Suicide Pact : Dr Saul and Dr Garbarino Testify

Issues of social immaturity and isolation, combined with romantic images from vampire novels, allegedly led a then-16-year-old boy to attempt suicide with a classmate, doctors testified Monday.

And, doctors concluded, the juvenile court system should be the venue to deal with the teen, who is facing an attempted murder charge in adult court for the alleged suicide pact.

“This is not a conventional crime,” said Dr. James Garbarino, a Loyola University professor who has written nearly two dozen books about child development, trauma and youth violence. Garbarino met with the teen in February, weeks before his 17th birthday.

“This is a mental health crisis that almost coincidentally involved criminal behavior,” Garbarino said. “Two troubled kids formed a suicide pact and were intent on implementing the plan, which was not directed at attacking people outside that little delusional system.”

Suicide pact

The boy was charged in December after reportedly telling police he and a 16-year-old girl made a mutual suicide pact. The boy led his father to the Hooker Lake boat launch, where the father found the girl bleeding Nov. 17 and called police.

“She said all I had to do was guide her hand,” the boy said, allegedly adding that he “took the knife and cut across her wrist. I then took the knife and cut my left wrist.” Both teens survived.

Under Wisconsin law, anyone over age 10 accused of a homicide-related offense can be charged automatically as an adult. But, as part of the reverse waiver process, the boy’s attorneys have the right to ask the court to consider hearing the case in juvenile court.

Juvenile court recommended

As part of a reverse waiver hearing that will continue in July, Garbarino testified Thursday that prosecuting the boy in adult court would not likely deter others and would not be in the boy’s best interests.

“This seems like such a, to use the term, no-brainer,” said Garbarino, who advocated for prosecuting the case in juvenile court. “It would be a travesty to do anything else.”

Dr. Jenna Saul, a child and adolescent psychiatrist from Wisconsin Rapids, echoed Garbarino’s conclusions. She also met with the boy in February.

In their testimony for the defense, both doctors described the boy as socially naive, young for his age and drawn in by the opportunity to love and be loved.

‘Utter infatuation’

Garbarino talked about the boy’s “utter infatuation” with the girl, as well as how taken the boy was with romantic vampire literature.

Saul said the boy spent his life trying to please others, even at the expense of disregarding himself, particularly after the girl said she could no longer bear the pain of living.

“He’s willing to do anything for other people,” Saul said. “So, he’s particularly vulnerable to being willing to be this self-sacrificing. … He wanted to help. He wanted to, in some way, take away the hurt for her. She came up with a solution: I need to die,” Saul said. “And he did not want her to have to die alone.”

Did not seek help

His pattern of not seeking help — from dealing with feelings about his parents’ separation to not asking for help after his special education services were withdrawn and his grades declined — also played a role.

Saul came to that conclusion after she asked the boy what he might have done differently, if he faced this situation again.

“His answer was he would have made sure he had met (the girl) when it was years before. … So, they could have been together, and she wouldn’t have had to suffer,” Saul said.

“It was astounding. He wasn’t asking for help. That wasn’t part of his repertoire, even after going through this.”

That indicated a need for mental health treatment, not incarceration, the doctors said.

The teen is out of jail on bond, under supervision from his parents.

Why Do Young Children Kill?

All states wrestle with how to protect society from children who kill while making sure they get the rehabilitation they need, and ensuring  justice for victims’ families.

The most effective rehabilitation comes from juvenile programs where young children receive therapy in a positive environment and behavioral interventions aimed at increasing empathy, self-management, and self-regulation.

In adult prison, the emphasis is on punishment. More vocational and academic programs have been added, but not every young adult prisoner takes advantage of them. Juveniles don’t do well in prison, and they certainly cannot be expected to benefit from being placed with adults with criminal thinking. Instead, in prison, they are placed in an environment where criminal thinking tends to be the social norm.

