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Guest Editorial: The Perfect Cultural Storm For A Tragedy by Dr. David M.Brady

Dr. David M.Brady
Naturopathic medical physician
Clinical Nutritionist

For those of you with your nerves still frayed and hearts broken over the horrific act of violence in Newtown, the holiday season was a very difficult one this year, and particularly so for those of us here in the neighboring communities of Connecticut. However, while we may all want to forget about it and move on, this incident had better not be forgotten so easily like those that have happened prior. It had better be a call to action on a multitude of fronts or these precious children and adult educators will be added to the long list of those who have recently died in vain. There are a multitude of cultural issues facing us as a society that we simply can no longer delay facing and effectively dealing with head-on.

The immediate reaction to tragedies like this latest one is to concentrate on gun access and availability. No matter what side of the issue you are on politically on the Constitutional right to bear arms, it is becoming impossible to rationally support the need for public access to semi-automatic assault rifles, high capacity magazines, and military-style ammunition. Their only real purpose, by design, is to kill lots of people very quickly. There is a big difference between defending rational rights to gun ownership, and even concealed weapon permits, versus private access to military-style weapons. However, regardless of these issues, the guns remain the low-hanging fruit in this conversation. Other issues are equally, if not more, important and responsible for creating an environment for this kind of situation to occur.

The constant exposure to violent video games, movies, TV shows, and music of our children during their developmental years creates desensitization to violence and, in a small number of subjects, a tolerance for actually committing these kinds of acts as a way of living out for real what they do on the television or computer screen on a daily basis. Would anyone really be surprised if next year you can buy a video game where the theme is a person with an assault rifle entering a school to shoot up the place?

The breakdown of the family unit which has occurred in the past several decades is yet another issue that must be honestly evaluated. This is complex and due to many issues such as the steep rise in divorce, escalating numbers of births by single mothers, and fatherless homes being the norm in large segments of our population, and all are clearly taking a toll on our children. Declining spirituality and faith, and the aggressive, and many believe excessive, level of politically-correct secular pressure to defer from categorizing anything as unacceptable behavior with negative societal influence also has not helped.

Our population is also literally eating “junk” and goes through their daily life consuming calorie-rich, nutrient-insufficient, foods of convenience routinely just like they are encouraged to do on all of the television commercials. The cold hard truth is that even in a country of abundance like the U.S. people are malnourished. Yes, I said it, malnourished! Of course, I am referring to the inadequate consumption of real or whole foods and the critical micronutrients they contain, not the amount of calories. This has significantly contributed to the epidemic of chronic illness, including mental illness, and skyrocketing healthcare expenditures. We are frankly, as a society, becoming fatter, stupider, and more culturally regressed by the day. Yes, all of this matters!
Finally, one of the most important factors, in my opinion (and credible data backs this up) creating the soil for this reality we now confront is the literal breakdown of the mental health system. Since an almost total federal defunding of comprehensive mental health services in the 60s, 70s and 80s we have seen serious negative effects on our society. Almost total privatization of the system has led to non-livable wages for counselors and many front-line mental health professionals and no funding for their continued education. In fact, many have pointed out correctly that the U.S. effectively has no mental health “system” at all. However, in an outstanding Medscape article published as a response to the Newtown tragedy, psychiatrist James Knoll, IV, MD stated “It is my contention that there exists no legitimate ‘system’ in the United States when it comes to mental health treatment. From a literal perspective, one might define a system as an organized, regularly interacting set of principles forming a network — especially for distributing something or serving a common purpose.” The reality is that we really have no “system” at all by the classic definition to even blame. After one tragedy in Massachusetts, the state’s former mental health director responded, “Will this case be the canary in the coal mine? Will it signal that we’ve gone too far in reducing client-staff ratios, in closing hospitals, in pushing independence for people who may still be too sick?”

The reality is that the standard of care has been reduced to the cheapest solution, if you want to call it that, which is basically a “drug them and shove them” (out the door) approach. People with serious mental illness, and clearly violent tendencies, are no longer institutionalized and given the long-term comprehensive care they need. It is cheaper and easier to just prescribe an antidepressant, an antipsychotic medication, or both, and send them off unsupervised to live among us. It has been reported that Adam Lanza, the Newtown shooter, was taking the atypical antipsychotic drug Fanapt (formerly known as Zomaril), a medication with a very problematic history of its own. We know from medical studies that while antidepressant drugs may be marginally effective and necessary for some, other large meta-studies show they may be no better than placebo. We now have over 30,000,000 Americans taking SSRIs and the majority of those prescriptions are written by GPs, NPs, and PAs, most of who have no advanced psychiatric training. We also know that teenagers and young adults can react differently to these medications than adults do, and a small but significant percentage of them can be made worse by these drugs. Many teenage girls have committed suicide after starting antidepressant medications for what was only mild depression prior. Some boys and young men have virtually disassociated from reality and have committed horrendous acts of violence, sometimes in a manner completely out of character for them previously.

I have, since this latest incident, heard some discussion about the lack of funding for mental health, but will more funding really just mean more of these medications being handed out to our already drugged-silly children without serious thought to who they may be inappropriate for, or will it finally result in the addition of more comprehensive services and approaches? The handing out of medications to our children like it is candy is out of control and the link between their use and these incidents is becoming compelling. Could this be one of the main elements in the rise of such incidents? After all, guns have been widely available for a very long time, while the mass and almost reflexive use of these medications, like these incidents, is relatively new.

