resolve. Preparing parents for these new stressors and helping them to view them as predictable and part of the therapeutic process is critical in maintaining their commitment to change. Some parents benefit from recommendations for adjunctive educational materials. Television shows, such as Supernanny, or parenting books, such as 1,2,3 Magic, can reinforce the skills learned in therapy.
Individual therapy for ODD. Individual work with patients with ODD is usually most effective in children of school age and older. The older the child, the more likely he will be to benefit from problem-solving skills training and social competency training. Therapy usually begins with alliance building—a challenge with children with ODD. The next step is usually to introduce a skill, to model and role-play the skill, and then to try to connect the skill to the patient’s day-to-day challenges. Patients typically are given homework assignments, such as "stop, think, and act"instructions for younger children and practice in thought monitoring for older children and adolescents.¹⁹
When PMT and individual therapy are not effective. Despite efforts to provide appropriate avenues of treatment for disruptive behavior, some families and children struggle to respond to PMT, social skills training, and problem-solving training. In such situations, a higher level of care is needed. Josephson and Serrano²⁰—and other researchers²¹—have found that when parents do not effectively use parent management techniques, it is often because of complex individual and marital dynamics—and even diagnosable disorders. In such cases, it may be necessary for the primary care clinician to refer the family to a larger mental health system (eg, an academic center or a community mental health center).
What about using medication to treat ODD? When disruptive behavior is associated with other principal diagnoses, it is clear that medication can help.⁴ However, when disruptive behavior is clearly a manifestation of ODD, medication plays no role in definitive treatment. When severe and persistent ODD develops into CD, then psychopharmacological interventions to assist with severe mood dysregulation and severe aggression may be warranted, along with referrals for higher levels of care (partial programs, inpatient treatment, and residential care).

TREATMENT OUTCOMES IN 3 CASES
In Case 1, adequately treating TJ’s ADHD did very little to mitigate the indulgent strategies that his mother used to assuage her own guilt and coercively minimize acute problems. She did not realize that she was impeding TJ’s development of self-regulation. Through PMT and individual therapy to help her see the role her own thoughts and emotions played in maintaining her son’s behavior, TJ’s mother was able to make strides in creating more appropriate limits and boundaries. Although TJ continues to have challenges, he is showing progress.
In Case 2, AT’s parents had been struggling with a lack of confidence in their parenting methods, and they responded well to PMT.

In Case 3, JS engaged well with the therapist and began to try out new ways of self-managing his anger and frustration. He also benefited from his mother’s response to her own treatment for ADHD.
Although not every case is a success story, with better understanding of the interactional components of ODD, primary care pediatricians can provide more appropriate interventions and will be more likely to elicit the needed change. While the major goal of working with disruptive patients is to enhance their own self-confidence in managing impulses and negative emotions, this cannot occur without working with the context within which these children live—that is, their families.

REFERENCES

1. Fravenglass S, Routh DK. Assessment of the disruptive behavior disorders: dimensional and categorical approaches. In: Quay HC, Hogan AE, eds. Handbook of Disruptive Behavior Disorders: Dimensional and Categorical Approaches. New York: Kluwer Academic/Plenum Publishers; 1999:49-71.

2. Finch AJ Jr, Nelson WM III, Hart KJ. Conduct disorder: description, prevalence and etiology. In: Nelson WM III, Finch AJ Jr, Hart KJ, eds. Conduct Disorders: A Practitioner’s Guide to Comparative Treatments. New York: Springer Publishing; 2006: 1-13.

3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Arlington, VA: American Psychiatric Publishing, Inc; 2000:83-103.

4. The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56:1073-1086.

5. Perepletchikova F, Kazdin AE. Oppositional defiant disorder and conduct disorder. In: Cheng K, Myers KM, eds. Child and Adolescent Psychiatry: The Essentials. Philadelphia: Lippincott Williams & Wilkins; 2005:73-88.

6. Newcorn JH, Halperin JM. Attention-deficit disorders with oppositionality and aggression. In: Brown TE, ed. Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults. Washington, DC: American Psychiatric Press, Inc; 2000:171-207.

7. Greenhill L, Kollins S, Abikoff H, et al. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD [published correction appears in J Am Acad Child Adolesc Psychiatry. 2007;46:141]. J Am Acad Child Adolesc Psychiatry. 2006;45:1284-1293.

8. Steiner H, Remsing L; Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:126-141.

9. Angold A, Costello EJ. Toward establishing an empirical basis for the diagnosis of oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 1996;35:1205-1212.

10. McHugh PR. Striving for coherence: psychiatry’s efforts over classifications. JAMA. 2005;293: 2526-2528.

11. Burke JD, Loeber R, Birmaher B. Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry. 2002;41:1275-1293.

12. Quinlan DM. Assessment of attention-deficit/ hyperactivity disorder and comorbidities. In: Brown TE, ed. Attention-Deficit Disorders and Comorbidities in Children, Adolescents, and Adults. Washington, DC: American Psychiatric Press, Inc; 2000:455-507.

13. Mayes R, Bagwell C, Erkulwater J. Medicating Children: ADHD and Pediatric Mental Health. Cambridge, MA: Harvard University Press; 2009.

14. Pappadopulos E, Jensen PS, Chait AR, et al. Medication adherence in the MTA: saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. J Am Acad Child Adolesc Psychiatry. 2009;48:501-510.

15. Peters CK, Josephson AM. Understanding and managing adolescent disruptive behavior: a developmental family perspective. Psychiatr Times. 2009; 26(2):42-47.

16. Kazdan AE. Parent Managed Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents. New York: Oxford University Press; 2005.

17. Mabe PA, Turner MK, Josephson AM. Parent management training. Child Adolesc Psychiatr Clin N Am. 2001;10:451-464.

18. Webster-Stratton C, Hancock L. Training for parents of young children with conduct problems: content, methods, and therapeutic processes. In: Briesmeister JM, Schaefer CE, eds. Handbook of Parent Training: Parents as Co-Therapists for Children’s Behavior Problems. 2nd ed. Hoboken, NJ: John Wiley & Sons; 1989:99-152.

19. Bloomquist ML, Schnell SV. Social competence training. In: Bloomquist ML, Schnell SV, eds. Helping Children With Aggression and Conduct Problems: Best Practices for Intervention. New York: Guilford Press; 2002:117-143.

20. Josephson AM, Serrano A. The integration of individual therapy and family therapy in the treatment of child and adolescent psychiatric disorders. Child Adolesc Psychiatr Clin N Am. 2001;10:431-450.

21. Weissman MM, Pilowsky DJ, Wickramaratne PJ, et al; STAR*D-Child Team. Remissions in maternal depression and child psychopathology: a STAR*D-child report [published correction appears in JAMA. 2006;296:1234]. JAMA. 2006;295:1389-1398.

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