Autism and Comedy Symposium – Comedy on the Spectrum

Comedy on the Spectrum
 A presentation by Prof Michael Fitzgerald at the “Autism and Comedy Symposium” at the University of Kent, Canterbury, UK, Jamuary 2016
Comedians with Autism
This is a provocative and novel investigation of the psyches of sixty artists, predominantly from the world of film, theatre and television/radio – writers, actors, producers and directors ranging from Shakespeare and Voltaire to major late-twentieth-century figures such as Spike Milligan, Sam Peckinpah and Frank Sinatra, by way of F. Scott Fitzgerald, Orson Welles and Judy Garland. Irish artists featured include Oliver St. John Gogarty, Jimmy O’Dea and Richard Harris.
Author: Fitzgerald M. (2015)
Publisher: Nova Science Publishers Inc.New York
ISBN: 978-1-63463-573-8
The Mind of the Artist and other books and free resources
Information for this presentation has come from Prof. Fitzgerald’s recent book “The Mind of the Artist”.
Information about that book along with 31 other books published, co- published and edited by Prof Fitzgerald are on his website.

Overlap: Autism and Schizophrenia – Considerable confusion surrounds the overlapping of autism and schizophrenia

Advances in Mental Health and Intellectual Disabilities

Author:   Michael Fitzgerald (Professor of Child Psychiatry, based at Department of Psychiatry, Trinity College, Dublin, UK)
Citation:  Michael Fitzgerald , (2014) “Overlap between autism and schizophrenia: history and current status”,Advances in Mental Health and Intellectual Disabilities, Vol. 8 Iss: 1, pp.15 – 23
ABSTRACT
Purpose

– Considerable confusion surrounds the overlapping of autism and schizophrenia. This has significant implications for clinicians given that correct diagnosis is critical for treatment.

Design/methodology/approach

-This paper sets out to clarify the position by reviewing the history and current status of the relationship between autism and schizophrenia. A general review was conducted using a chronological approach that focused on phenomenology, aetiology, genetic mechanisms and treatment.

Findings

– Persons with autism are far more rigid, have difficulties set shifting and get far more upset and aggressive when their routines have changed. They have far more severe theory of mind and empathy deficits than those with schizophrenia.

Research limitations/implications

– Future diagnostic refinement by means of molecular genetic studies will alter the diagnostic categories. Further studies of the conditions of autism and schizophrenia are therefore necessary.

Practical implications

– Both conditions need treatment both clinically and practically.

Originality/value

– This paper elucidates the relationship between autism and schizophrenia from a historical and current perspective. It emerges that this confusion is likely to be resolved by molecular genetic studies that will alter the diagnostic categories.

        

 

The man who knew Infinity – Ramanujan and Hardy, both has Asperger’s Syndrome

austismandcreativity
Autism and Creativity is a stimulating study of male creativity and autism, arguing that a major genetic endowment is a prerequisite of genius, and that cultural and environmental factors are less significant than has often been claimed.
Chapters on the diagnosis and psychology of autism set the scene for a detailed examination of a number of important historical figures.
English Language Edition
Author: Fitzgerald M.  (2004)
Publisher: Brunner Routledge:  New York
ISBN: 978-1583912133
For example:
* in the Indian mathematician Ramanujan, the classic traits of Asperger’s syndrome are shown to have coexisted with an extraordinary level of creativity –
* more unexpectedly, from the fields of philosophy, politics and literature, scrutiny of Ludwig Wittgenstein, Sir Keith Joseph, Eamon de Valera, Lewis Carroll and William Butler Yeats reveals classical autistic features.

 

Autism and Creativity will prove fascinating reading not only for professionals and students in the field of autism and Asperger’s syndrome, but for anyone wanting to know how individuals presenting autistic features have on many occasions changed the way we understand society. This is quite simply the best book I have read on autism in history . . .

“Fitzgerald is clearly an experienced clinician and his deep understanding of the spectrum of autism conditions comes across in his writings. But he is also an exceptional scholar, and the thoroughness of his biographical research combined with his clinical acumen minimises the obvious risks inherent in historical  diagnosis. He makes a plausible case for the Autistic mind being a different – and potentially highly creative – kind of mind“.

Professor Simon Baron-Cohen, Director, Autism Research Centre, Cambridge University.