Fellow health care providers, citizens, and especially parents, we have a toxic soup of issues facing us, and particularly for our children, which may very well be leading to the acts of horror we have witnessed now on a multitude of occasions since Columbine. However, having an honest and non-political discussion as a nation about them will be difficult, but imperative. This will ultimately involve taking on powerful interests including the NRA, Big Pharma, Big Food, and the entertainment industry. These days our politicians are financially beholden to these very same powerful interests, they are barely capable of speaking civilly across the aisle to one another, and have become virtually worthless in affecting any kind of meaningful change. Do the politicians really have the backbone? I seriously doubt they do unless their feet are held to the fire by an outraged populous, and a united health care workforce, that will no longer stand by and see our children slaughtered in their schools.

Dr. Brady is a licensed naturopathic medical physician and certified clinical nutritionist. He is currently the Vice Provost of the Division of Health Sciences, Director of the Human Nutrition Institute, and associate professor of clinical sciences at the University of Bridgeport. He is also the Chief Medical Officer of Designs for Health, Inc., and maintains a private practice, Whole Body Medicine, in Trumbull, CT. Dr. Brady has been a featured presenter at many of the most prestigious conferences in integrative and functional medicine, including the Institute for Functional Medicine, American College for Advancement in Medicine, American Academy of Anti-Aging Medicine, International and American Associations of Clinical Nutritionists, and more. He is a contributing author for Integrative Gastroenterology, the first integrative medical textbook on gastroenterology by Johns Hopkins physician Gerard Mullin, MD, and is a contributing author for Laboratory Evaluations for Integrative and Functional Medicine by Lord and Bralley and the second edition of Advancing Medicine with Food and Nutrients, Second Edition, by Ingrid Kohlstadt, MD.

clinical pharmacology cover

Handbook of Clinical Psychopharmacology for Psychologists

Mark Muse

and Bret A. Moore Editors

Wiley, 2012

The Handbook of Clinical Psychopharmacology for Psychologists provides the foundations of knowledge that readers will want for comprehensive understanding in clinical psychopharmacology, located in the broader context of biology, psychology, and social environment. For the prescribing psychologist the book will prove a user-friendly, efficient training tool, and for consulting healthcare psychologists, an essential desk reference.

Handbook successfully combines information from neuroanatomy, nervous system structure and functions, biochemistry, and physiology, with current information on pharmacology, research, and practice. The authors place the issues firmly in a meaningful context for those who treat patients into today’s mental health and health industry.

Co-editor Dr. Mark Muse, American Board of Professional Psychology (ABPP) diplomat, and licensed Louisiana prescribing medical psychologist, along with co-editor Dr. Bret Moore, ABPP and licensed New Mexico conditional prescribing psychologist, highlight the concept of the integrative view throughout the text.

They use the term psychobiosocial to stress the need to combine psychological, biological, and social systems. They point out that research and theory, and especially treatment, must be viewed in this broad and inclusive perspective. They present a view that takes into account the multiple influences and feedback loops on and by a “living, surviving, and adapting person.”

“I worked in primary care in Maurepas at a family clinic,” Dr. Muse told the Times, “and found the experience taxing and eye-opening. I would never have found myself in primary care if it were not for the medical psychology piece. I worked with underprivileged children who had never seen a psychologist, nor had their psychotropics ever been reviewed by a prescribing mental health specialist. The family practitioner was doing the best he could, as there were no psychiatrists in sight. He was progressive and forward-looking and wanted desperately to get a mental health professional on board.”

This awareness for a comprehensive model is highlighted throughout the Handbook, and most clearly in the beginning chapters, where Muse and Moore set out the philosophical framework, defining psychopharmacology as a subset of medical psychology and medical psychology as including “… health psychology, rehabilitation psychology, pediatric psychology, neuropsychology, and clinical psychopharmacology, as well as subspecialties in pain management, primary care psychology, and hospital-based (or medical school-based) psychology.”

As an educational resource the Handbook has real muscle. Chapters are logically structured with consistent statements of theme, effective expansion into relevant subtopics, and concise summaries. The writing style is clear, fast and straightforward. An excellent use of tables and charts graphically consolidates information. Sections for “Key Terms” make it easy to scan and process information. Post-tests engage the reader and contribute to interactive learning.

The Handbook also includes a CD-ROM with practice questions based on the American Psychological Association’s Psychopharmacology Examination for Psychologists (PEP). The reader can prepare for the actual experience of the exam, with 150 questions from ten content areas, presented in a timed, 3-hour format if desired. This ingenious approach no doubt comes from Muse’s bent toward education methods, a theme mirrored in his website, MensanaPublications.

“Those preparing for the PEP never seem to get enough rehearsal questions to satisfy their hunger,” Mark explained. “There are an additional 250 questions as a Mensana CE quiz with the same title,” he said, allowing additional practice.

The Handbook easily fulfills its promise of reviewing foundations for psychologists who want to be conversant with psychopharmacology, and should also be especially useful to those who simply want to be able to help their clients ask the right questions about medications.

