Victims Say Film on Molesters Distorts Facts
Sharon Waxman, New York Times- 2/24/2004

LOS ANGELES-"Capturing the Friedmans," the Oscar-nominated documentary that raises questions about the guilt of a father and son convicted of child molestation, is being criticized by six of their former victims, who say the film omitted or distorted important information about their cases.
The six are suggesting that the director, Andrew Jarecki, created more ambiguity than actually existed about the case both to heighten the dramatic impact of the film and to elicit sympathy for the Friedmans. The film tells the story of the disintegration of a seemingly average Long Island family after the father, Arnold Friedman, and son, Jesse, were accused of molesting children in computer classes they held in the basement of their Great Neck home in the 1980's. The film, an Academy Award nominee for best documentary, has been critically praised and brought intense debate at screenings, in editorials and on talk shows about the Friedmans' guilt and whether the case showed failures of the justice system.
     Both Arnold and Jesse Friedman pleaded guilty to dozens of counts of child molestation in 1988. Arnold Friedman committed suicide in prison. Jesse Friedman, 34, who served 13 years in prison before being released, recently submitted a motion in Nassau County Court to vacate his conviction, citing disclosures in the film about police evidence that could have helped his case. The court motion has angered former victims and their families who had not previously attacked the film, which was released last May.
     Mr. Jarecki, the director, "ignored and hid evidence that Jesse was guilty and didn't reach out to actual victims, because I never heard from him," said the mother of one of 13 victims. Her son gave grand jury testimony against Jesse Friedman in 1987. The New York Times has agreed to protect her identity and her son's. Mr. Jarecki said in an e-mail interview that he had tried to reach each of the 13 accusers of Jesse Friedman by registered mail and Federal Express, though he said he may not have had correct addresses for all. Two are included in the film, one on camera and another on audiotape. Asked how many victims he spoke to, Mr. Jarecki said: "I don't know how many I spoke to. It was more than three." Mr. Jarecki said he had made 500 attempts to reach 100 of the Friedmans' former computer students.
     The mother said that Mr. Jarecki's film omitted a third co-defendant, Ross Goldstein, a teenage neighbor who also pleaded guilty to charges of child molestation and who corroborated some of the children's accusations at the time and went to prison. She also said that Mr. Jarecki omitted a tearful confession by Jesse Friedman in prison on Geraldo Rivera's talk show in 1989. Mr. Friedman detailed how his father had molested him as a child. In interviews Jesse Friedman has retracted his confessions, saying he pleaded guilty because he feared he could not get a fair trial and would get the maximum penalty.
      The mother of the accuser said: "What fame is there in making a film about a pedophile who's a pedophile? What gives it the added twist? That it wasn't true." She said Jesse Friedman was not innocent. "I'm very suspicious," she added. "I know the truth. I think it's clear. He had all the evidence, and for some reason he chose not to use it." Mr. Jarecki responded by e-mail: "I had no agenda in making this film other than to tell the story in a way that related it in all its complexity. I did not see ambiguity as a tool. It was a natural outcome of a three and a half year process. I did not shy away from showing the disgusting nature of Arnold Friedman's pedophilia, and I did not shy away from showing the disturbing failures in the police investigation."
     Mr. Jarecki said the material on Mr. Goldstein was left out because it duplicated statements by the 13 children but was included in the just-released DVD. He said he considered the Rivera interview unnecessary, since the film showed Jesse Friedman's confession in court. But attacks on the film continue. Two former victims, including the son of the woman who spoke to The Times, wrote an open but anonymous letter last week to the Academy of Motion Picture Arts and Sciences, which will give out the Oscars on Sunday. They said that the film portrayed the victims as if they had invented their stories to satisfy an overzealous Nassau County police force. They wrote: "We did not lie. We did not exaggerate. We were never hypnotized to tell our stories." They said the director had twisted the facts in the film to make it appear that they had. If the film wins an Oscar, they wrote, "it will be won at the expense of silencing the plaintive voices of abused children once again, just as our own voices were silenced 16 years ago by the threats and intimidation of our tormentors." The signers are a 24-year-old law student and a 27-year-old businessman; their identities have been confirmed by the judge who presided over the trial, Abbey Boklan, who is now retired. A spokesman for the academy had no comment. Voting for the Oscars closes on Tuesday.
Four other victims who have retained a lawyer to fight Jesse Friedman's motion to vacate his guilty plea also criticized the film. "I don't see the film as a representation of any type of investigation that was done," said Salvatore Marinello, their lawyer, who said the four men did not want to be interviewed.
     "I see the film as a capsulized version of what was taking place in the Friedman household during the time the case was pending," Mr. Marinello said. "There's no doubt that it's fascinating. But why are we reliving these events? Because some director decided to make a movie. They believe the motion filed on Jesse's behalf was simply a result of publicity garnered from the movie, that there's no factual basis." Mr. Marinello also said he knew of no attempt by the filmmaker to reach his clients.
     Mr. Jarecki has been inconsistent in responding to some questions about his research. Asked repeatedly by The Times whether he knew of a lie-detector test that Jesse Friedman took and failed while he protested his innocence in the 1980's, Mr. Jarecki said he did not. But in an interview on a Web site, Mr. Jarecki spoke in detail about the lie-detector test, saying he considered it inconclusive.
     The mother of the victim who spoke to The Times said her son appeared to recover quickly after he was molested at the age of 7 but had severe emotional problems when he became an adolescent. The man, who is the 24-year-old law student who wrote to the academy, also wrote on Jan. 29 to the judge who presided over the case. "This director's cause is wrong and his purpose is self-serving at my expense as well as at the expense of other victims," he wrote to Ms. Boklan. The letter is posted on a Web site of psychologists who specialize in child molestation and find fault with the film (www.leadershipcouncil.org). "It was under the guise of an educator that Arnold and Jesse Friedman used computer technology to show young children pornography," the law student wrote. "I became afraid of everything beyond my control. My childhood curiosity was replaced with an inherent distrust for adults, authority figures and every unknown."
     Last week Jesse Friedman released a statement saying he was not surprised that some of his accusers are standing by their statements to the grand jury. "There has never been any dispute about the fact that these statements were made," he said. "While I know these claims are untrue, I respect their right to make them, and I believe it is likely that they continue to believe these events took place." But Mr. Friedman spoke differently in an interview on "Dateline NBC" last month, when he challenged former victims to come forward, as well as in an interview on the DVD release of the film, in which he says that he and his brother David cooperated with the film in the hope that his former accusers would recant. "The whole purpose of this movie for David and I was to try to get my conviction overturned," Mr. Friedman says in a segment for the DVD shot in September, 22 months after his release from prison. He hoped the movie would "set up an environment where people in the computer class would come forward and say, `I know I said certain things to the grand jury, but those things weren't true.' "
     Mr. Jarecki denies that he has become an advocate for Jesse Friedman. Still, Mr. Jarecki has submitted an affidavit on his behalf to the court. "One of the hallmarks of a balanced film on a controversial subject is that advocates on both sides will never be satisfied that the film supports their agendas," he wrote by e-mail. "Unlike some documentaries that underscore a point of view, `Capturing the Friedmans' presents all the evidence and allows the audience to decide for themselves."