Autism & Creativity
Co-Author: Michael Fitzgerald, Yoshiki Ishisaka, Ayako Hanashima, Taki Ōta (2008)
Publisher: Seiwa Shoten Pub: Tokyo
ISBN: 978-479-11-06875

Buy it now

Mass Killers – Can we identify a mass killer e.g. pilot, school shooter etc. in advance?

These are extremely rare events and it is almost impossible to predict with any degree of accuracy rare events. Nevertheless, we must try but at the same time realise that many of the individual features of the profile I describe about potential mass killers are not rare in the general population. It’s the more overall picture that is relevant.

We must look at:-

  1. 1.      Medical history pattern deviating from average medical history pattern of pilots, students, military personnel etc

 

  1. 2.      Childhood history of being bullied, being a loner, being very routine bound person with special interests in death, perversions, dead animals, serial killers, mass killing, police work, military activities, horror movies, killing of animals, e.g. cats etc showing callous and unemotional trails, moodiness and showing gross lack of empathy, problems reading other people’s minds emotionally, being excessively controlling and dominating, problems with reciprocal social relationships, having sensory problems, noise, taste, touch, being significantly clumsily, being very unpopular in school but having special talents with numbers, mathematics, technology, engineering, construction and logic.

Other features would include poor eye contact, problems reading non-verbal behaviour, problems sharing emotional thoughts, problems turn taking and being very poor at group games. Many or most readers will dismiss this profile as nonsensical. The only answered to them is to ask them to produce a better alternative approach to the problem. Clearly we have to be extremely careful in labelling people inappropriately. If one is totally anti-labelling or identifying potential mass killers then one has to accept the activity of mass killers.

If one hears of a person who is in an average job and who has never performed above the average or indeed less than the average level and they state they will one day be famous and that “everyone will know my name” and they have the profile outlined above then airline management or schools managers or army commanders should ask some questions and explore the background and motive of this person a little more. If in addition to the above profile already described, a person is depressed, has recently experienced stress at his job, has had personal relationship breakup or conflict with his employers or problems with his work performance, is in a position of major responsibility e.g. airline pilot, then they should be examined further, if they make unusual and bizarre statements which could be taken as a joke if one wasn’t listening carefully.

Another scenario is a pupil (almost always male) with the profile described, who shows strange comments on his social media sites, has been bullied (or is being bullied in school), is depressed, ostracised, can’t relate to girls, is a loner, has had an academic crisis or access to guns at home or elsewhere and makes violent threats, these should be investigated by the health and safety officer in school (who should be responsible for gun attacks in school) in conjunction with the management of the school where a thorough investigation should take place. People like the readership keep Adam Lanza, Harold Shipman and Timothy McVey in mind.

 

References:

Autism Spectrum Disorders - Recent Advances - New Book Cover ‘Autism and School Shooting’

by Michael Fitzgerald

has been published in April 2015 in the book ‘Autism Spectrum Disorders – Recent Advances’

by InTech Publishing in a book edited by Michael Fitzgerald.

Click here to download for free

 

young violent dangerous to know

 

Young Violent and Dangerous to Know’, a book by Michael Fitzgerald

was published by Novinka, New York in 2013 and focuses on mass killers and serial killers.

Click here for more details

 

Psychopathy -Risk Factors, Behavioural Symptoms and Treatment Options

 

A new book called “Psychopathy”

published in 2014 by Nova Science, New York, edited by Michael Fitzgerald,

has a chapter on ‘Criminal Autistic Psychopathy’ by Michael Fitzgerald, a not uncommon diagnosis in mass killers.

Click here for more details

The Mind of the Artist – Attention Deficit Hyperactivity Disorder, Autism, Asperger Syndrome & Depression

The Mind of the Artist
This is a provocative and novel investigation of the psyches of sixty artists, predominantly from the world of film, theatre and television/radio – writers, actors, producers and directors ranging from Shakespeare and Voltaire to major late-twentieth-century figures such as Spike Milligan, Sam Peckinpah and Frank Sinatra, by way of F. Scott Fitzgerald, Orson Welles and Judy Garland. Irish artists featured include Oliver St. John Gogarty, Jimmy O’Dea and Richard Harris.
The chapters, which range from quite brief vignettes to more in-depth studies, examine the background of each individual before considering their personality, social relationships and work. Professor Fitzgerald brings his expertise to bear in elucidating the psychological factors, strengths and frailties that shaped the lives and careers of these prominent creators, many of whom are regarded as geniuses.
The lives of extraordinary artists are of interest in themselves; when their stories are told from the perspective of expert psychological insight, the results are fascinating and revealing


Click here to read more or purchase this book from Nova Publishers

Did W.B. Yeats have Aspergers Syndrome?