In a spirited Forward, “Integrating Care: A Forward on Changing Times,” Drs. Pat LeLeon and Jack Wiggins, both past APA presidents, applaud the

text and the direction. “… an excellent treatise written by psychologists for psychologists,” they write. And, “Lamentably, it has become commonplace in physicians’ offices to dispense psychotropic medications without an appropriate diagnosis and to do so by providers with little or not training in alternative psychological interventions for behavioral disorders.” LeLeon and Wiggins also point to Louisiana’s Drs. Glenn Ally and James Quillin as prominent in the prescriptive authority movement in psychology.

In Chapter 1, “Medical Psychology: Definitions, Controversies, and New Directions,” Drs. Muse and Moore explain the philosophical issues and controversies in the field, a theme repeated in many of the chapters: that the living, adapting human requires a biopsychosocial paradigm, and not the medical model.

The term Medical Psychology is an umbrella term they say, “… it encompasses the multiple specialties and make up health-care psychology, embracing the biopsychosocial paradigm of mental/physical health and extending that paradigm to clinical practice through research and the application of evidenced-based diagnostic and treatment procedures.” They explain the limitations in the Cartesian idea that mind and body are separate, the limitations of the medical model, or the idea that an individual’s social environment is irrelevant.

They object to Louisiana’s Act 251 because, they say, it “… builds upon the definition issues by the U.S. Drug Enforcement Agency (DEA) which recognizes that the term medical psychologist refers to a mid-level provider/practitioner who has prescriptive authority.”

In Chapter 2 Muse and Moore outline more of their rationale, “Integrating Clinical Psychopharmacology within the Practice of Medical Psychology.” Authors point to interesting research demonstrating the complexity and interactions in this psychobiosocial perspective, with examples such as: research on OCD that indicates behavioral therapy is more effective than medication and behavior therapy together; that phobias are better treated with CBT and provides longer- lasting effects; and that 70 percent of the response to antidepressants medications is considered to be placebo. Authors summarize the major large-scale studies such as the STAR*D, TADS, and CATIE studies.

Chapter 3, “Neuroscience,” by Drs. Ken Fogel and George Kaplka (Pediatricians and Pharmacologically Trained Psychologists: A Practitioner’s guide to Collaborative Treatment) write, “Homeostatic balance is the ‘holy grail’ of living things, …” They include sections on neurons,

neurotransmitters, central nervous system, structure and function of the brain, and peripheral nervous system.

In Chapter 4 “Nervous System Pathology” authors provide a comprehensive list of disorders including “Nuerodegenerative/cognitive disorders,” “Mental Retardation,” “Neurodevelopmental Disorders,” “Vascular Disorders.” Readers will appreciate a section on “Behavioral/Psychological disorders with a Neuropathological Basis.”

Chapter 5 reviews “Physiology and Pathophysiology,” including the functional systems of the body, including endrocrine, hormonal, cardiac, digestive systems, and others.

Dr. Robert Younger, ABPP and Navy psychologist with prescriptive authority authors Chapter 6, “Biopsychosocial and Pharmacological Assessment and Monitoring.” He writes that safe and effective use of medications requires psychologists to know “… how to assess the biomedical status of patients, including ongoing assessment of iatrogenic effects of medications in general.” He explains history taking, psychological assessment, as well as physical and neurological examinations and laboratory testing. A list of drug-drug interactions, drug overdose, and a section for adverse drug reactions, are included.

Chapter 7, “Differential Diagnosis in Medical Psychology,” includes important sections on “Medical Disorders that Present as Psychological Disorders,” and “Psychological Disorders that Present as Medical Disorders,” along with other topics that are critical for today’s psychologists.

In “Pharmacology,” Chapter 8, the author addresses how drugs interact with the body to produce effects as well as how they are metabolized and distributed.

Chapter 9, “The Practice of Clinical Psychopharmacology,” by Drs. William Burns, Lenore Walker, and Jose Rey, is one of the longer chapters and explains the “integration of psychotherapeutic and pharmacotherapeutic modalities of treatment.” An extensive table on “Drug Indications, Dosage Ranges, Side Effects, Routes of Administration, FDA Approval for Children, and Pregnancy Risk” is worth the cost of the book. Also described is drug metabolism and CYP450 (Cytochrome P-450), the enzymes involved in detoxification.

“Research in Clinical Psychopharmacology” Chapter 10, and “Professional, Legal, Ethical, and Interprofessional Issues in Clinical Psychopharmacology” Chapter 11, complete the text.

“My hope,” Dr. Muse explained to the Times, “… is that it is a true reflection of the breadth of training a medical psychologist undergoes. I would like the detractors to read it before asserting that prescribing psychologists’ training is insufficient. It is, in fact, more rigorous than psychiatry or practical nursing’s preparations for integrating psychotropics into overall mental health diagnosis and treatment …”

Handbook of Clinical Psychopharmacology for Psychologists is a valuable addition to any psychologist’s library resources, a practical guide for key knowledge bases regarding biological, pharmacological, differential diagnosis, ethical issues, and the important contributions and perspectives that psychologists can bring to the challenges of modern healthcare.

Dr. Mark Muse and Dr. Bret Moore will be presenting aspects of Handbook at the American Psychological Association Convention, on Thursday, August 2, in a presentation titled, “New Resources for Preparing for the Psychopharmacology Exam for Psychologists (PEP).”