Addict: 'Gambling Just Took Over my Life'
Sam Skolnik, Seattle Post-Intelligencer- 2/24/2004

Nothing could stop Alan Y. from gambling. Not the pleas of his ex-wife and two sons. Not his increasingly desperate financial situation. Not even the U.S. Army, which court-martialed him in 1999. Alan, who asked that his last name not be used, is a Seattle native who attended the University of Washington. He served in the Army for 27 years.
     His descent into problem gambling was dramatic and severe, and his struggle is far from over.
It began in 1996, when he went with friends to a riverboat casino in Lake Charles, La., on a bus the casino had sent to San Antonio. The gambling clearly filled a deep need, and he soon began making solo trips to the casino -- a 400-mile drive one way that he often took at 90 mph. In 1997, Alan was assigned to Fort Lewis near Tacoma. Casinos dotting Interstate 5 were now just 30 minutes away. "I was there almost every chance I got," said Alan, 53. "Gambling just took over my life." He was thrilled to be posted to a base so close to his home, where friends remained and his children lived. But during his long gambling bender, "Gosh, I made excuses not to go see them."
     According to Alan, who is Japanese American, both his father and brother are also compulsive gamblers. He said he met his father for the first time in California when he was 18. He took his son to the racetrack every day, Alan said. "I think it's cultural," Alan said of gambling. "It's accepted within our communities." He said he has noted the high incidence of Asians in local casinos -- and the way the casinos market specifically to them. Alan said he believed that they "hire Asians knowing it would attract more Asians." The marketing worked on him, he said. "I have to kind of laugh," he said. "I gravitated toward the Emerald Queen," he said, in part because of the Asian entertainers they regularly brought in and the strong Asian feel of the Tacoma casino. He also said he saw new Asian immigrants zealously gambling, and usually losing. "They're spending all their money. I know they are," he said. "They don't even have to speak English. You can see it on their faces."
     Alan, who is now a social worker, said he gambles for the incredible adrenaline rush it provides.
"I got super high when I would go in. I just couldn't be beat. ... I knew I could beat the game," he said. Occasionally he did, like the time he won $8,000 in about four hours during a blackjack session at the Emerald Queen. Twelve hours later, he'd lost it all.
     In 1998, Alan filed for Chapter 7 bankruptcy protection. That allowed him, he said, to continue to gamble, heavier than ever. He began writing bad checks, including some between his own accounts, which caught the attention of federal authorities. Through deception, the logistics supply officer obtained a government Visa card and began taking large cash advances on the card from casino cages, including at the Drift On Inn, a Shoreline card room. Over the next two months, he said, he took $10,000 worth of those advances at "the Drift," at $500 a pop. During that time, he left the base and told his superiors he wasn't coming back. But one officer traced a call to his mother's house in Seattle, where he was staying. He was ordered to report to Madigan Army Medical Center for evaluation.
     In January 1999, a finance clerk noticed the $10,000-plus debt on his unauthorized government credit card. The Army moved to court-martial Alan and confined him to base. But he went AWOL again, flying to Las Vegas for a last stand. He ran out of money, cashed in his return-trip plane ticket, and then lost that cash, too. He walked aimlessly through the neon-lit streets until his ex-wife wired him enough money to buy a ticket back to the base. He pleaded guilty to multiple charges of improperly using the credit card and to going AWOL, which could have netted him 55 years in prison. But he found a sympathetic judge who gave him a dishonorable discharge instead of any jail time.
     Since his court-martial, Alan said, he has been in treatment and has attended Gamblers Anonymous meetings, although not regularly because of a demanding work schedule. He said that he and his girlfriend, whom he met in a G.A. meeting, plan to soon start going again regularly.
"The urge is diminishing, and I really believe I'm turning around," he said. But he hasn't completely stopped. He said he most recently gambled in December. At his longest recent stretch, Alan said, he stopped gambling for a year, between December 2001 and November 2002. The urge to gamble likely will never completely go away, he said. "What's scary is that I know it could grab me at any minute. Once a compulsive gambler, it's too easy to get sucked back into it."

