October 30

Infant Mental Health Screen-a Gov-approved Assault

AHRP board member, Dr. Karen Effrem, a pediatrician turned public advocate for children, has connected the dots of a disturbing concerted campaign to drag young children-even infants–into a mental health dragnet.

The players include:  government officials, drug companies and their beneficiaries within the mental health “advocacy” community who have become stakeholders in increasing the labeling and drugging of children.

The blueprint was formulated in the President’s New Freedom Commission Report.
That Orwellian nightmare is being implemented even as the evidence demonstrates that the psychiatry’s practice guidelines are corrupted by
industry.  And even as the evidence shows the treatments prescribed for children are causing harm.
Contact: Dr. Karen Effrem

Vera Hassner Sharav

veracare@ahrp.org <mailto:veracare@ahrp.org>

In the last several weeks, the corporate media has begun concertedly touting the benefits of infant mental health.  The Wall Street Journal published a warm fuzzy story about how brain research is giving new insights into the workings of babies’ minds and how therapy can correct problems early (the story and AHRP board members unpublished response are below).  Both the CBS

Early Show and Good Morning America
<http://abcnews.go.com/GMA/OnCall/story?id=2640591&page=1> ran similar stories recently.  The Good Morning America story actually wants us to believe the ludicrous idea that one in forty babies are depressed.  (See AHRP infomail <https://ahrp.org/cms/content/view/387/31/>  for more information and vote in the online poll against giving babies Prozac here
<http://abcnews.go.com/GMA/OnCall/story?id=2640591&page=1> ).
This media effort seems to be timed to promote this preposterous, unscientific and very dangerous idea of infant mental health screening and
treatment right before Congress reconvenes this week to finish their work on the appropriations bills.  There are at least seven different programs that fund and promote mental health screening and two that are specifically involved with infant mental health screening.

The two infant programs are called the State Early Childhood Comprehensive System which admits, despite protestations to the contrary from Congress and SAMHSA, that the plan is to mentally screen ALL children from birth to age five.  This is funded in the Maternal and Child Health Block Grant.  The other program is called Foundations for Learning funded under No Child Left Behind that proposes to screen and treat children birth to age seven AND their families if they show any kind of behavior problems or are AT RISK of developing these problems.  (For more details click here <http://www.edwatch.org/pdfs/FY2007-MH-cuts.pdf>  and see the letter to President Bush <http://www.edwatch.org/updates06/082206-letter.htm> written by Dr. Effrem to which AHRP was a signatory.)

Besides being so obviously counterintuitive, these programs are dangerous for several reasons:

1) If psychiatric experts and groups like the US Surgeon General and the authors of the Diagnostic and Statistical Manual admit, respectively, that the diagnostic criteria for adult mental illness are “value judgments based on culture” and “subjective,” how can one accurately identify problems in non-verbal infants?

2) Despite the fact that only one of the three stories mentions drugs in a related poll, and that the greater emphasis is on therapy for infants and
their parents,  children have been put on more and more toxic drugs at younger and younger ages.  The 2000 study by Zito and colleagues noted that 3000 prescriptions for Prozac were given to infants during the period studied.  The 2006 Vanderbilt showed that 2.5 million American children are being  given antipsychotics, none of which were approved for children until Risperidal was approved as a chemical straitjacket for children with autism a few weeks ago without a public hearing.  The youngest in that study was 18 months old.  USA Today’s review of adverse drug reactions found 45 deaths from these toxic drugs with the FDA admitting that 45 may only represent one to 10 percent of the total.

3)  The most disturbing factor is that these programs put government entities in charge of what is normal mental health, parenting, and family
life even including home visitors that invade the sanctity of the home to monitor families in how they raise their children.  (For more details on the lack of scientific evidence for and constitutional problems with these programs, see Dr. Effrem’s written testimony to Congress about these
programs here <http://www.edwatch.org/pdfs/102306-Response.pdf> .)

Congress will be finishing work on the appropriations bills this week that was not completed before the election. Among them will be the Labor/Health and Human Services/Education bill.  If you want to protect the minds and bodies of our youngest citizens, it is imperative that you contact, by phone if at all possible, your own members of Congress (House member and two Senators) to register your strong opposition to federal funding for these ridiculous infant mental health programs.  Also please contact the following members of Congress in leadership positions:

US House Majority Leader John Boehner at 202-225-6205 House Appropriations Subcommittee Chairman Ralph Regula at 202-225-3876
US Senate Majority Leader Bill Frist at 202-224-3344
Senate Appropriations Committee Thad Cochran at 202-224-5054

October 27, 2006
Wall Street Journal
To the Editor,

Elizabeth Bernstein’s October 24th article that uncritically promoted the
concept of infant mental health is deeply disturbing for several reasons.

First, agreement on valid diagnostic criteria for infant mental health is
nowhere near the level portrayed in the article. Dr. Benedetto Vitiello,
chief of child and adolescent psychiatry at the National Institutes of
Mental Health has admitted the “diagnostic uncertainty surrounding most
manifestations of psychopathology in early childhood.”

The National Center for Infant and Early Childhood Health Policy said in a
2005 paper, “Diagnostic [mental health] classifications for infancy are
still being developed and validated.”