The book is widely available from the publisher (Wiley) and distributors. Also, Mensana Publications offers a 20 percent discount on the Handbook and all other books bought through the website link to the publisher.

Dr. Muse completed his doctorate in clinical research and counseling psychology at Northern Arizona U. in 1980 and next was awarded the Licentiate degree in clinical psychology by the Universitat de Barcelone in 1984. He later completed a postdoctorate M.S. in clinical psychopharmacology. He served as full professor at the Universitat de Ramon Llull, Barclona, lecturing in Catalan and Spanish. He returned to the U.S. in 1998. He is the author of six books in the area of psychology as well as numerous articles appearing in psychology and medical professional journals.


Procrastination and Task Avoidance Theory, Research, and Treatment

Joseph R. Ferrari, Judith L. Johnson, and William G. McCown

Springer Series in Social and Clinical Psychology, 1995

Procrastination and Task Avoidance is another one of Dr. William McCown’s premier works, covering an intriguing area of psychology, procrastination. For those who want to better understand the complexity in this common, yet often debilitating behavior, the authors bring together theory, research and application.

They explain the interwoven elements of anxiety, depression, passive-aggressiveness, perfectionism, agitation, conscientiousness, and other related characteristics, regarding this behavior that affects life satisfaction in 25 percent of all adults.

Professor and psychologist, Dr. William McCown, currently Director of the Graduate School at Louisiana University at Monroe, told the Times, “Although this book is 15 years old, sales continue to be strong … This attests to the fact that clinicians often encounter people with problems related to procrastination and are frequently stymied.”

Up until Procrastination little scientific attention was given to his characteristic, which is often at the root of problems in human productivity and happiness. The authors speculate that the trait may have been considered too minor or too “flippant a topic to be granted much scientific credence.” However, they say it is both a contributor and an outcome of psychiatric conditions, negatively impacting productivity in work, school, families, and relationships.

“I became interested in this topic for my master’s thesis research,” Dr. McCown said, “because I was trying to make sense of the behavior of some clients that I had seen in treatment. At the time I found that there was almost no literature on the topic.”

“Several years later,” he said, “I wrote the book with Joe Ferrari, a colleague from Illinois that I had previously published with, and my former spouse [Dr. Judith Johnson], who previously was at the New Orleans VA Medical Center. Our intent was to write a book that was both practical and scholarly. We include extensive case histories to illustrate the multiple etiologies of chronic procrastination, which really is a serious problem for many people. It is causally linked to health problems, poor school performance, and general life dissatisfaction.”

Procrastination is laid out logically and with the thoroughness and vision that characterizes McCown’s other books. Many of the chapters could stand alone, combining theory, research and application and walking the reader through what is known about the topic. This is psychology at its most interesting,

where authors clarify and define the topic, so that the reader sees how the behavior might have developed, how it is best measured, how it is nested in personality and clinical syndromes, and how it might be modified.

“I believe that procrastination may have multiple etiologies,” said Dr. McCown, noting why the book was needed and some of the confusion that still exists. “There is the trend today to say that it is simply a facet of low conscientiousness. This is not true,” he explained. “Sometimes very perfectionistic people are procrastinators, in part because they fear that they will not live up to their own high standards. Depression and anxiety may also be causal factors, both of which are not related to conscientiousness.”

Procrastination and Task Avoidance provides this clarity in a concise eleven chapters, beginning with, “An Overview of Procrastination.” Authors review definitions, prevalence, and clinical significance. In one of the few studies on prevalence in a nonstudent population, McCown and Johnson found that over 25 percent reported that procrastination was a significant problem. Using his

Adult Inventory of Procrastination McCown found scores for men reach a peak in the mid to late 20s, then decline until about age 60, when scores begin to go up. For female scores decline from a high in the early 20s, and are lower than males. But then at age 60, females’ procrastination scores rise and are higher than for men. McCown also examined over 1500 college students and found that 19 percent of freshmen, 22 percent of sophomores, 27 percent of juniors and 31 percent of seniors indicated that procrastination was a significant source of personal stress.

In Chapter 2, “ Procrastination Research,” authors examine childhood personality development, the behavioral perspective of reinforcement, escape, and avoidance conditioning, the role of state anxiety, and of specious rewards. They review cognitive and cognitive-behavioral theories with irrational beliefs, self-statements, locus of control, learned help- lessness, and irrational perfectionism. Sections on depression, low self-esteem, and anxiety are included, along with how procrastination relates to achievement motivation, intelligence and ability, impulsivity and extraversion. Authors also note the neuropsychological and biological variables.

In Chapter 3, “The Use of Self- Report Measures,” assessment methods are described, including McCown’s and Johnson’s Adult Inventory of Procrastination (AIP), the Mann’s Decisional Procrasti- nation Scale, General Procrasti- nation Scale, and Procrastination Assessment Scale-Students.

Authors provide a model in Chapter 4, “Academic Procrastination,” including how fear of failure and achievement-related fear often

result in avoidance. They clarify the fear of failure, procrastination, avoidance, big five characteristics, and self- worth, then flow into specific treatment of academic procrastination.

Chapter 5 is “Trait Procrastination, Agitation, Dejection, and Self- Discrepancy,” and the author defines how discrepancies between “ideal self” and actual evoke emotions of disappointment or shame, and how discrepancies between the “ought self” which represents duties and responsibilities evoke fear and uneasiness.