Lifting the Veils of Autism, One by One by One
Erica Goode, New York Times- 2/24/2004

He is blond and 3 years old, 33 pounds of compressed energy wrapped in OshKosh overalls. In an evaluation room at Yale's Child Study Center, he ignores Big Bird, pauses to watch the bubbles that a social worker blows through a wand, jumps up and down. But it is the two-way mirror that fascinates him, drawing him back to stare into the glass, to touch it, to lick it with his tongue. At 17 months, after several ear infections and a bout of the flu, the toddler's budding language skills began to deteriorate, his parents tell the evaluators. In the playroom, he seems intent on his own activities and largely oblivious to the adults in the room. Only when the therapist bends down to tickle him does he give a blinding smile and meet her gaze with startling blue eyes.
      Sixty years after it was first identified, autism remains one of the most puzzling of childhood disorders. Its cause or causes are still unknown. But in recent years, investigators have begun to dislodge some of its secrets. Studies have offered clues to the brain mechanisms that may lie behind some features of autism — the tendency to focus on objects rather than human faces, for example — and geneticists have begun to home in on genes that may be involved. Scanning has provided glimpses of ways autism may affect brain development: the brains of autistic children, studies find, appear to be larger than normal for some time after birth. In the future, experts say, such research may yield effective medical treatments to augment or even replace the intensive behavioral therapy that is the prescription most autistic children now receive.
      In learning more about autism, a disorder that in some form affects at least 425,000 Americans under 18, scientists may also increase knowledge about language development, emotion, even friendship and love. "Ultimately, research on autism may teach us a lot about what it means to be social," said Dr. Thomas Insel, the director of the National Institute of Mental Health.
      Autistic children were once thought to have a form of childhood schizophrenia. Prone to repetitive, sometimes self-destructive behaviors and driven by "a powerful desire for aloneness and sameness," as Dr. Leo Kanner of Johns Hopkins put it in a now classic 1943 paper, they often spent their lives in institutions. Parents watched helplessly as their children disappeared into a world beyond their reach. But much has changed. The notion that autism was caused by "refrigerator" mothers and absent fathers, promoted by psychoanalysts in the 1950's and 1960's, has yielded to the realization that the disorder is strongly rooted in genetics and abnormalities of brain development and function. Environmental influences early in life may also play a role.
      At the same time, a sharp rise over the last decade in the number of autism cases diagnosed in the United States and other countries has raised public awareness and helped secure more government financing for research. In the 2003 fiscal year, the National Institutes of Health spent an estimated $81.3 million on autism research, compared with $9.6 million in 1993. The last two decades have brought a sea change in the way scientists view autism and those who suffer from it. Researchers now recognize, for example, that autism is not synonymous with mental retardation: more than 80 percent of children with autism were once thought to be mentally retarded. More recent estimates place the number at 70 percent, or lower if related disorders are included.
      Dr. Kanner believed autism to be a product of upper-middle-class homes, a conclusion based on the children he examined, who were the progeny of doctors, lawyers and scientists. But it is now clear that autism crosses class boundaries. Boys are four times as likely as girls to have the disorder. This sex ratio has led one researcher, Dr. Simon Baron-Cohen, director of the autism research center at Cambridge University in England, to speculate that autism is a form of "extreme maleness," but the theory has yet to be supported by research.
     More rigorous studies have allowed clinicians to identify autism in children of younger and younger ages. In the past, the disorder often was not diagnosed until children were 4 or 5. But by studying home movies of birthday parties or first baths, investigators have found telltale signs of autism in children of 12 months or younger. Dr. Geraldine Dawson, director of the University of Washington's autism center, for example, studied infants from 8 to 10 months old who were later identified as autistic. The infants, she said, often failed to respond when parents called their names. "Even very young babies, when you call their name, will turn and look at you," Dr. Dawson said. As toddlers, autistic children show other differences. For example, they make eye contact less frequently, and, unlike most 1-year-olds, do not point at objects or people.
      Autism's hallmarks are a delay in language development, an inability to relate to other people and stereotyped or rigid behavior. But researchers have found that children vary greatly in the nature and the severity of their disabilities. "If you put 100 people with autism in a room, the first thing that would strike you is how different they are," said Dr. Fred Volkmar, a professor of child psychiatry at Yale and an expert on autism. "The next thing that would strike you is the similarity." Some children attend regular schools, others are so disabled they require institutional care. Some children speak fluently, others are mute. Some are completely withdrawn; others successfully navigate a path through the outer world. In fact, studies show that many children with autism can improve with treatment, and some — from 15 to 20 percent, experts say — recover completely, holding jobs and living independent lives.
      Yet the realization that autism takes many forms has also made its diagnosis more complicated. In 1994, psychiatrists added a new diagnostic category — Asperger's syndrome — to the psychiatric nomenclature, to take account of children who displayed some features of autism but did not meet the full diagnostic criteria. Many researchers view Asperger's as distinct from autism. But the differences become blurred in cases where children have normal or above normal I.Q.'s. In such instances, experts say, whether Asperger's or autism is diagnosed is often arbitrary. "I don't think anyone's got good evidence for a clear distinction between people with high-functioning autism and Asperger's," said Dr. Tony Charman, a researcher in neurodevelopmental disorders at University College London.