Nationally, 10 percent of all murders are committed by juveniles, according to the Office of Juvenile Justice and Delinquency Prevention. That’s about 1,043 murders a

year. More younger children are committing increasingly violent crimes. The irony is younger children have a better chance of being rehabilitated because they stay under juvenile control longer, so that therapeutic interventions and supervision continues.Most of the time violent juveniles are transferred to adult court and tried as adults. If convicted, they remain in a juvenile detention center until they are 19, and then they are transferred to the adult prison to serve the remainder of their sentence. If one happens to be tried as a juvenile and is convicted, he serves his entire sentence in a juvenile detention center and is freed by the time he turns 19.

Experts say violent crime among  juveniles is down nationally. And when it happens, we know what treatments can be effective. What works is one-on-one and group therapy and empowering a child through academic and vocational classes. What doesn’t work is Scared Straight programs and boot camps. In fact, they actually have been shown to have negative effects.

Still, for many of these kids, their time in youth facilities is not long enough to reverse a lifetime of letdowns from the adults in their lives. Nationally, 40 percent of first-time offenders return to juvenile court.

Violence toward others peaks in adolescent years, but a violent adolescent doesn’t necessarily become a violent adult. Some two-thirds to three-

quarters of violent youths grow out of it and become more self-controlled. This, coupled with the efforts to rehabilitate in the juvenile justice system, is why some

ay trying children as adults is no benefit to society.

New York State will spend  $170 million this year on 21 juvenile facilities, employing more than 2,000 employees to oversee fewer than 700 children.

The facilities are disastrously mismanaged, and as many as 80 percent of the young men who serve time end up committing more crimes within a few years of their release.

Low-risk youths — those found guilty of crimes like shoplifting, trespassing and petty theft — should be sent to community-based programs that do a much better job of rehabilitation and are only $15, 000 per youth per year, instead of $220,000 per year in the state juvenile facilities.  For youth whose families can follow through on recommendations, multisystemic therapy is a less expensive and more efficient intervention. Multisystemic therapy keeps children in their family’s homes, in their communities.

Decades of research show that keeping young offenders locked up far from their families is a sure way of turning them into career criminals. Preliminary data collected by the New York City juvenile justice system suggests that recidivism for children handled through the city’s largest community-based program, Juvenile Justice Initiative, could be lower than 20 percent. This program provides intensive counseling and services to the family, to help parents better manage the child’s behavior.

The Juvenile Justice initiative, and similar nonprofit programs have helped the city cut the number of youths it sends upstate by more than 60 percent since 2002. These programs have reduced the number of children in state facilities  from more than 2,300 in 2000 to about 680 today.

Gladys Carrión, the commissioner of the state’s Office of Children and Family Services, has closed several unneeded facilities in the last three years, with a struggle. The politically powerful unions that represent juvenile facility workers are fighting to keep facilities open no matter what the cost to children or the state.

The unions succeeded in passing a law in 2006 that requires the state to give one year’s notice to workers before closing any juvenile facility. In January the state ordered the closure of the Tryon boys’ facility in upstate Fulton County. The facility — which gained national notoriety after a mentally ill 15-year-old boy died there in 2006 — has been empty of children since June. It still has a staff of 80 people working there and will only officially shut down in January 2012.

Juvenile Justice Priorities: Improving Access to Legal Services, Improving JJ Outcomes

Attorney General Eric Holder  Spoke at the National Association of Counties Legislative Conference in Washington, D.C. ~ Monday, March 7, 2011

He noted that the Association of Counties, and the Department of Justice have common goals, of doing more and more to serve our citizens while resources diminish. He identified two specific priorities for the Justice Department:

“how we can improve the effectiveness of our juvenile justice system, and how we’re going to ensure that every American can access the legal services they need and deserve.”