Secondly, and very dangerously, this article will be used as an excuse to
expand state and federal universal mental health screening programs based on
these unscientific criteria that have arisen as a result of the President’s
New Freedom Commission on Mental Health.  The State Early Childhood
Comprehensive System is funded through the Maternal Child Health Block Grant
in 48 states.

This program is described in Minnesota documents as a “.federally-funded
grant project to coordinate and integrate early childhood screening systems
to assure that all children ages birth to five are screened early and
continuously for the presence of health, socioemotional [mental health] or
developmental needs.”  Both Indiana and Illinois have passed laws and are
implementing plans for the mental health screening of all children birth to
age twenty-one based on these federal reports and programs.

Thirdly, articles like this will further fuel the already alarmingly high
and medically unjustifiable rates of psychotropic drug use in young
children.  The 2000 study by Zito that found a 300% increase in the rates of
psychotropic drug use of two to four year old children between 1991 and
1995, also showed three thousand prescriptions for the antidepressant Prozac
in infants less than one year old.  Four to ten million children are on
psychostimlants like Ritalin.

A government study released this month found serious side effects in 40
percent of preschoolers studied and another 10 percent dropped out due to
intolerable side effects.  Two-and-a-half million children are on
antipsychotic drugs that are not FDA approved for use in children, except
for Risperidal, which was just approved as a chemical straitjacket for
autistic children with irritating behavior without a single public hearing.
These antipsychotic drugs, associated with a shortened lifespan, have caused
at least forty-five deaths in children, the youngest being four years old,
and the FDA admits that 45 may only represent one to ten percent of the

Finally, according to many of the same experts cited above, as well as
numerous other independent studies, there is no evidence of long-term safety
or effectiveness of either drug or non-drug therapy in these young children.
These experts cannot even agree on outcomes saying, “Broad parameters for
determining socioemotional outcomes are not clearly defined.”

A broad and growing coalition of national groups, including The Alliance for
Human Research Protection, EdWatch, ICSPP, and the Association of American
Physicians and Surgeons has formed to speak out against this scientific and
ethical outrage being perpetrated against our children by the
psychopharmaceutical establishment.

One would hope psychiatry, government, and the Journal would listen and “do
no harm.”

Dr. Karen Effrem

Wall Street Journal
Sending the Baby To a Shrink
Expanding Field of Infant Mental Health Aims To Head Off Depression and Other Disorders
October 24, 2006; Page D1

Jean M. Thomas, a Washington, D.C., psychiatrist, recently saw a patient who
was struggling with her emotions. She was agitated and couldn’t stop crying.
She was recovering from an eating problem and had trouble forming

She was 11 months old.

Therapists are increasingly moving their treatments from the couch to the
crib. While the field of infant mental health — which encompasses the study
of children from birth through age three — has been around for decades, new
research on everything from brain development to maternal depression is
giving it a boost. A widely used mental health and development diagnostic
manual for infants was revised last year for the first time since 1994 to
include two new subsets of depression, five new subsets of anxiety disorders
(including separation anxiety and social anxiety disorders) and six new
subsets of feeding behavior disorders (including sensory food aversions and
infantile anorexia).

By starting treatment as soon as possible — even before their patients are
out of diapers — doctors feel they are helping kids become better adjusted.
But the field is also getting a push from anxious parents, who are
increasingly eager to catch serious problems, such as autism or anxiety
disorders, in their children as early as possible. Indeed, doctors are
finding that they can recognize the signs of some of these problems earlier
— sometimes in infants as young as one.

“Early intervention can make a difference,” says Dr. Thomas, who practices
at Children’s National Medical Center in Washington, D.C.

The growing understanding of the baby’s mind is leading to new therapies
that address a variety of issues, including sleep and eating problems and
excessive crying. What they all have in common is that they focus on the
relationship between the baby and the primary caregiver — usually the
mother, but sometimes also the father and even the nanny. “It’s very
important to meet with who the baby is in love with,” says Christine
Anzieu-Premmereur, a psychiatrist and director of the Parent-Infant Program
at Columbia University College of Physicians and Surgeons.

While many of these therapies were initially designed to help kids with
early signs of emotional problems, more and more they’re being utilized by
parents of healthy babies seeking assistance with common parent-infant
issues, such as toilet training and separation anxiety.

Psychologists at the Marycliff Institute in Spokane, Wash., and the
University of Virginia have developed a specific course of group therapy
called “Circle of Security,” to help new parents understand their attachment
to their own parents and how it affects their developing relationship with
their baby. Parents and their babies meet once a week for 20 weeks, and each
family is videotaped interacting for a half hour, with the parent
periodically leaving the child and returning. The group watches the
videotape from a different family each week, studying how the child
expresses its needs and how the parents react.

“If parents can reflect on where the struggles are, they will do a better
job of parenting,” says Kent Hoffman, one of the therapy’s creators.
Currently, Circle of Security — which is practiced at approximately 10
universities in the U.S., as well as an additional six abroad — has been
used by a variety of clients, from doctors and their families to mothers in

The growing demand from parents for infant mental-health services is, in
turn, driving a rapid expansion in the field. While no one tracks the number
of infant mental health professionals, the World Association for Infant
Mental Health, an organization that seeks to educate early-childhood
professionals, currently has 44 affiliate organizations around the world,
more than double the number it had in 1996. This year alone, new groups
formed in Nebraska, New Zealand, Portugal and Latvia.