Calculations, Yes; Eye Contact, No
As a child, Donald Jensen lay in bed at night, tracing numbers in the air with his finger. He memorized lottery numbers. He was riveted by the pages of the calendar. Now 19, his facility with mathematical calculation seems magical. Given any date — Jan. 7, 1988, for example — he can, in an instant, identify the day of the week it fell on. (It was a Thursday.) He virtually never makes mistakes. Yet even in childhood, there were signs that Donald was exceptional in other ways. He was mesmerized by the washing machine, becoming upset if the laundry was finished before he got up in the morning. He started talking late. Once, when his grandmother slipped on some ice in the yard and fell, he continued to chatter about numbers, seemingly oblivious to her plight.
      Problems in school led doctors to diagnose autism when Donald was 6, his uncle, Glen Jensen, said. As an adult, Donald's gifts — he is among the 1 to 10 percent of people with autism known as autistic savants — connect him to the world. "What day were you born?" he asks visitors. But the things that Donald cannot do also separate him from other people. He rarely makes eye contact. Ask him how he calculates dates or what numbers mean to him and the inquiries are met with silence. His ability to empathize with other people has grown over the years — "John was angry today, and that was upsetting to me," he will say — but unexpected events disturb him, and his conversations sometimes take the form of asking questions over and over.
      What lies at autism's core? Over the decades, researchers have come up with a variety of theories. But most were based on what clinicians observed, not on what might be going on in the brain. Only recently have sophisticated technologies allowed researchers to begin bridging the gap between the consulting room and the laboratory. Dr. Ami Klin, an associate professor of child psychology and psychiatry at Yale, and his colleagues began with the observation that people with autism often have a great deal of intellectual knowledge, but lack "street smarts," and are unable to use what they know in social situations. "Many of our clients know the currencies of all countries in the world, but they cannot go to McDonald's and buy a burger and count the change," Dr. Klin said. "They know all the bus ramps, but can't take a bus."
      In a series of experiments to find out why it is so difficult for someone with autism to function in the world, the Yale team , including Warren Jones, a research associate, developed a device for tracking eye movements that could be mounted on the brim of a baseball cap. Then they had subjects, who either had autism or did not, watch a video clip from the 1967 film "Who's Afraid of Virginia Woolf" and monitored their gaze. The normal subjects closely tracked the social interactions among the actors in the films, focusing especially on the actors' eyes. In contrast, people with autism focused on objects in the room, on various parts of the actors' bodies and on the actors' mouths. In one scene, Richard Burton and Elizabeth Taylor kiss. The subjects without autism looked at the actors' embrace; the autistic subjects' eyes went elsewhere: one man stared at a doorknob in the background.
      Such research suggests that from birth, the brains of autistic children are wired differently, shaping their perception of the world and other people. "In normal development," he said, "being looked at, being in the presence of another, seeking another — most of what people consider important emerges from this mutually reinforcing choreography between child and adult." If this duet cannot take place, Dr. Klin said, "development is going to be derailed."
      Studies using brain scanning techniques like fast M.R.I. lend weight to the idea that for people with autism, perception molds behavior. "There is a deep relationship between what we see and what we know," said Dr. Robert Schultz, an associate professor at Yale's Child Study Center. Researchers have long known, for example, that people with autism have difficulty recognizing faces. In non-autistic subjects, a brain area called the fusiform gyrus is activated in response to the human face. But when pictures of unfamiliar faces are shown to children or adults with autism, studies show, the region is less active. Dr. Schultz said that autistic people appear to identify faces the way other people identify objects, by piecing features together. While most people are better at recognizing images of faces when they are right-side up, autistic subjects identify them faster when they are upside-down.
      A recent study, presented at the annual meeting of the American Association for the Advancement of Science in Seattle this month, illustrates this. Dr. Dawson, of the University of Washington, and a colleague reported that when autistic adolescents and adults were shown pictures of faces, another brain area involved with object recognition was activated, while the fusiform gyrus remained quiet. Yet when the researchers showed photos of the subjects' mothers, the fusiform brain did light up.
      Work by Dr. Isabel Gauthier, an assistant professor of psychology at Vanderbilt University, suggests that, in fact, the fusiform gyrus is not programmed to react to faces per se but to things that people care about and learn to distinguish in detail. Dr. Gauthier trained people to become experts on "greebles," a class of simply-drawn imaginary beings. When the subjects became adept at telling one greeble from another, she found, the fusiform gyrus lighted up in response to pictures of the creatures. Similarly, when car experts were asked to identify different car models, the region was activated, Dr. Gauthier reported last year in the journal Nature. The research suggests that children with autism can be trained to become better at face recognition — something that scientists at Yale and other universities are trying. But the seeming indifference to the human face that often accompanies autism has led the Yale resarchers to propose that the fusiform gyrus may be a component of the social brain, intimately tied up with basic emotional responses like fear, anxiety and love. In fact, some studies have found abnormalities in the amygdala, a brain region involved with emotion and social awareness. But the findings are inconclusive, and differences in autistic brains have been found in structure, including the temporal lobes and the cerebellum.

A Telling Find: Bigger Brains
In his early description of autism, Dr. Kanner noted that heads of the children were larger than normal. Modern researchers have confirmed this observation, finding that for some period of time during childhood, autistic children have bigger brains than their non-autistic counterparts. In 2001, Dr. Eric Courchesne, a professor of neuroscience at the University of California at San Diego, and his colleagues found that 4-year-olds with autism showed increases in the volume of the brain's gray matter, where the cell bodies of neurons are located, and white matter, which contains nerve fibers sheathed with an insulating substance called myelin. In a 2003 study in The Journal of the American Medical Association, Dr. Courchesne reported that at birth, the heads of infants with autism were smaller than normal, but then showed "sudden and excessive" growth in size from 1 to 2 months and from 6 to 14 months. By adolescence, however, the children's brains were the same size as those of other children or slightly smaller.
      Dr. Martha Herbert, an instructor in pediatric neurology at Harvard, has begun to zero in on precisely where this growth spurt occurs. At the annual meeting of the Society for Neuroscience in October, she reported that in autistic children, the outer zones of white matter became enlarged compared with normal brains beginning after age 6 months and continuing into the second year of life. Those outer zones, Dr. Herbert said, are insulated later in development than the areas of white matter deeper in the brain. "It seems that something is going on that gets more intense," Dr. Herbert said.
      In another study, Dr. Manuel Casanova, a professor of neurology and neuropathology at the University of Louisville, found an increase in autistic brains in the stacks of neurons known as mini-columns that extend through the layers of the neocortex. The brains of people with autism not only had more mini-columns, Dr. Casanova found, but the neurons that made up the columns were less variable in size than in normal brains.
      Such findings are intriguing, but their meaning is not clear. One possibility is that the enlargement in white matter reflects an overabundance of myelin, which could disrupt the timing of communication signals throughout the brain. But this growth in volume, Dr. Herbert said, could also represent an increase in nerve fibers, the migration of other types of cells or some type of inflammation. Dr. Casanova, for his part, theorizes that the proliferation of mini-columns might result in a deluge of stimulation, or as he puts it, "way too much information." "The sound of rain on a roof might seem like driving nails into a tin roof, a fluorescent light might become extremely perturbing," Dr. Casanova said. Dr. Nancy Minshew, a professor of psychiatry and neurology at the University of Pittsburgh, argues that autism's core lies in higher brain areas, rather than in deeper structures that govern emotion. "When I started about 20 years ago, I looked at autism and said this disorder is in the cortex of the brain," Dr. Minshew said. "It's the classical disorder of cognition."