A number of historical figures, including Eamon de Valera, WB Yeats and American artist, Andy Warhol, had Aspergers Syndrome according to Professor Michael Fitzgerald. They all showed signs of Asperger’s syndrome, a type of autism in which the person affected generally has a very high IQ, but extremely poor social and communication skills. This is explained in the following books: ‘In Autism and Creativity: Is There a Link between Autism in Men and Exceptional Ability?’ published by Brunner-Routledge and Unstoppable Brilliance, published by Liberties Press. “WB Yeats for example did very poorly at school. He failed to get into Trinity College and was described by his teachers as ‘pedestrian and demoralised’. His parents were told he would never amount to anything”, This is typical of people with Asperger’s syndrome. They do not fit in as they do not relate to others. They are often seen as odd or eccentric and may be bullied at school as a result. Many people in Ireland are thought to have Asperger’s syndrome, with males significantly more likely to develop the condition than females. unstoppable brilliance

Mass Killers – 2 New Books – Can we identify a mass murderer (e.g. pilot, school shooter etc) in advance?

BTB 2 Young Violent and Dangerous to know

These are extremely rare events and it is almost impossible to predict with any degree of accuracy rare events. Nevertheless, we must try but at the same time realise that many of the individual features of the profile I describe about potential mass killers are not rare in the general population. It’s the more overall picture that is relevant.

We must look at:-

1. Medical history pattern deviating from average medical history pattern of pilots, students, military personnel etc

2. Childhood history of being bullied, being a loner, being very routine bound person with special interests in death, perversions, dead animals, serial killers, mass killing, police work, military activities, horror movies, killing of animals, e.g. cats etc showing callous and unemotional trails, moodiness and showing gross lack of empathy, problems reading other people’s minds emotionally, being excessively controlling and dominating, problems with reciprocal social relationships, having sensory problems, noise, taste, touch, being significantly clumsily, being very unpopular in school but having special talents with numbers, mathematics, technology, engineering, construction and logic.

Other features would include poor eye contact, problems reading non-verbal behaviour, problems sharing emotional thoughts, problems turn taking and being very poor at group games. Many or most readers will dismiss this profile as nonsensical. The only answered to them is to ask them to produce a better alternative approach to the problem. Clearly we have to be extremely careful in labelling people inappropriately. If one is totally anti-labelling or identifying potential mass killers then one has to accept the activity of mass killers.

If one hears of a person who is in an average job and who has never performed above the average or indeed less than the average level and they state they will one day be famous and that “everyone will know my name” and they have the profile outlined above then airline management or schools managers or army commanders should ask some questions and explore the background and motive of this person a little more. If in addition to the above profile already described, a person is depressed, has recently experienced stress at his job, has had personal relationship breakup or conflict with his employers or problems with his work performance, is in a position of major responsibility e.g. airline pilot, then they should be examined further, if they make unusual and bizarre statements which could be taken as a joke if one wasn’t listening carefully.

Another scenario is a pupil (almost always male) with the profile described, who shows strange comments on his social media sites, has been bullied (or is being bullied in school), is depressed, ostracised, can’t relate to girls, is a loner, has had an academic crisis or access to guns at home or elsewhere and makes violent threats, these should be investigated by the health and safety officer in school (who should be responsible for gun attacks in school) in conjunction with the management of the school where a thorough investigation should take place. People like the readership keep Adam Lanza, Harold Shipman and Timothy McVey in mind.

References:

1. ‘Autism and School Shooting’ by Michael Fitzgerald has been published in April 2015 in the book ‘Autism Spectrum Disorders – Recent Advances’ by InTech Publishing in a book edited by Michael Fitzgerald.

2. ‘Young Violent and Dangerous to Know’, a book by Michael Fitzgerald was published by Novinka, New York in 2013 and focuses on mass killers and serial killers.

3. A new book called “Psychopathy” published in 2014, edited by Michael Fitzgerald, published by Nova Science, New York, has a chapter on ‘Criminal Autistic Psychopathy’ by Michael Fitzgerald, a not uncommon diagnosis in mass killers.