He noted that “one of the most important lessons I learned as a federal prosecutor, as a judge, as a United States Attorney, as Deputy Attorney General, as Attorney General – and, above all, as a father of three children: that the work of protecting, assisting, and empowering our young people could not be more urgent.   “

He noted that:

  • The nation’s juvenile justice system is in need of change, that it doesn’t spend resources as wisely as it should, and does not improve as many lives as it could.
  • Although African-American youth make up 16 percent of the overall youth population, they make up more than half of the juvenile population arrested for committing a violent crime.
  • Abused and neglected children are 11 times more likely than their non-abused and non-neglected peers to be arrested for criminal behavior.
  • That so many of those who enter our juvenile justice system either can’t afford – or do not know to ask for – access to legal guidance.
  • Some youth even plead guilty to criminal offenses without the advice of a lawyer.
  • Even though many of those who are incarcerated enter the juvenile justice system for non-violent offences, they often emerge violent – or, at the very least – traumatized.
  • A scientific review of nine “Scared Straight” programs around the country showed that children ordered into these programs are nearly 30 percent more likely to offend than youths who are not.
  • In another study, 12 percent of the adjudicated youth in state-operated and large locally or privately operated juvenile facilities reported experiencing at least one incident of sexual victimization while incarcerated.

“A recent Utah Youth Suicide Study reported that young victims of suicide had nearly a seven in ten chance of an association with the juvenile justice system, calling us to question whether the current system is improving lives – or devastating them.”

TRANSITIONING OUT OF JUVENILE JUSTICE

  • Each year, 100,000 young people exit formal custody.   And some of them have nowhere to go.   Too many of these young people return to unstable homes – or end up in shelters, on the streets, or in other potentially dangerous, or violent, situations.   And many are not welcomed back to their community school and struggle to find educational opportunities.
  • Within a year of reentry, one study found that only 30 percent of previously incarcerated youth are involved in either school or work.   The unfortunate fact is that many end up in our jails and prisons.

Robert Kennedy believed that the link between justice and children could never be broken without compromising our founding ideals – and our most sacred principles.   He was right.

Mr. Holder noted that justice in the juvenile system is a moral issue that makes good fiscal sense:

  • “How we treat our children answers the question of who we are as a nation.”
  • “Better serving our young people makes good economic sense by keeping them out of over-stressed and under-funded corrections facilities and saving precious law enforcement resources.”

Mr. Holder advised that we

  • Broaden our approach to juvenile justice and ensure that sound research and respected analysis are a part of our decision-making process”.
  • Transition from a prosecution-and-punishment model to a prevention-and-intervention paradigm.  Adopt  a comprehensive plan of action that engages law-enforcement partners, medical professionals, social services providers, lawyers, parents, teachers, coaches, mentors, and community leaders.

Mr. Holder talked about the success of the Safe Start Program, and  the launch of the Defending Childhood Initiative – the federal government’s most comprehensive effort ever to address and overcome the crisis of childhood exposure to violence, that President Obama pledged $25 million to this initiative in his budget proposal.

Mr. Holder talked about alternatives to juvenile justice involvement for youths involved in minor offenses.

  • He mentioned specifically, the Civil Citations program in Miami-Dade County where youth who commit minor misdemeanors are  referred to targeted interventions aimed at reducing delinquent behavior and providing positive social outlets instead of arresting them and placing them in the juvenile justice system.  This program has reduced recidivism to 3 percent  and arrests by 30 percent for youth that participate in the program.

In addition to his emphasis on intervention and prevention over punishment, Mr. Holder also addressed the failure of our justice system to provide juveniles (as well as adults) with access to legal services.

According to The Office of Juvenile Justice and Delinquency Prevention’s Survey of Youth in Residential Placement :

  • Only one half of young people in detention facilities have a lawyer.
  • In many jurisdictions, youth are encouraged – whether explicitly or implicitly – to waive their right to counsel.
  • When juveniles assert their right to have a lawyer, court-appointed lawyers often enter the picture too late.
  • Across the country, too many public defender officers are underfunded and understaffed

Mr. Holder discussed his Department’s new Access to Justice Initiative:

  • An office established in an effort to ensure that quality legal representation is available, affordable, and accessible to all Americans.
  • Includes an agenda to help counties face the “impossible choice between funding critical health and human services or upholding core Constitutional rights.”

The  Office of Justice Programs is also working to implement solutions for indigent defense and juvenile justice reform by:

  • Establishing the Indigent Defense Hiring Project
  • Working with the National Juvenile Defender Center to establish a National Fellowship Program for law school graduates to become public defenders for three years.

When Young Children Kill: Rehabilitation Not Punishment!