Child Rearing Not at Fault
In 1964, Bernard Rimland, a British psychologist with an autistic son, put forward the view, then controversial, that genes, not faulty child rearing, lay behind the disorder. Most experts now agree that autism is strongly determined by heredity. Studies indicate, for example, that if parents have one child with autism, the chance that they will have a second autistic child is 2 to 6 percent — about 100 times the general risk.
      Twin studies also argue for a large genetic component. Identical twins, the studies suggest, run a 60 to 85 percent chance of having autism or a similar disorder if their twins have it. For fraternal twins, the chances are 10 percent. Two very rare forms of autism — one associated with the congenital disease known as tuberous sclerosis and the other with fragile X syndrome — are known to be caused by chromosomal defects.
      But in most cases, autism is thought to have a more complex genetic origin, involving multiple genes acting together. "The bulk of people with autism develop it because they have inherited a particular genetic predisposition," said Dr. Anthony Bailey, a professor of psychiatry at Cambridge Finding those genes, however, is a difficult task. The disorder is relatively uncommon, and most people with autism do not have children, making it difficult to track successive generations of a family. To get around these obstacles, some researchers are studying families having two or more members with autism and searching for similarities in the genome that could provide the crucial link to the disorder. Cure Autism Now, an advocacy group based in Los Angeles, has started a program to collect DNA samples from such families and use them for research.
      Large-scale studies are in progress at a variety of institutions in the United States and other countries. DeCode Genetics, an Icelandic company that last year identified a gene that may contribute to schizophrenia, announced in January that it would use the Icelandic population to search for genes underlying autism and similar disorders like Asperger's. Some researchers are also hunting for genes that may underlie specific aspects of autism.
      Dr. Daniel Geschwind, director of the neurogenetics program at the University of California, Los Angeles is hoping, in a study of autistic children and their families, to find genes that contribute to the delayed development of language. No specific gene for autism has yet been pinpointed. But promising areas have been identified on a variety of chromosomes, including the 2, 3, 7, 13, 15 and the X chromosome. "My sense is that we are close to the tipping point in this illness," said Dr. Insel of the National Institute of Mental Health, "and that over the next couple of years we will have, not all of the genes, but many of the genes that contribute."
      At the same time, the disorder is not entirely genetic, indicating that some environmental influences, either during a mother's pregnancy or in the first years of life, have roles in setting off the disorder, perhaps by changing the way genes function without actually altering DNA. Over the years, many candidates have been proposed, including German measles during pregnancy; yeast infections; the sedative drug thalidomide; childhood vaccines; viruses; the labor-inducing drug Pitocin; and dietary, hormonal or immune system changes during pregnancy. But so far, researchers say, solid evidence for any single factor has not emerged. Still, several research groups are trying to address the issue of environmental triggers. A study based at Columbia University, for example, will follow 100,000 pregnancies in Norway, examining a variety of environmental influences, including infections, vaccinations, mercury exposure and prenatal stresses.
      Experts disagree about the importance of environmental influences. But there is a consensus that autism probably has more than one cause, its symptoms the common end point of different biological pathways. Yet it may be some years, experts say, before scientists are able to link the findings from genetic studies and brain research with the outer signs of the perplexing world that people with autism inhabit. When it comes to autism, said Dr. David Amaral, a professor of psychiatry at the University of California at Davis,"In many respects, we're still in the dark ages."

Poor Care Reported at Mental Facility
Steve Hymon, Los Angeles Times- 2/25/2004

Mentally ill adults at Metropolitan State Hospital in Norwalk were often misdiagnosed, over-medicated and improperly restrained for weeks at a time, according to a newly released U.S. Department of Justice investigation. In one case, investigators found that no treatment was offered to an 18-year-old patient who had been sexually abused and neglected since she was 2. The report stated this "constitutes a substantial departure from generally accepted professional standards of care." Another patient was kept in walking restraints 24 hours a day for a month — one of several examples of what investigators concluded were excessive measures that were not justified in patient charts.
      The report includes dozens of instances when care was determined to be lacking. From April 2001 to March 2002, there were 475 patient-on-patient assaults, the study found. In another instance, a female patient gained access to the employees' cafeteria, where she broke a glass and swallowed bits of it. The conclusions come a year after the Justice Department found similar problems with the facility's treatment of children and teenagers. The investigations were launched in 2002 after years of complaints from families and patient advocates about the state-run facility.
      Metropolitan typically houses from 800 to 900 patients at its sprawling facility behind barbed wire. Most of them are adults who were committed to the facility by civil courts, sentenced to the hospital for criminal wrongdoing or placed there by counties across the state. The state Department of Mental Health, which runs Metropolitan, has until early May to file a response to the report, at which time state and federal officials will begin deciding on how to fix the problems. If those negotiations fail, the Justice Department can try to force improvements by suing the state under the Civil Rights of Institutionalized Persons Act. The report's findings are based on visits that Justice Department investigators made to Metropolitan in June and July 2002.
      Catherine Bernarding, a Metropolitan hospital spokeswoman, declined to comment on the latest findings and referred all calls to the state Department of Mental Health. John Rodriguez, deputy director of long-term care with the department, said the new report "didn't raise any new issues that we hadn't been aware of from the earlier children's report. We don't agree with everything…. I do believe that there are enough issues that are on point." He said the state has hired a consultant to fix problems at the facility. The hospital also is working on a new program in which patients work with doctors to find better ways to rejoin the community after they are released, Rodriguez added.
      Federal officials declined to comment on the report, but a Justice Department official who would speak only on the condition of anonymity said there was anecdotal evidence that the hospital is making the necessary fixes — but no firm proof. The official added that investigators told Metropolitan officials about specific problems when they visited the hospital, to give officials there a chance to fix problems that put patients' lives in jeopardy.
      The care of the mentally ill in large institutional settings has long been controversial. Critics often have decried what they call a cookie-cutter approach to treating patients with unique illnesses, histories and reactions to powerful medications. Many of the problems found at Metropolitan speak to those issues:
• Improper use of medications. Specifically, the report stated that "Metropolitan's psychiatrists often appear to be confused as to which medications are associated with particular side effects."
• Patient record-keeping. One patient's records stated that the patient had never been arrested and — quite to the contrary — that the patient also had prior convictions for beating a police officer and assault with a deadly weapon.
• Discharge procedures. "Preparation for discharge while in the hospital appears to be almost nonexistent," the report stated.
      Rodriguez said he is concerned that the report gives a narrow picture of life in a large institution. "I don't believe we have large systemic problems that are putting patients in jeopardy," he said, "but you can always do a better job, and weed out bad employees or processes if that's what is causing it."
      Los Angeles County pays Metropolitan to house about 325 patients, most of whom are adults, said Dr. Rod Shaner, medical director of the Los Angeles County Department of Mental Health. He said the department regularly monitors the well-being of patients at the hospital. "I think there's a sense the staff at Metropolitan Hospital is in the process of making significant changes, and there is evidence that they are doing everything they can to move in the right direction," Shaner said. "For those of us who have worked in those settings there are great challenges, but there are also responsibilities to provide a good level of care."
      Pamila Lew, a staff attorney with Protection and Advocacy, a group that represents patients at the hospital, said she has concerns about the pace of change at Metropolitan. She would like the public to have a voice in fixing the hospital. "We're happy they did the report, but in terms of monitoring progress and giving input, it has been difficult," she said.
      In response to the Justice Department findings, the state Senate budget subcommittee will hold a hearing on problems at Metropolitan on March 22 in Sacramento, said Suzanne Wierbinski, chief of staff for state Sen. Martha Escutia (D-Whittier). The hospital is in her district.