New Book on Psychopathy edited by Prof. Michael Fitzgerald

Psychopathy: Risk Factors, Behavioral Symptoms and Treatment Options
Psychopathy: Risk Factors, Behavioral Symptoms and Treatment Options
Click to enlarge
Editors: Michael Fitzgerald (Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)
Book Description:
Psychopathy is one of the most serious and challenging conditions that society and mental health professionals face. The consequences of the actions of persons with psychopathy on other individuals or society at large are very great. Persons with psychopathy are extremely difficult to treat and indeed some treatments in the past have been shown to cause deterioration affects. This book explores the issue of psychopathy from the point of view of the individual with psychopathy, brain aspects of the condition, cultural aspects, treatment aspects and it’s relation to autism and other empathy disorder which it can on occasion overlap with.
Offenders with high levels of psychopathy are among the most challenging persons mental health professionals have to treat. They need very careful and skilled interventions. Chromis is an innovative programme described by Tew, Bennett and Atkinson which shows promise. It is a future focused programme which pays attention to control and choice, collaboration and transparency and has a cognitive skills component, a motivation and engagement components. Marc Wilson and Samantha Harley have an interesting chapter on narcissism, psychopathy and Machiavellianism. They found a relationship between vertical individualism and all three constructs and between hierarchical and narcissism. Their conclusions suggest that hierarchical, autonomous societies may socialise members in such a way that may foster aversive personalities. Don Ambrose in his chapter on unmeritorious meritorocy focuses on a topic that severely affected almost everyone in the developed world in some way. He highlights the admiration for businessmen with psychopathic traits and the negative consequences of this. In the chapter on criminal autistic psychopathy Fitzgerald highlights the overlap between psychopathy and autism. Hans Asperger in his initial descriptions recognised the overlap between psychopathy and autism with his term autistic psychopathy. This idea faded from view over the last thirty years because there was a wish to separate autism from psychopathy. This wish did not prevent the overlap. Fitzgerald (2010) has introduced the sub group of autism spectrum disorders called criminal autistic psychopathy to cover the section of the spectrum where criminality occurs. It links with the new work on callous and unemotional traits (Fitzgerald 2003) and with mass killings, school and other location shootings where criminal autistic psychopathy is not rare.The chapter on cognitive neuroscience in child and adolescent psychopathy by Halty and Prieto point out among other issues that in the case of children with psychopathic features there is evidence of fewer references to welfare of victims when they have to justify transgressions. The chapter by Halty and Prieto on psychopathy in child and adolescent populations discuss the issue of psychopathy in children and adolescents and the importance of callous and unemotional traits as well as the influence of parenting practices in the development of child and adolescent psychopathy. Laura Nunes’s chapter on psychopathy: risk factors and behavioural symptoms focuses on treatment of options in extremely difficult area and proposes a biogram. In the chapter on Hans Asperger autistic psychopathy revisited focuses on the neglected paper of 1938 long before Leo Kanner wrote his paper on autism. Asperger worked on this topic throughout the 1930’s. It also focuses on the differential diagnosis of autism and schizophrenia, obsessive compulsive disorder and other personality disorders. Ana Calzada and colleagues give us a very important chapter on brain scanning and psychopathy. These neuroanatomic differences in violent individuals are very important in terms of aetiology diagnosis and treatment problems and important areas for future research. (Imprint: Nova)References:
Fitzgerald M. (2003) Callous-Unemotional Traits and Asperger’s Syndrome. Journal of the American Academy of Child and Adolescent Psychiatry 42, 9, 10-11.
Fitzgerald M. (2001) Autistic Psychopathy. Journal of the American Academy of Child and Adolescent Psychiatry 40, 8, 870.
Fitzgerald M. (2010) Young Violent and Dangerous to Know. Nova Science: New York.
Table of Contents:
PrefaceChapter 1. The Treatment of Offenders with High Levels of Psychopathy through Chromis and the Westgate Service: What have we Learned from the Last Eight Years?
(Jenny Tew, A.L. Bennett and R. Akinson, National Offender Management Service, Ministry of Justice, United Kingdom and The Centre for Forensic and Criminological Psychology, The University of Birmingham, Birmingham, England; The Westgate Personality Disorder Treatment Service, HMP Frankland, and National Offender Management Service, Ministry of Justice, UK)Chapter 2. Psychopathy: A Proposal for an Integrated Evaluation
(Laura M. Nunes, Fernando Pessoa University, Oporto / Portugal)Chapter 3. MRI Study in Psychopath and Non-Psychopath Offenders
(Ava Calzada-Reyes, Alfredo Alvarez-Amador, Mitchell Valdes-Sosa, Lester Melic-Garcia, Alonso Y. Aleman and Jose del Carmen Iglesias-Alonso, Department of Clinical Neurophysiology, Institute of Legal Medicine, Independence Avenue, Plaza, Havana City; Cuban Center of Neuroscience, Havana City and Department of Clinical Neurophysiology, Carlos Juan Finlay, General Hospital, Havana, Cuba)Chapter 4. Unmeritorious Meritocracy: The Ascendance of Psychopathic Plutocracy in the Globalized 21st-Century
(Don Ambrose, Rider University in Lawrenceville, New Jersey, US)