All states wrestle with how to protect society from children who kill while making sure they get the rehabilitation they need, and ensuring  justice for victims’ families.

The most effective rehabilitation comes from juvenile programs where young children receive therapy in a positive environment and behavioral interventions aimed at increasing empathy, self-management, and self-regulation.

In adult prison, the emphasis is on punishment. More vocational and academic programs have been added, but not every young adult prisoner takes advantage of them. Juveniles don’t do well in prison, and they certainly cannot be expected to benefit from being placed with adults with criminal thinking. Instead, in prison, they are placed in an environment where criminal thinking tends to be the social norm.

Nationally, 10 percent of all murders are committed by juveniles, according to the Office of Juvenile Justice and Delinquency Prevention. That’s about 1,043 murders a year. More younger children are committing increasingly violent crimes. The irony is younger children have a better chance of being rehabilitated because they stay under juvenile control longer, so that therapeutic interventions and supervision continues.

Most of the time violent juveniles are transferred to adult court and tried as adults. If convicted, they remain in a juvenile detention center until they are 19, and then they are transferred to the adult prison to serve the remainder of their sentence. If one happens to be tried as a juvenile and is convicted, he serves his entire sentence in a juvenile detention center and is freed by the time he turns 19.

Experts say violent crime among  juveniles is down nationally. 

When youth do commit violent crimes, we know what treatments can be effective. What works is one-on-one and group therapy and empowering a child through academic and vocational classes. What doesn’t work is Scared Straight programs and boot camps. In fact, they actually have been shown to have negative effects.

Still, for many of these kids, their time in youth facilities is not long enough to reverse a lifetime of letdowns from the adults in their lives. Nationally, 40 percent of first-time offenders return to juvenile court.

In sum, there are a number of reasons that trying youth is no benefit to society:

  • Violence toward others peaks in adolescent years, but a violent adolescent doesn’t necessarily become a violent adult.
  • Some two-thirds to three-quarters of violent youths grow out of it and become more self-controlled.
  • Efforts to rehabilitate in the juvenile justice system are often successful.

Juvenile Tried as an Adult

In February, 2009, Jordan Anthony Brown, then 11 years old, was charged with first degree murder in the shotgun slaying of Kenzie Marie Houk, his father’s pregnant girlfriend while she was sleeping. He will be tried as an adult and could become the youngest American ever to be sentenced to life in prison without parole.

A western Pennsylvania judge has ruled that Jordan Brown will be tried as an adult, because the juvenile justice system is not likely to rehabilitate him by the time he turns 21. If convicted of his current charges of first degree murder, Jordan at 12 years old, would be the youngest American to serve a life sentence without any chance of parole.

Police say that in February 2009, when he was 11, Jordan used a .20-gauge shotgun to kill Kenzie Houk, 26, in the family’s farmhouse outside Pittsburgh. She was 9 months pregnant; the unborn baby also died.

“There is no indication of any provocation by the victim that led to her killing,” Lawrence County Judge Dominick Motto wrote in his ruling yesterday. “The offense was an execution-style killing of a defenseless pregnant young mother. A more horrific crime is difficult to imagine.”

The judge based his decision on Jordan’s refusal to take responsibility for the crime, which two court doctors for the prosecution and defense said was necessary for rehabilitation.

The trial could begin in May.

In August, he Pennsylvania state House Judiciary Committee heard from the relatives of both victims and convicts today on a proposal to abolish life sentences without parole for juveniles.

The United States is the only country that sentences juveniles to life in prison without parole, and Pennsylvania has about 450 juvenile lifers, more than any state, said Rep. Kenyatta Johnson, D-Philadelphia.

At Philadelphia’s City Hall, committee members listened to testimony for and against House Bill 1999, which also would grant every juvenile lifer in the state parole hearings after serving 15 years of a life sentence, and every three years thereafter.

Bobbi Jamriska, 38, of Shaler, spoke on behalf of the National Organization of Victims of Juvenile Lifers. In 1993, Maurice Bailey of Crafton Heights, then 16, killed Jamriska’s sister, Kristina Grill, 15. Grill, was stabbed in the neck and beaten severely; investigators said her body had bloody footprints on her belly.