Problem Gamblers Abandoned
Sam Skolnik, Seattle Post-Intelligencer- 2/25/2004

No more than 200 people were expected to sign up for Washington's first-ever program to help gambling addicts get subsidized treatment. In the first eight months of the yearlong program, however, 226 enrolled. At least 150 more were expected before the program was to end in October 2003, but the money ran out.
      For those struggling to get out of gambling's grip, the brief, subsidized treatment program filled a desperate need. And then it vanished. "It was really helping. It was really working," recovering gambler Denise A. testified at a recent legislative hearing on restoring money for the program. But she couldn't afford to continue after the program ended. Within 30 days, "I was back out gambling again," she testified. "And within two weeks of that, after going out on a four-day binge of gambling, I tried to commit suicide."
      Despite clear evidence of the rising scourge of problem gambling -- and proof that treatment for such gamblers works -- advocates haven't been able to persuade legislators to restart the $500,000 program, which operated from November 2002 to June of last year. Now, Washington again is on the long list of states that profit from legalized gambling but do nothing to treat problem gamblers.
      Legislation to provide money for a problem-gambling treatment program had gained momentum in recent months, but those efforts largely have been undercut by committee wrangling. Observers and treatment proponents, though, say the issue is more visible than in previous years and there is still time before the session ends March 11 to patch together a substantive solution.
      Without the now-defunct treatment program, which was funded by the Washington State Lottery's Mega Millions game, the state's efforts are aimed at prevention. The state lottery -- which netted $98 million last year -- provided $532,000 during the same time period for awareness advertisements, public service announcements and the telephone referral line of the non-profit Washington State Council on Problem Gambling. Last year, the Washington State Gambling Commission gave about $30,000 to the council. By comparison, the state spends about $90 million annually to assist alcoholics and drug addicts. Much of that money comes indirectly from state taxes on alcohol sales, said Ken Stark, director of the Division of Alcohol and Substance Abuse within the Department of Social and Health Services.
      The lack of any state dollars for problem gambling treatment is a high concern for Stark, who recently testified at a legislative hearing about the issue. "There's nobody in state government with the specific responsibility to deal with this," Stark said. "I think it's pretty problematic for gamblers who need help. It can take over your life, much in the same way as alcoholism and drug addiction can."

Taxes on winnings
With annual net receipts of $1.3 billion and growing, the gambling industry has a giant foothold in Washington. And with the possibility of a future expansion of statewide gambling -- slot machines in private card rooms, keno games sold every five minutes in bars and taverns -- the state stands to become that much more financially dependent on the industry. "If a state is going to legalize gambling, they have an obligation to help those who develop problems," said Keith Whyte, executive director of the National Council on Problem Gambling. "The more involved they become, the more obligated they are to help."
      Although Washington state does not directly tax gambling establishments' winnings, the cities and counties in which they reside do, using the money for things such as road improvements and police and fire departments. According to the Washington State Gambling Commission, its non-tribal licensees -- including card rooms, pull tab/punch board outlets and bingo halls -- paid about $44 million to their localities in fiscal 2003. At the same time, each tribe, through its compact with the state, has to pay an annual 2 percent "community contribution" tax. That means that last year, they were obligated to pay a total of about $14 million.
      Proposals in the House and the Senate this session addressed problem gambling. But substitute versions of both bills were stripped of funding for treatment -- and then failed even to make it to floor votes. The revised Senate bill only suggested that Indian tribes, as they renegotiate their compacts with the state, make funding for problem gambling "a topic of negotiation." The initial House bill, sponsored by Rep. Eileen Cody, D-Seattle, would have raised up to $4 million per year by adding a licensing surcharge onto the net revenue of private card rooms and pull tab/punch board purveyors. Exempted would have been the tribes, the state lottery and non-profit bingo operations. The Recreational Gaming Association, which represents private card rooms, or "minicasinos," fought the bill strenuously, arguing that it was unfair to tax only a portion of the industry.
      A compromise fashioned by Rep. Steve Conway, D-Tacoma, was then struck: For the first year, the state lottery and the Gambling Commission each would kick in $500,000 for problem gambling treatment, and a task force would be created to devise a permanent funding mechanism. But even that never reached a floor vote. However, in recent days, Conway and other treatment supporters have managed to include in the House budget half a million dollars to restart the gambling treatment program for one year -- but only if the House compromise creating a task force also passes. "These groups whose business is gambling have got to step up to the table and address the health needs of those who develop problem gambling habits," Conway said. "We've got to get this permanent source of funding established."
      The behind-the-scenes impetus for the initial Cody bill was Jennifer McCausland, a former state deputy insurance commissioner. She has lobbied nearly everyone in Olympia with any potential say on the matter, including Gov. Gary Locke. McCausland's son died in a car accident in Australia that she said was linked to his gambling addiction. Ben Hossack, 29, neglected to pay for things like basic car maintenance because of his consuming gambling habit. Hossack, a 1994 University of Washington graduate, began gambling in high school but took up the habit more seriously after the Tulalip Casino opened in 1992, McCausland said. After college, Hossack returned to his native Australia to serve in the army there. His gambling problems worsened, she said, until he entered a three-month rehabilitation program. He got out in January 2003 -- three months before his car accident. He had been turning his life around, McCausland said, but still didn't have money to fix his car. "I don't know how this has gotten so neglected," she said. "This is a huge problem."