Chapter 5. Narcissism, Psychopathy and Machiavellianism: Associations between Cultural Factors and Interpersonal Dominance
(Marc Stewart Wilson and Samantha M. Hartley, School of Psychology, Victoria University of Wellington, New Zealand)

Chapter 6. Hans Asperger’s Autistic Psychopathy: Revisited
(Michael Fitzgerald, Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)

Chapter 7. Criminal Autistic Psychopathy.
(Michael Fitzgerald, Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)

Chapter 8. Stability of Psychopathic Traits in Youth: Long-term Trends and Comparisons with the Stability of the Five Factor Model of Personality
(Mary Ann Campbell, Rosemary Beauregard and Fred Schmidt, Psychology Department & Centre for Criminal Justice Studies, University of New Brunswick-Saint John Campus, Saint John, New Brunswick; Children’s Centre Thunder Bay, Thunder Bay, Ontario; Psychology Department, Lakehead University, Thunder Bay, Ontario, and Centre for Criminal Justice Studies, University of New Brunswick-Saint John Campus,
New Brunswick, Canada)

Chapter 9. Disordered Self in Schizophrenia and Autism Spectrum Disorders. The Autisms and the Self.
(Michael Fitzgerald and Victoria Lyons, Department of Psychiatry, Trinity College Dublin (TCD), Dublin, Ireland)

Chapter 10. Exploring Treatment Options for an Allegedly “Untreatable” Disorder, Psychopathy: An Integrative Literature Review
(Chasity Bailey, Rahul Sehgal, Adrian Coscia, Deborah Shelton, University of Connecticut, Center for Correctional Health Networks-CCHNet, School of Nursing, CT, USA, and others)

Index

Series:
Psychiatry – Theory, Applications and Treatments
   Binding: ebook
   Pub. Date: 2014
   Pages: 7×10 – (NBC-C)
   ISBN: 978-1-63463-090-0
   Status: AN

Recent Activities

Prof Michael Fitzgerald

M. McDermott, M. Duffy, A. Percy, M. Fitzgerald, C. Cole (2013) “A school Based Study of Psychological Disturbance in Children Following the Omagh Bomb” Child and Adolescent Psychiatry and Mental Health, 7/36 (peer reviewed)

Fitzgerald. M., (2014) “Overlap Between Autism and Schizophrenia: History and Current Status” Advances in Mental Health and Intellectual Disabilities, 8,1,15/23 (peer reviewed)

Not Peer Reviewed Fitzgerald , M., (2013) “Author Response: All Future Psychiatrists Should be Neuro-Psychiatrists” The Psychiatrist, 37,12,404

Appointment on Editorial Board,  Journal of Autism and Developmental Disorders 2014

Fitzgerald M., (2012) “Schizophrenia and Autism/Aspergers Syndrome: Overlap and Difference”, Clinical Neuro-Psychology, IX,4,171/176 (peer reviewed)

Skeppar P. Thorr R. Agren S. Skeppar I. Parson B., Fitzgerald M. (2013) “Neuro-developmental Disorders with Co-Morbid Affective Disorders Sometimes Produce Psychiatric Conditions Traditionally Diagnosed as Schizophrenia” Clinical Neuropsychiatry 10 3/4, 123/133(peer reviewed)

Cleary L., Looney I.K. Brady N., Fitzgerald M., (2013) “Inversion Effects in the Perception of the Moving Human Form: a Comparison of Adolescents with Autism Spectrum Disorder and Typically Developing Adolescents” Autism, DOI: 10,1177/136236131349945

Cleary L., Fitzgerald M., Brady N., Gallagher L., (2014) “Holistic Processing of Faces as Measured by the Thatcher Illusion is Intact in Autism Spectrum Disorders” Autism DOI:10.1177/1362361314526005 (peer reviewed)