“There are bad seeds, individuals who are not fit to be part of a lawful functioning society,” she said. “There has to be within the legal system a means to keep these individuals from doing more harm to the innocent.”

She said life sentences are only imposed on juveniles in extreme situations, and that granting convicted killers parole hearings would force victims’ families to relive their losses.

But supporters of the new legislation note that juveniles’ brains are not fully developed and they lack key decision-making abilities.  Many juvenile lifers did not actually commit murder but were accessories, and the sentence is disproportionately meted out to minorities.

One-third of the state’s juvenile lifers were convicted of second-degree murder, said Ashley Nellis, a research analyst with the Washington D.C.-based The Sentencing Project, which researches and advocates for sentencing reforms.

Nellis also noted that the state’s 450 juvenile lifers, 315 are black.

“Social and medical research on young people verifies that they are categorically less culpable than adults because of their relative lack of maturity and underdeveloped ability to understand the consequences of their actions,” Nellis said. “Pennsylvania should join the growing consensus that rejects this practice.”

Holistic/Alternative/Integrative/Complementary Medicine

Acupuncture for Depression in Pregnancy

A randomized controlled trial of acupuncture for depression during pregnancy suggested that symptoms were reduced with a response rate similar to standard depression treatments.  Acupuncture may be a viable treatment option for depression during pregnancy.

150 pregnant women who met criteria for major depression were given either acupuncture specific for depression or one of two active controls: control acupuncture or massage. They received 12 sessions during 8 weeks. The acupuncturists who administered treatment were blinded to treatment assignment. The Hamilton Rating Scale for Depression was used to rate severity. 63% of the women who received depression-specific acupuncture reported a significant reduction in symptoms, compared to 44% of women in the other two groups combined.

Many pregnant women with depression stop taking medications when they become pregnant, due to concerns this may harm their unborn babies.  Women with depression are at increased risk for preterm births, and are at increased risk for post partum depression, so treatment of depression during pregnancy is important. Post partum depression interferes with a woman’s ability to care for her infant, and can have lasting effects; previous studies suggest that children of mothers with postpartum depression perform more poorly in school, become frustrated more easily, and have poorer problem solving.

Acupuncture may be a good option in treating depression in pregnant women; this treatment appears to be more effective than other tested non-pharmacologic treatments. Depression during pregnancy is common; up to 14% of women may have depression when pregnant.

Acupuncture for depression during pregnancy: a randomized controlled trial.

Manber R, Schnyer RN, Lyell D, Chambers AS, Caughey AB, Druzin M, Carlyle E, Celio C, Gress JL, Huang MI, Kalista T, Martin-Okada R, Allen JJ.

Obstet Gynecol. 2010 Mar;115(3):511-20.PMID: 20177281

Use of Nondrug Coping Skills to Help Children With Cancer

There are a number of  current integrative and complementary treatment studies for children and adolescents.

Timothy Culbert is the medical director of the integrative medicine program at Minneapolis-based Children’s Hospitals and Clinics of Minnesota, one of the largest hospital-based, pediatric complementary medicine programs in the country.  Dr. Culbert and his colleagues are about to launch a study at four hospitals in the U.S. and Canada to examine in greater depth the use of nondrug coping skills in kids with cancer.

Several years ago, they developed a “Comfort Kit” designed to teach children coping skills including: deep-breathing relaxation techniques; aromatherapy, in which patients inhale chemicals produced by plant oils; and acupressure, a variant of acupuncture with pressure applied to certain points in the body.

In several pilot studies, Dr. Culbert’s team found that kids can learn such skills and appear to find them helpful. In one study of 150 kids who underwent surgery , 87% said the techniques helped them cope with pain after the procedure. Another study found that a majority of kids with cancer felt relief from their nausea with accupressure.

At the University of Alberta in Edmonton, Canada, Sunita Vohra is running a clinical trial with 80 participants to examine whether a self-calming strategy can help children with a variety of diagnoses, including attention-deficit hyperactivity disorder and opposition-defiant disorder. The aim is to teach children to focus on “their presence in the moment”—by paying attention to breathing and other sensations and blocking out external commotion.