Treatment program worked
Gary Hanson, executive director of the Washington State Council on Problem Gambling, said that his group ideally should have a budget of $2 million a year to be able to run the types of prevention, awareness, training and subsidized treatment programs necessary to care for the number of active adult problem and pathological gamblers in the state -- estimated at 95,000 in 1999, the most recent figure available. "The comparison of what revenues (the gambling industry) generates with what this issue gets is incredible," Hanson said. The benefits of an ongoing treatment program "would be tremendous." That seems clear. The $500,000 grant last year that trained qualified social workers and psychologists around the state in specialized gambling-addiction treatment, and subsidized assistance for those who needed the counseling, was a success.
      A study of the state-run treatment program found that the gamblers had become deeply indebted, were filing for bankruptcy and were committing crimes to bankroll their compulsions. Before the program, the Nov. 1 study found, 52 percent of the 116 participants surveyed said they were gambling at least three days a week. By the program's end, nearly two-thirds of those questioned said they either weren't gambling at all or were gambling once a month or less. Three months later, more than a third of the program participants said they still weren't gambling, although 12 percent said they had reverted to daily gambling. The gamblers also reported fewer occurrences of financial problems, criminal activity and family conflicts.
      But 90 percent of the participants couldn't continue treatment after the program ended because they couldn't pay for it. Treatment advocates were frustrated with the program's quick exit. "It's almost worse than not having had any program at all," said Tim Christensen, president of the Association of Problem Gambling Service Administrators, a national group that helps states deliver problem gambling-related services. "They got the counselors trained and the services up and running. You were giving people help and hope, and then it gets taken away."

'Achilles' heel of industry'
Treatment proponents say the state's lack of interest is only part of the problem. Gambling operators, they say, do little to address problem gambling, offering pamphlets at casino cages and making generally small contributions to the problem gambling council.
      Dolores Chiechi, executive director of the Recreational Gaming Association, said she recognizes that gambling operators should play a larger role in confronting the issue -- which she called "the Achilles' heel of the industry." "It's personally important to me," said Chiechi, whose organization was among the pro-gambling interests that spent at least $225,000 lobbying lawmakers last year. "While I understand that personal responsibility is what's most important, it's also important for us to be compassionate and proactive. "Our industry shouldn't be taking advantage of those who clearly have problems," she said, referring to those, for example, who come into card rooms in tattered clothes or "who gamble 17 hours a day, every day." Chiechi said that toward that end, her group helped fund a 16-minute problem-gambling awareness video for new casino dealers and other floor staff members. Despite that effort, she said, most card rooms do not show the video to incoming employees.
      Few say gambling operators should be held directly responsible for those who become hooked. Yet some industry veterans are reluctant to admit that a problem even exists. "We know they come to us by a freedom of choice," said Rick Davis, director of gaming operations for Freddie's Club in Renton and Diamond Lil's Card Room one block away. "They sit at our tables, win, lose or draw, looking to have a good time. So where do we draw the line as a shepherd? It's hard."
      Davis said his casinos offer pamphlets for gamblers who may be developing problems. And pit bosses and security personnel, he said, will keep an eye on those who develop "clear-cut signs" of problems, such as if the customer is depressed, crying or acting irrationally, or if betting patterns suddenly and dramatically increase. "At that point, we still don't stop you, but we'll keep a close eye on you," Davis said. Ultimately, it's up to the customer to recognize the problem, he said. For those who do, the casino will grant requests for a "self-bar" or "self-exclusion" -- although it is not permanent. If customers ask to return, Davis said, they have to wait only a week before they are allowed back in.
      At the larger Indian casinos, policies are slightly different. Self-exclusions at the Muckleshoot and Tulalip casinos, for example, are permanent. Once you sign a statement at the Muckleshoot Casino, you are permanently barred and face a possible trespassing arrest if you return. Lee Topash, the health and safety manager at the Tulalip Casino, serves on the board of the problem gambling council. He is well-versed on the issue and quickly acknowledged that gambling can become an addiction "just like drugs or alcohol." At the Tulalip Casino, however, officials don't do much to monitor the issue, other than post problem-gambling fliers. About 200 customers have barred themselves from the casino since the policy was implemented in 1997, he said, although casino officials don't promote the option.
      By another measuring stick regarding how seriously gambling operators take the issue -- donations to the problem gambling council -- the Tulalips come up short. From 2001 to 2003, the Tulalip Tribes gave $16,000 to the council. During the same period, the Muckleshoot Casino and the Emerald Queen Casino, run by the Puyallup Tribe -- conventionally seen as the two other "Big Three" Indian casinos in the state -- gave $150,000 and $100,000, respectively. Several smaller Indian casinos and many private card rooms have donated smaller amounts, ranging from $200 to $10,000, over the last three years. In the same period, the net receipts at Indian casinos totaled $1.6 billion, according to the Washington State Gambling Commission. Private card rooms netted $722 million.
      Until recently, the Gambling Commission had a contract with the problem gambling council mandating that the commission -- whose regulatory charge is to make sure gambling in the state is conducted fairly and safely -- provide $150,000 annually. The contract was invalidated in mid-2002 after the Attorney General's Office concluded that the commission, which is funded by gambling licensing fees, legally could support only some of the council's operations. Since the contract was invalidated, the commission has donated only $31,000.