Fitzgerald M., McNicholas F., (2014) “Attitudes and Practices in the Management of ADHD Among Healthcare Professionals who Responded to a European Survey”  Irish Journal of Psychological Medicine 31,31/37 (peer reviewed)

Not Peer ReviewedFitzgerald M., (2014) “Unfair Playing Field”, Psychiatric Bulletin 38,2,87

(peer reviewed) Caci H., Anderson P., Donfrancisco R., Farone S., Fitzgerald M., Doepfner M., (2014) “Daily Life Impairments Associated with Childhood/Adolescent ADHD as Recalled by Adults: Results from the European Lifetime Impairment Survey” CNS Spectrums, 1/10 DOI: http://dx.doi.org/10.1017/s1092852914000078

Not Peer Reviewed Fitzgerald M, Molneux G.,(2004) “Overlap Between Alexithymia and Aspergers Syndrome”, American Journal of Psychiatry, 161:11, 2134-2135
(peer reviewed) Caci H., Doepfner M., Asherson P., Donfrancesco R., Farone S., Herves A.,  Fitzgerald M., 214 (2013) “Daily Life Impairments Associated with Self/Reported Childhood/Adolescent Attention Deficit Hyperactivity Disorder and the Experiences of Diagnosis and Treatment: Results from the European Lifetime Impairment Survey”  European Psychiatry, 29,316/323

Serotonin Reuptake Inhibitors, Suicidality in Children and Adolescents.

There has been a major controversy in the media because of the relationship between suicidality in children and adolescents and SSRI antidepressants.  The FDA (Food and Drug Administration) in America state that antidepressants increase the risk of suicidal thinking and behaviour (suicidality) in children and adolescents with major depressive disorder and other psychiatric disorders.  Anyone considering the use of an SSRI or any other antidepressant in a child or adolescent must balance this risk with the clinical need.  Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behaviour.  Families and care givers should be advised of the need for close observation and communication with the prescriber.  Pooled analyses of short term placebo / controlled trials of nine antidepressants (SSRIs and others) in children and adolescents with major depressive disorder, Obsessive Compulsive Disorder, or other psychiatric disorders have revealed a greater risk of adverse events representing suicidal thinking or behaviour (suicidality) during the first few months of treatment in those receiving antidepressants.  The average risk of such events on drugs was 4%, twice the placebo risk of 2%. No suicides occurred in these trials. This is a good and reasonable summary of the current situation.  It emphasises close monitoring in the early weeks and suggests close attention to risks / benefit of the medication.  Clearly the benefits will outweigh the risks in those with more severe depressive states.

 

It is interesting that efficacy could not be established for the SSRIs except for Fluoxetine in paediatric usage.  It is important as well to note that major depression increases the risk of childhood suicide about 12 fold.  More than half of the kids with this disease try to kill themselves, and about 7% do complete suicide according to USA Today 2004. One has to measure this against the fact that 2 in 100 children on antidepressants become more suicidal because of the pills and there were no reported suicides again according to USA Today 2004. The reasons for the increased suicidality might be due to the fact that the medications can increase impulsiveness and that as the children who have been depressed become more energetic this increases the likelihood of suicidality.  It is interesting that there isn’t evidence for the tricyclic antidepressants in children but the current controversy might drive clinicians because of the concerns about the SSRIs to go back to prescribing the tricyclic antidepressants which are generally regarded to have higher side effect rates. This would be a retrograde step.  The worry is now is that some severely depressed children wont get the antidepressant treatment they require because of the current controversy.  Indeed a report in USA Today states that some doctors ‘fear kids could be denied needed care’.  This is where the good clinician comes in who is able to weigh up the risks and the benefits, who is able to identify a depression as being severe and in need of antidepressant treatment.  Clearly mild depressions should be treated with psychotherapy.  The British Medical Journal 2004 came to a reasonable conclusion that doctors should not hesitate to use antidepressants for clearly defined depressive disorders but they should carefully monitor patients in the first weeks of treatment.  There is a signal for suicidality when you look at studies of antidepressants that is the SSRIs nevertheless a report in the Journal of the American Academy of Child and Adolescent Psychiatry 2004 stated that ‘none of the reported differences with regard to suicidality between any of the drugs and placebo are statistically significant’.  This report claims that there has been an underestimation of the reduction of suicidality in patients treated with antidepressants.  My own personal conclusion is that there is a signal for suicidality but this can be managed within the context of the doctor patient relationship and careful monitoring in the early weeks after prescription. It is difficult to communicate this common sense approach in the context of media controversy.