Vohra is beginning an individualized study of the use of probiotics—micro-organisms thought to be healthy for the person that consumes them—with gastrointestinal diseases. Dr. Vohra is also studying whether melatonin aids sleep in kids with attention-deficit hyperactivity disorder.

Wake Forest’s Dr. Kemper has investigated the pediatric use of music therapy, chiropractic care that involves manipulating the body, and “healing touch,” which is based on the premise that the presence of one person’s electromagnetic energy field has an affect on another person.

Dr. Kemper’s research, including one published in the journal Pediatric Research, has shown that music helps soothe kids with cancer. In 2008, she and her colleagues published findings on eight premature infants showing that live harp music can help them gain weight. Previous findings depicting this effect puzzled them, because such babies can’t increase the number of calories they are eating on their own.

To figure out what was going on, Dr. Kemper’s group put devices called actimeters, which measure very small movements, on the legs of the infants and found that those babies who were exposed to the music were alert and paying attention compared to those in a quiet room or getting the usual care. Soothed babies exhibit fewer tiny muscle movements compared with more tense babies, which reduces the amount of calories they burn.

It isn’t always clear from these studies what the active ingredient is that’s responsible for the apparent benefit of the therapy. Recent preliminary findings from Dr. Kemper’s group show that kids with cancer report feeling calmer, less anxious and more comfortable in the presence of someone performing healing touch. Yet the study can’t tease apart whether it is the mere presence of a calm person in the room or the actual healing touch that appears to affect the patient.

A method that is safe can be utilized even if it is not shown to be effective, because it gives children and families a sense that they are doing something. The caution is that if a therapy has side effects,expensive, or is used in place of a therapy known to be effective, then the risks outweigh the benefits.

Use of Nondrug Coping Skills to Help Children With Cancer

There are a number of  current integrative and complementary treatment studies for children and adolescents.

Timothy Culbert is the medical director of the integrative medicine program at Minneapolis-based Children’s Hospitals and Clinics of Minnesota, one of the largest hospital-based, pediatric complementary medicine programs in the country.  Dr. Culbert and his colleagues are about to launch a study at four hospitals in the U.S. and Canada to examine in greater depth the use of non-drug coping skills in kids with cancer.

Several years ago, they developed a “Comfort Kit” designed to teach children coping skills including: deep-breathing relaxation techniques; aromatherapy, in which patients inhale chemicals produced by plant oils; and acupressure, a variant of acupuncture with pressure applied to certain points in the body.

In several pilot studies, Dr. Culbert’s team found that kids can learn such skills and appear to find them helpful. In one study of 150 kids who underwent surgery , 87% said the techniques helped them cope with pain after the procedure. Another study found that a majority of kids with cancer felt relief from their nausea with accupressure.

At the University of Alberta in Edmonton, Canada, Sunita Vohra is running a clinical trial with 80 participants to examine whether a self-calming strategy can help children with a variety of diagnoses, including attention-deficit hyperactivity disorder and opposition-defiant disorder. The aim is to teach children to focus on “their presence in the moment”—by paying attention to breathing and other sensations and blocking out external commotion.

Vohra is beginning an individualized study of the use of probiotics—micro-organisms thought to be healthy for the person that consumes them—with gastrointestinal diseases. Dr. Vohra is also studying whether melatonin aids sleep in kids with attention-deficit hyperactivity disorder.

Wake Forest’s Dr. Kemper has investigated the pediatric use of music therapy, chiropractic care that involves manipulating the body, and “healing touch,” which is based on the premise that the presence of one person’s electromagnetic energy field has an affect on another person.

Dr. Kemper’s research, including one published in the journal Pediatric Research, has shown that music helps soothe kids with cancer. In 2008, she and her colleagues published findings on eight premature infants showing that live harp music can help them gain weight. Previous findings depicting this effect puzzled them, because such babies can’t increase the number of calories they are eating on their own.