In “Dimensions of Perfectionism and Procrastination,” Chapter 6, authors explain the distinct dimensions of “other-oriented perfectionism,” (the individual sets unrealistic standards for others), “self-oriented perfectionism” (the standards apply only to oneself), and “socially-prescribed perfection- ism” (concerns meeting expectations of others). Within this multidimensional perspective authors delve into correlational research and suggest a fascinating set of issues, including how socially- prescribed perfectionism correlates with fear of failure.

In Chapter 7, “Procrastination, Negative Self-Evaluation, and Stress in Depression and Anxiety,” authors pull together a variety of constructs and research to show how procrastination results from interactions between early learning, anxiety, depression and negative self-concept. A review of the impact of life stresses is included, and the development of “self- uncertainty,” pessimism, and

optimism. Included is a model for overall adjustment.

In Chapter 8, “The Role of Personality Disorders and Characterological Tendencies in Procrastination,” authors explain the relationship between procrastination and personality disorders.

Specific guidance for treatment is offered in Chapters 9, “Treatment of Academic Procrastination in College Students,” and 10, “Treating Adult and Atypical Procrastination.” Authors include the common cognitive misconceptions of individuals who procrastinate, such as overestimation of time left to perform a task, underestimation of time needed, and overestimation of future motivation. Authors also describe a 10-session group approach with detailed instructions and point out the need for a careful and full assessment because of many issues that can be overlooked, such as stress or the “addiction” to procrastination.

“During the past 20 years I’ve treated or treated or supervised treatment of over 300 people who had procrastination problems,” Dr. McCown told the Times. “They can and do get better, but often it takes multiple treatment interventions to find what works.”

“One consistent finding,” he said, “is that about a third to half of the variance in the construct can be accounted for by ADHD symptoms. Whether there are deeper similarities is yet to be researched. It would be exciting if the behavioral and other interventions effective for adult ADHD also worked for procrastination.”

“I have seen cases where procrastination had a psychodynamic or family etiology,

though the prevailing wisdom among many clinicians is that it is best characterized and treated by cognitive behavioral methods.”

“I want to emphasize that procrastination tends to be chronic. Like depression, it seems to be stress-related. If a person is successfully treated, they will most usually require follow up sessions to keep from relapsing in the future.”

The final Chapter, “Epilogue as Prologue,” completes the text with a perspective on the need for additional research to propel this important area forward. Dr. McCown explained, “Since the time I wrote it the literature regarding procrastination has increased 300 fold. There is even a meta-analysis available in the literature. Unfortunately, what are lacking are quality studies to determine what type of treatment works best for which type of procrastinators.”

Procrastination and Task Avoidance is an informative, interesting, and worthwhile text for clinicians and research psychologists who deal with the human condition. The content is still quite useful, even though Dr. McCown may be planning to update. “I hope we can put out a second edition soon,” he noted. That would be a treat.

Dr. William G. McCown, clinical psychologist, professor, and international consultant, is the coauthor/editor of eight books. He has held various positions in the U. of Louisiana at Monroe, including Director of Training and interim Associate Provost. Presently he is interim Director of the Graduate School.


Clinical Assessment and Intervention for Autism Spectrum Disorders

Clinical-Assessment-and-Intervention-for-Autism-Spectrum-DisordersEdited by Dr. Johnny Matson 2008, Academic Press

In Clinical Assessment and Intervention for Autism Spectrum Disorders, premier scientist and LSU Professor and Distinguished Research Master, once again brings together a slate of experts to help clinicians sift through a complex and evolving area of psychological practice.

The work clarifies and lays out the research and what is known about autism and related difficulties. While a straightforward compellation of research is valuable in itself, two main themes in Clinical Assessment create a more interesting and useful reference.

First, the theme of evidence-based practice is echoed throughout, with authors often pointing to important gaps in the research and also that many treatments selected by consumers lack evidence for their value.

Secondly, the theme of lifespan and the long-term view for assisting those with developmental challenges is addressed in many of the key chapters, helping the clinician or research look beyond early childhood.

Louisiana contributions include Dr. Matson and Dr. Marie S. Nebel-Schwalm, Dr. Karen Sheridan, and Dr. Troy Raffield writing from Pinecrest Developmental Center in Pineville, Louisiana.

The text is a bold effort to inform the clinician and research psychologist in a field where there are many gaps in what is known and many approaches that are not evidenced-based. The text is a collection of experts discussing what is known in the field, often in stand alone chapters, and echoing the message that there is a large amount we still do not know. Readers will find guidance for best practices in working with children who struggle with developmental delays, and also for better awareness to a life-span perspective.

Clinical Assessment is structured in three parts, Part I – Introduction, Part II – Assessment, and Part III – Interventions.

In Part I, Chapter 1, “Assessment and Intervention in Autism: An Historical Perspective,” authors summarize the history and development of the diagnostic criteria, as well as the history of treatment.

Chapter 2, “Evidence-Based Practice for Autism Spectrum Disorders,” provides the current state of evidenced-based treatment, with a description of “science, pseudoscience, and antiscience.” Criteria for evaluating different treatments is reviewed and several strategies in applied behavior analysis (ABA) are highlighted. The author critiques non-behavioral treatments.