In the U.S., there are new graduate programs that aim to train professionals
in the field — including one that started last month at Seton Hall
University, in South Orange, N.J. — and new academic journals, such as the
Journal of Early Childhood and Infant Psychology and the Journal of
Developmental Processes. Two years ago, the Michigan Association for Infant
Mental Health created a system to give accreditation to professionals who
have completed specific coursework in the field and passed other
requirements. Currently, the system is in the process of being adopted by
four other state infant mental-health associations: Texas, New Mexico,
Oklahoma and Arizona.

The growth in the field comes as experts increasingly demonstrate that the
emotional and social development of young children is every bit as important
as their motor and cognitive development. “Those first few years are
unprecedented in the life cycle for how rapidly the changes occur, as well
as for the complexity of the changes,” says Charles Zeanah, a professor of
psychiatry at Tulane University, and author of the “Handbook of Infant
Mental Health.” “The experiences that young children have are very

Doctors, of course, have been studying the cognitive development of children
for many decades. In the late 1960s, Selma Fraiberg, a researcher at the
University of Michigan, began examining the infant-caregiver relationship.
She coined the phrase “ghosts in the nursery” to denote emotional patterns
that parents bring with them from their own childhood, and created services
for vulnerable babies and their families as well as one of the first
training programs for professionals in the field.

Since then, research has shown that a baby’s environment affects both its
psychology and its neurobiology. If a mother is depressed, for example, her
baby may become listless and nonresponsive. Additionally, studies show that
negative experiences during infancy can alter brain chemistry. Experts
understand that many adult disorders — such as depression, anxiety or
attention-deficit hyperactivity disorder — start in childhood, and
increasingly can recognize them as early as late infanthood or early

Doctors have developed an integrated roadmap of what an infant’s healthy
emotional, social and cognitive development should look like. “By
understanding the building blocks of healthy development, we can see when a
baby is going off the healthy pathway,” says Stanley Greenspan, a clinical
professor of psychiatry, behavioral sciences and pediatrics at George
Washington University’s medical school and author of “Infant and Early
Childhood Mental Health,” which lays out risk factors for specific disorders
as well as explicit interventions for each one.

Next month, the Interdisciplinary Council on Developmental and Learning
Disorders, a nonprofit organization of which Dr. Greenspan is the chairman,
will release a report in conjunction with the U.S. Centers for Disease
Control that will offer guidance on early identification and preventive

Many babies who show up at a therapist’s office have no serious issues. “The
parents got the message that these are the critical years, and it’s caused a
lot of anxiety,” says Claire Lerner, director of parenting resources at Zero
to Three, a Washington-based infancy educational group that published the
newly revised diagnostic manual. “They’re watching for every marker.” She
says that good therapy can still help a healthy child: “It’s an opportunity
for parents to tune into their child, understand what makes him tick and to
develop strategies to help him thrive.”

In Washington, Dr. Thomas sees babies who have physical or psychological
problems as well as babies with parents whose expectations are out of sync
with the child’s abilities. “What if the parent expects the child to sit at
six months and the child is not sitting?” she says. “The parent might worry
that the child is delayed or retarded. They might pressure the child and
then the child gets frustrated.”

Dr. Thomas practices “early childhood family-based therapy” in which she
observes the parents with their baby — both while she is in the room as
well as through a one-way mirror — and points out what pleases and what
frustrates the child. Often, she gives the parents a daily homework
assignment, such as setting a timer for every 20 minutes while the baby is
awake and then, when it rings, finding some small activity that both baby
and parent can enjoy, such as following the child’s lead in play. “This is
about helping the parent and the child have good experiences together that
are going to be driving healthy development,” says Dr. Thomas.

The cost of infant mental-health therapy varies, but generally runs between
about $85 to $250 per session. Typically, insurance will not cover it unless
one of the participants — either parent or child — is given a diagnosis.
But some therapists say they are reluctant to give the baby a diagnosis.

For Elizabeth Thomason, the price was worth it. After her son Peter was
born, she had trouble bonding with him — the labor had been difficult, he
had an intestinal problem that required surgery and refused to sleep, and
the overwhelmed new mom fell into a post-partum depression. “He was not
getting a lot from me — I just fed him, changed his diaper, put him to
bed,” says Ms. Thomason, 32, who worried that her depression would
permanently affect her baby. “There was no joy.”

When her therapist suggested she see a clinical social worker who
specializes in infant mental health, she quickly agreed. Once a week for
about five months, the infant specialist came to Ms. Thomason’s home and the
two women discussed the baby’s issues, how Ms. Thomason was feeling about
her baby and different techniques to soothe him. “She helped us get the
dialogue going between us,” says Ms. Thomason. “Just having someone there to
listen was huge.”

Write to Elizabeth Bernstein at elizabeth.bernstein@wsj.com




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