To figure out what was going on, Dr. Kemper’s group put devices called actimeters, which measure very small movements, on the legs of the infants and found that those babies who were exposed to the music were alert and paying attention compared to those in a quiet room or getting the usual care. Soothed babies exhibit fewer tiny muscle movements compared with more tense babies, which reduces the amount of calories they burn.

It isn’t always clear from these studies what the active ingredient is that’s responsible for the apparent benefit of the therapy. Recent preliminary findings from Dr. Kemper’s group show that kids with cancer report feeling calmer, less anxious and more comfortable in the presence of someone performing healing touch. Yet the study can’t tease apart whether it is the mere presence of a calm person in the room or the actual healing touch that appears to affect the patient.

A method that is safe can be utilized even if it is not shown to be effective, because it gives children and families a sense that they are doing something. The caution is that if a therapy has side effects,expensive, or is used in place of a therapy known to be effective, then the risks outweight the benefits.

Acupuncture for Depression in Pregnancy

A randomized controlled trial of acupuncture for depression during pregnancy suggested that symptoms were reduced with a response rate similar to standard depression treatments.  Acupuncture may be a viable treatment option for depression during pregnancy.

150 pregnant women who met criteria for major depression were given either acupuncture specific for depression or one of two active controls: control acupuncture or massage. They received 12 sessions during 8 weeks. The acupuncturists who administered treatment were blinded to treatment assignment. The Hamilton Rating Scale for Depression was used to rate severity. 63% of the women who received depression-specific acupuncture reported a significant reduction in symptoms, compared to 44% of women in the other two groups combined.

Many pregnant women with depression stop taking medications when they become pregnant, due to concerns this may harm their unborn babies.  Women with depression are at increased risk for preterm births, and are at increased risk for post partum depression, so treatment of depression during pregnancy is important. Post partum depression interferes with a woman’s ability to care for her infant, and can have lasting effects; previous studies suggest that children of mothers with postpartum depression perform more poorly in school, become frustrated more easily, and have poorer problem solving.

Acupuncture may be a good option in treating depression in pregnant women; this treatment appears to be more effective than other tested non-pharmacologic treatments. Depression during pregnancy is common; up to 14% of women may have depression when pregnant.

Acupuncture for depression during pregnancy: a randomized controlled trial.

Manber R, Schnyer RN, Lyell D, Chambers AS, Caughey AB, Druzin M, Carlyle E, Celio C, Gress JL, Huang MI, Kalista T, Martin-Okada R, Allen JJ.

Obstet Gynecol. 2010 Mar;115(3):511-20.PMID: 20177281

Impact of Parental Divorce, Bibliography

1.  Wolchik, SA West, SG, Westover S, Sandler, IN, Martin, A, Lustig, J Tein, J & Fisher, J (1993) The children of divorce parenting intervnetion: Outcome evaluation of an empirically-based program. American Journal of Community Psychology, 21, 293-331

2. Cummings EM & Davies, PT (1994) children and Marital Conflict. New York, Guilford Press

3. Hetherington, EM, Clingempeel, WG, Anderson, ER, Deal, JE Hagen, MS Holier, EA & Linder, MS (1992) Coping with marital transitions: A family systems perspective Monographs of the Society for Research in Child Development, 57

4. Buchanan, CM, Maccoby EE, & Dornbusch, SM (1991) Caught between parents: Adolescents’ experience in divorced homes Child Development, 62, 1008-1029

5. Hetherington, EM, Cox, M, Cox, R (1982) Effects of divorce on parents and children. In M. Lamb (Ed.) Nontraditional familieis) pp 223-288 Hillsdale, MJ Erlbaum.