In Chapter 3, “Autism Spectrum Disorders: A Lifespan Perspective,” authors review the importance of the lifespan perspective, a theme mirrored in many of the chapters that follow. The author introduces sections on “Lifespan Theories” and “Outcomes Across the Lifespan.” They provide a review of outcome evidence and discuss common concerns that clinicians will encounter in key developmental periods.

Part II is “Assessment,” and begins with a chapter by Louisiana State University authors Marie S. Nebel-Schwalm and Dr. Johnny Matson, on “Differential Diagnosis.”

The authors point out that ASD are five disorders that share features but that researchers and clinicians do not always agree on the methods used to diagnose or even the distinctions between disorders on the spectrum. This is a critical area since families need information to “maximize the child’s quality of life,” the authors note.

Sections on “Etiology,” “Genetic,” “Neurobiological,” “Immunological,” “Perinatal,” and “MMR Vaccinations,” are included. They summarize that there is little evidence of causal variables (80 percent of those with ASD have no known cause) and that among the theories such as immunological, “consistent empirical results are lacking.” Assessment challenges are reviewed in “Differential Diagnoses within the Spectrum,” “Comorbid Psychopathology and Differential Diagnoses,” “Intellectual Disabilities,” “Language Disorders.” Included are descriptions of interview methods, observational systems, clinician rating scales, and over 10 informant rating scales and checklists.

Chapter 5, “Assessment of Challenging Behaviors in People with Autism Spectrum Disorders,” focuses on functions of assessment when clinicians are looking at problem behaviors such as aggression, tantrums, stereotypy, and eating behaviors.

In “Communication and Social Skills Assessment,” Chapter 6, authors note a consensus that a comprehensive assessment in this area is of vital importance to providing help to families and individuals. They review theory, classification, and the purposes of assessment. In “Assessment Procedures,” authors lay out specific information for the reader in behavioral observation, role-play tests, rating scales, and behavior checklists.

Chapter 7 is an overview of “Assessment of Independent Living/Adaptive Skills.” Sections include, “Home-Based or Parent/Caregiver-Report Assessments,” “School-Based or Teacher-Report Assessments,” “Clinic-Based or Clinician-Report Assessments,” and “Self-Report Assessments.” Authors note that this is a critical area related to “level of independence for community integration” and write that in some cases, adaptive behavior is more important than IQ, especially in adolescence and adulthood.

Chapter 8 is “Pharmacology Effects and Side Effects.” Authors look at instruments for assessing response to psychotropic medication, noting important gaps in research and evidence.

Part III, “Interventions,” begins with Chapter 9, “Challenging Behaviors.” Authors cover the definition of challenging behaviors and those common to ASD. In “Approaches to Intervention,” authors review the evidence for behavioral treatment, and conclude that the ABA approach for reducing these behaviors should become the norm.

Chapter 10 reviews the critical area of “Communication Intervention for Children With Autism Spectrum Disorders.” The authors note that speech and language problems are the “defining characteristics of autism and related conditions within the autism spectrum.” In this comprehensive chapter the authors outline specifics of “Speech-Based Interventions,” “Milieu-Based Interventions,” and “Social Interaction Interventions.”

“Teaching Adaptive Skills to People with Autism,” Chapter 11, is authored by two Louisiana psychologists, Dr. Karen Sheridan, now at the Resource Center on Psychiatric and Behavioral Supports in Hammond, previously with the Pinecrest Developmental Center, in Pineville, Louisiana, and Dr. Troy Raffield, who continues with Pinecrest.

The authors point out that developing skills in adaptive functioning is critical when transitions to community living are the goal. These skills, the authors note, are associated with quality of life and so have absolute value. They review “Applied Behavior Analysis,” “Task Analysis,” “Visually Cued Instruction,” and “Modeling.” They review techniques including sections on vocational skills, domestic skills, self-care, community, and leisure skills.

The final chapters, “Comprehensive Treatment Packages for ASD: Perceived vs. Proven Effectiveness,” a review of “Pharmacotherapy,” completes the work.

Clinical Assessment and Intervention for Autism Spectrum Disorders offers an important foundation for those wanting to ground themselves in evidenced- based information in this essential area of clinical practice and research.

Editor’s note: An expert in mental retardation, autism, and severe emotional disorders in children and adolescents, Dr. Johnny Matson has produced 600+ publications including 37 books. Among many duties, he is Editor-in-Chief for Research in Autism Spectrum Disorders (Oxford England) and Editor-in-Chief for Research in Developmental Disabilities (Oxford, England).


Child & Youth Care Forum

Child-&-Youth-Care-ForumJournal of Research and Practice in Children’s Services

Editor-in-Chief: Carl F. Weems, PhD Springer

Carl F. Weems, PhD, Professor of Psychology at the University of New Orleans, oversees this peer-review, multidisciplinary publication by Springer, Child & Youth Care Forum: Journal of Research and Practice in Children’s Services. Dr. Weems guides a host of experts from around the nation and the world in the Forum’s Editorial Board, including an array of colleagues from the New Orleans area, giving this comprehensive platform for improving the lives of children a clear Louisiana connection.

Contributors and readers in psychology, psychiatry, and social work, as well as those in public policy and government, will find the journal to be a valuable, useable resource. blending theory and applications for all those dedicated to the well-being of youth in today’s world.