Gamblers Anonymous
In the absence of subsidized treatment in Washington, problem gamblers often are turning to Gamblers Anonymous alone for help. On a misty Tuesday night last month, 18 problem gamblers huddled around a makeshift table in the cold basement of the Woodland Park Presbyterian Church on Phinney Ridge. They have been meeting there weekly since the 1970s. Applause filled the room as members celebrated 30-day, 60-day and one-year anniversaries of living without placing a bet. The topic of the day was the 20 Questions posed to gamblers to see if they have problems. Seven or more "yes" answers to questions such as "Have you ever gambled to escape worry or trouble?" means they have a problem.
      Asked to share stories about which question had particular meaning to them that day, several said that Question 13 -- asking whether gambling had ever made them careless about the welfare of themselves or their families -- was the toughest to face. One man said he had neglected his son because of his obsessive gambling sessions in California card rooms. His son won't talk to him, even after he sat by his son's hospital bed for days after a near-fatal car accident. "I don't know how he is, or how his recovery is going," said the man, who has been in his own recovery from gambling for more than seven years. "Most of the amends I can make, I will. Those I can't, I can't." Said another man simply: "As much as I have a craving to gamble, I didn't gamble today. "Here I am."

In Oregon, $3 Million a Year for Gambling Addiction Treatment
Sam Skolnik, Seattle Post-Intelligencer- 2/25/2004

When it comes to dealing with their problem gamblers, Washington and Oregon are like night and day. Washington does virtually nothing. But Oregon, with a gambling industry 20 percent smaller, spends about $3 million annually to treat gamblers who develop problems. As legislators in Olympia consider reinstituting some form of subsidized gambling treatment, they need only look next door to see how one of the most ambitious programs in the country has succeeded.
      Oregon law mandates that 1 percent of the state lottery's net proceeds are dedicated to a problem gambling fund. The money supports a "stepped-care" approach, backing everything from a hot line, public service advertisements and community outreach efforts to inpatient treatment for the most serious pathological gamblers. The first substantive level of treatment involves one-on-one counseling or group therapy sessions and family involvement. Three of the 27 treatment programs around the state are geared toward African American or Hispanic populations. The sessions, like the rest of the program, are free. The state also offers three "crisis respite" facilities that provide inpatient treatment, including one that is operated out of a mental health residential care facility and another out of an alcohol and drug treatment center. These inpatient services generally do not last more than a week.
      In 2002, 1,380 Oregon residents signed up for some form of gambling treatment -- an increase of nearly 40 percent from the previous year, according to a March 2003 report on the program. An additional 272 family members signed up for counseling. "Any state that's going to be in the business of gambling needs to put resources in place to address problems that stem from that," said Jeff Marotta, the problem-gambling services manager with the Oregon Department of Human Services. The comprehensive Oregon program is one of the two best-funded in the country, according to the Association of Problem Gambling Service Administrators. Only Indiana's, which offers similar services, is larger.
      According to the March report by a consulting firm in Wilsonville, Ore., three out of four gamblers who enrolled in the Oregon program reported either no gambling or reduced gambling as they left treatment. At the time of their discharge, 71 percent of the clients who completed their full course of recommended treatment said they had abstained from gambling, and an additional 27 percent said they had reduced their gambling. Six months later, 46 percent of that group reported that they still were abstaining, and an additional 44 percent were gambling less than when they entered the program. But perhaps more significant, the percentage of adults who were problem gamblers dropped from 3.3 percent in 1997 to 2.3 percent in 2000, according to extensive surveys done in those years. During that same four-year period, gambling revenues rose by an estimated 19 percent, according to ECONorthwest, a Portland-based consulting firm.
      Gary Hanson of the Washington State Council on Problem Gambling said that with even a portion of Oregon's budget, his group could restart and expand the subsidized treatment and counselor training program, and even hire someone to focus on youth and adolescent gambling. "You give us a good funding source that we can rely on," Hanson said, "and we could create a very good program."

Mental Health Care Providers Urge Efficiency for Vermont System
Tim McCahill, Associated Press- 2/25/2004

MONTPELIER, Vt. -- Psychiatrists and administrators of Vermont's hospitals urged officials Wednesday to consider the entire state's system of mental health care as they work to resolve deficiencies at the Vermont State Hospital. In a report released Wednesday, the Vermont Association of Hospitals and Health Systems, a group that represents the state's medical centers, recommended that certain facets of the mental health system be changed to improve the quality of care patients receive. The recommendations include changing state law to allow patients who are involuntarily committed to receive psychiatric treatment without a court order and adopting a unified mental health code for medical centers across the state.
     By issuing the report, the association hoped to add its voice to the growing debate over the role of the state hospital, whose recent financial woes have led many to rethink the workings of the entire mental health care system in Vermont. In September the state hospital lost its federal certification and almost $3 million in funding from Medicaid and Medicare programs. Since then some lawmakers have called for the facility to be closed and its patients moved to psychiatric wards at other hospitals in Vermont. "When we look at the Vermont State Hospital in isolation we forget that patients also interact with other hospitals in the state, with community mental health centers and with community providers," said Richard Palmisano, chief executive officer of the Brattleboro Retreat, one of six hospitals in Vermont that offers psychiatric care.
     Speaking at a news conference Wednesday, Palmisano and other hospital officials were quick to point out that the changes they recommended would cost money. But officials also noted that their chief concern was improving care for the state's mentally ill. "Our position is to try to work with policy makers and other professionals as to how we can configure a system that delivers ethical, humane and effective care for people who need it," said Dr. Albert Lorboti, medical director at the Windham Center for Psychiatric Care.