6. Guidibaldi, J, Perry, JD, Nastasi, BK (1987) Assessment and intervention for children of divorce: Implications of the NASP-KSU nationwide survey. In J Vincent (Ed.) Advances in family intervention, assessment, and theory (Vol. 4, pp 33-69) Greenwich, CT: JAI Press

7. Wolchik SA, West, SG, Westover, S Sandler, IN, Martin, A, Lustig, J, Tein, J & Fisher, J (1993) The chidlren of divorce parenting intervention: Outcome evaluation of an empirically-based program. American Journal of Community Psychology, 21 293-331

8. Grych, JH Fincham, FD (1999) The Adjustment of children from divorced families: implications of empirical research for clinical intervention. In Galatzer-Levy, RM  and Kraus, L (Ed.) The Scientific Basis of Child Custody Decisions pp. 96-119

9. Mazur, E, Wolchik, SA Sandler, IN (1992) Negative cognitive errors and positive illusions for negative divorce events: Predictors of children’s psychological adjustemnt. jouranl of Abnormal Child Psychology 20 523-542

10. Fogas, B, Wolchik, S, Braver, S, Freedom, DS et al. (1992) Locus of control as a mediator of negative divorce-related events and adjustment problems in children. American Journal of Orthopsychiatry 62, 589-598

11. Lazarus, RS, Folkman, S (1984) Stress, appraisal, and coping. New York. Springer.

12.  Armistead, L, McCombs, A, Forehand, R, WIerson, M, Long, N, Faubger, R (1990) Coping with divorce A study of young adolescents. Journal of Clinical Child Psychology, 19, 79-84

When Parents Kill Children

On Jan. 27, Julie Powers, 50, a mother of two in Tampa, drove her 13-year-old son, Beau, home from soccer practice and allegedly shot him in the head “for talking back” to her. Then she went upstairs and shot Calyx, her 16-year-old daughter dead as she sat at her computer doing her homework, according to an arrest affidavit. At the time, her husband was serving in Qatar as an army colonel. Powers said her kids were “mouthy.”

This is an unusual situation, because typically, it is younger children who are more likely to be killed. And usually, if a child is killed for being “mouthy” it is the result of a parent losing their temper, being aggressive, and throwing a child against a wall.

Killing newborns is much more common than killing older children.

As far as death by homicide goes, you’re more likely to be killed on the day you are born than on any other day of your life.

Younger children are much more likely to be killed than teenagers. If a child is killed for being “mouthy,” the remark that came out here, that’s more likely to lead to fatal battering. [Usually, in such cases,] a 3-to-5-year-old is thrown against a wall in an overzealous attempt at discipline and dies — as opposed to [a parent] planning to kill and shooting them with a gun.

Typically, circumstances in which parents kill their children include:

“ALTRUISM”:  When a mother plans to take her own life and believes her children are better off in heaven with her.

PSYCHOSIS:  The parent is acutely psychotic.

FATAL BATTERING: [as described above].

UNWANTED:  such as when a mother has  an infant born out of wedlock.

SPOUSAL REVENGE: a parent kills the children to hurt the partner, typically after infidelity or a separation

The case in Florida doesn’t appear to fit into any of these categories, based on the information we currently have. It is likely that there is more to the case than that the children were merely being mouthy.

When parents kill their children, the methodology may depend on the child. Age is one factor: a  3-year-old can be easily strangled or overdosed. Teens are not going to cooperate in being killed so the use of a knife or gun is more necessary. In some cases of fathers who kill teenagers there has been a real standoff and hostility, but that’s not typical for mothers.

Fathers are more likely to murder the whole family. In 95% of those cases in which whole families are killed, the fathers are the killer.

Is there any way to prevent these types of crimes?

There is no easy answer to intervening here. Better access to mental health care may be helpful.

Awareness; a woman who is very depressed and has young children who makes a suicide attempt has a 1-in-20 chance that she will try to take the kid with her. Specific inquiries about thoughts of harm toward children should occur in any evaluation of a seriously depressed mother.

What happens to parents who kill their children?

Most parents who kill their children go to prison rather than mental institutions. According to the FBI, women who kill their children and are not found insane, serve a mean length 17 years in prison. In women who kill newborns, the mean length is 9 years. Of all homicide perpetrators, none have a higher incidence of being found insane than mothers who kill their children.

Mothers who commit infanticide

They are not a general danger to the community. There are infanticide laws in 22 countries, including England, Canada and Australia — instead of women being charged with murder, mothers who kill children that are less than 1 year old are charged with infanticide. In the U.K., the vast majority get probation rather than prison. The recidivism rate is very low. The risk of suicide is substantial, however.