This may be one of the most important contributions of Forum, noted Dr. Weems to the Times. “The Journal tries to bridge research and practice in children’s intervention and psychological services broadly,” he said, “while focusing on publishing scientifically excellent empirical papers and theoretical reviews.”

This broad approach is the goal. “We also try to integrate across fields and publish work from developmental psychology, education, medical anthropology, pediatrics, pediatric psychology, psychiatry, school psychology, and social work. So the multi-disciplinary nature of the journal.”

Dr. Weems took over the editorial leadership of the journal in 2009 when Springer Senior Editor Judy Jones asked him to be the Editor. He knew he was filling some big shoes. In his first editorial he explained, “My primary goal as editor is to continue the excellent stewardship that the journal has benefited from since its inception in 1971 with founding editor Jerome Beker (as the Child Care Quarterly, see Beker 1971) and to specifically carry on the publishing initiatives begun by my most recent predecessor Dr. Marc Atkins (a focus on publishing of high quality empirical papers in child services). My hope is that CYCF remain an international, interdisciplinary outlet for publishing high quality empirical papers and theoretical reviews that have implications for child and adolescent intervention and services broadly defined, but to also expand the content.”

At U. of New Orleans, Dr. Weems’ research interests include developmental psychopathology of anxiety and depression. He specifically looks at how to integrate developmental, cognitive, biological and behavioral theories, a perspective that supports his editorial duties on the Forum. He also has looked at severe stress, physiological response, brain development and function. One of his recent publications, “Post traumatic stress, context, and the lingering effects of the Hurricane Katrina disaster among ethnic minority youth,” in the Journal of Abnormal Child Psychology, is an example of this wide-angle viewpoint.

Carl is joined in these goals by R. Enrique Varela, PhD, from Tulane University. Dr. Varela serves as Associate Editor for the Child & Youth Care Forum, and brings his research in development of anxiety in youth, and also a particular emphasis on cultural, familial, and cognitive influences in this process.

Brandon Scott, PhD, from the U. of New Orleans serves as Editorial Assistant. He works closely with Dr. Weems in the Youth and Family Stress, Phobia, and Anxiety Research Lab at UNO, and his current research interests focus on understanding the role of emotion regulatory processes in anxiety-related problems for children and adolescents.

Jody Camps, PhD, from Children’s Hospital New Orleans, and Natalie Costa, PhD, from University of New Orleans also serve on the board. Dr. Costa brings her expertise at investigating why anxiety aggregates in families and the association between parent and child anxiety.

Psychology Chair and Distinguished Professor at UNO, Paul Frick, PhD, is included on the Forum’s Editorial Board. Paul is an international expert in understanding the different pathways through which youth develop severe antisocial behavior.

Tulane’s, Michael Scheeringa, MD, Professor from Tulane Medical School also serves on the Editorial Board.

While the journal seems to enjoy the variety of scientific talents from the New Orleans area, that is only a small part of the overall approach, explained Dr. Weems to the Times. “The Journal is really international in scope,” he said, “members of the board are from the US, Canada, the Netherlands, Britain, Croatia, Sweden, etc. I think local psychologists who are interested in multi- disciplinary knowledge development will be interested.”

Together the experts create a platform to bridge the gap between research and practice, and to give readers a perspective and source for effective practices with children, adolescents, and families. To accomplish this, articles include science about how children and adolescent can overcome difficulties of mental health problems, traumatic stress, negative family dynamics, and community issues such as crime or violence. Another goal is to help “normal children actualize their potential,” as understood from the perspective of positive psychology and other theoretical frameworks.

The February issue included two articles from Louisiana researchers: “Perceptions of Parenting, Emotional Self- Efficacy, and Anxiety in Youth: Test of a Mediational Model,” authored by Laura Niditch and R. Enrique Varela; and, “The Good Enough Home? Home Environment and Outcomes of Young Maltreated Children,” by Neil W. Boris, Sherryl Scott Heller, and Charles H. Zeanah, all of the Tulane U. School of Medicine. And also Janet Rice, Department of Biostatistics, Tulane U. School of Public Health.

The Forum offers free downloads of some of their most popular articles, including the “The Good Enough Home?” article.

Other popular, free articles include: “Exploring the Feasibility and Benefits of Arts-Based Mindfulness- Based Practices with Young People in Need: Aiming to Improve Aspects of Self-Awareness and Resilience,” “Teenagers’ Explanations of Bullying Robert Thornberg,” and “The Play of Children: Developmental Processes and Policy Implications.”

Dr. Weems said, “Next month [April] is a special issue, “Advancing intervention science through effectiveness research: A global


perspective.” We hope to increase the impact of the journal on research and practice and continue publishing scientifically excellent empirical papers and theoretical reviews that have implications for those practicing in the field.”

What is the most rewarding part of his editorial role? “Getting to see research that isn’t yet published and trying to steer a solid course for knowledge development.”

But some of the challenges included, “Finding reviewers who are experts, who will agree to do a review, and who will turn th

eir reviews in on time. A quick turnaround for authors, with fair reviews is essential for a good journal.”

The journal’s goal is to provide the ideas and innovations needed, not simply to resolve children’s problems, but to “foster what is best for child and adolescent’s development and functioning. In other words, to help the child and adolescent actualize and attain their fullest potential.” To this goal, Dr. Weems is looking for important contributions. “We would love to receive submissions from Louisiana psychologists – clinical or researchers– on topics of research and practice in children’s intervention and psychological services,” he told the Times.

The website for Child & Youth Care Forum is: ychology/journal/10566


Chameleon by Dan Dylan (Dr. Dan Lonowski)

Louisiana psychologist Dan Lonowski, working under pen name Dan Dylan, has crafted a realistic, hair-raising psychological thriller in his debut fiction novel, Chameleon.

Chameleon’s protagonist, Dr. John Foster, is a retired FBI profiler who has settled down into a clinical psychology practice. The setting is Chicago and Foster’s typical work involves clinical and forensic psychology. As the story begins Foster is consulted by a young wife regarding her new husband’s disturbing and suspicious behavior. From here Foster and the array of characters are launched into a deadly progresssion of events.

The reader is brought into the inner workings of the villain’s mind, a sociopath named Eddie Vinson, who unravels into a manipulative and violent serial killer. As the events unfold the hero Foster is compelled by his need to help the potential victims, into a lethal game of one-ups-manship with the villain, returning to his FBI training and gritty, street smart past.

Chameleon treats the reader to an insider’s view of the practice of psychology and the frightening realities of a decompensating sociopath who targets the hero.

At the same time, Lonowski is able to describe the background of abuse that is so often part of the cycle of violence, and that leads to the destruction of lives.

The fictional tale is gritty, realistic and suspenseful. The sprinkling of actual psychology practice issues and technology adds flavor and interest. The plot, body count, tension and transition of the hero from office psychologist back to street savvy FBI agent move the story to the finale between the hero and villain

Authentic psychological terminology and practice perspectives offer an interesting viewpoint for suspense fans. The realistic progression and decompensation of the villain into a full blown serial killer, with the back story of how and why a person can cut a swath of human destruction without looking back, is darkly fascinating and clinically accurate.

The story is not for the faint of heart, but for readers who enjoy psychological thrillers this work will engage them in the many layers and levels, and is a commendable offering into this complicated fiction genre.

Dr. Dan Lonowski considered writing in his mid-thirties. But family and work made it impossible, he explained to the Times.

However, in the following years, his practice required literally thousands of reports which forced him to develop his descriptive writing skills, as he reported accurate and authentic descriptions of human nature.

“One ordinary day, a colleague and I shared a conversation about the likelihood of a sociopath

intentionally committing suicide,” he told the Times. “I believed it unlikely that an Antisocial Personality Disordered individual would attempt to end his or her life. I could conceive, however, that he or she might fake suicide as a manipulation to achieve some personal goal, and, perhaps, by accident or miscalculation, death could result. The upshot of that discussion was Eddie Vinson, antagonist, who claimed his place in my imagination. I compared him metaphorically to a chameleon,” said Dan, “hence the title of my novel. Vinson, like other sociopaths I have known, hides in plain sight while committing terrible acts, often violent and deadly ones.”

In writing Chameleon Dan explained that the characters he created took the story forward. “Many authors attest to the fact that their characters take on lives of their own and develop wills that run counter to a carefully crafted plotline,” Dan noted. “Before I began writing, I would have said it couldn’t happen, at least not to me. Well, it happens! The cast of Chameleon came to life, and in many cases, all I had to do was follow where they led. I could ‘hear’ their dialogue, visualize the locations to which they drew me, and, often, I did not end up where I had planned to go. My muse proved to be a spineless creature as the characters simply took over. I have since talked with other authors who reported this same ungovernable influence in their creative writing, an influence that leaves us wondering if the finished work should bear our names.”

One part of the creative process, Dan noted, was brainstorming with wife Lynda. “My editor and wife, Lynda, a.k.a. Dylan, and I spent many an hour brainstorming scenes or characters and their development, and this, too, was a satisfying part of the creative process.”

Dan is about halfway through his second novel, with working title Deadly Eyes. “It is a psychological study

of a voyeur who escalates from benign observations of those around him when a sexual awakening draws him into watching women in their most private moments. His compulsion drives his evolution into a creative and vicious serial killer. At the request of readers, I reprise some of the characters from Chameleon, and introduce intriguing new ones I hope readers will enjoy.”

A third novel is going to be set in a fictional state psychiatric hospital and will capture the comedy that was his clinical psychology internship.

Using the platform of fiction, and by exploring child abuse and its ramifications for individuals and society, Dan hopes to give his readers a small slice of one psychologist’s perspective.

“I have learned so much from the training and experiences gained through my career. I am one of those fortunate individuals who are able to do exactly what they are meant to do. I am thankful for what my profession has taught me about the human condition, from its best to its worst, and now, as I approach retirement, if it is meant to be, I will write every day with two goals in mind. First, to tell a good story, and second, to help my readers gain a realistic understanding of my profession from within – to see from my perspective what it has been like to be an applied clinical psychologist. In thirty-five years, I have been privileged to become a part of people’s lives and, for many, to help them along the road to greater understanding and self-awareness.”

Chameleon is available for purchase on Amazon, Barnes and Noble, and as an e-Book on Kindle and Nook devices and apps for iPad, iPhone, iPod touch, PC, Mac, Blackberry, and Android-based devices. See more about the author with an exclusive excerpt from Chameleon at