Child Psychiatry: Out of Control?

[TrainingDummy]

http://www.cnn.com/2007/LAW/03/23/dr....ap/index.html

Read the article. Done? Good!

In too many threads starting with an article (and I'm guilty myself) not enough people read the original article. Anyway, what do you think about the way child psych is headed in the US? I am about to graduate from college with my BA in psychology. I had originally wanted to be a clinician, but in grad school I'll be heading in more of a research direction, particularly focusing on adolescents (not 4 year olds!). The point being, I think I'm fairly well-versed on the subject matter and the arguments on both sides.

In my opinion, the F.D.A. has been way too lax about child psychiatry. Even if the clinicians ARE right in prescribing medicine, they are still putting the medicine in the hands of parents with no clinical background and expecting them to monitor these kids. It's also tough for psychiatrists who are trying to fight the increased use of psychiatric medication in youth; they are painfully aware that a mother denied medication for her child will merely look at the next name down in the yellow pages. For many parents (like the one in the article), these medications seem to be not a last resort that should be carefully considered but a "get out of responsible parenting free" card.

So what should be done? What responsibilities does the FDA have? What about the APA (American Psychological Association)? Or do you think I am overreacting when I say this has reached the proportions of a social epidemic?

[PeterGustafsson]

Hi!

Slight threaddrift ahead:

Originally Posted by TrainingDummy

http://www.cnn.com/2007/LAW/03/23/dr....ap/index.html

Read the article. Done? Good!

In too many threads starting with an article (and I'm guilty myself) not enough people read the original article. Anyway, what do you think about the way child psych is headed in the US?

I have read the article. While I can not comment from an US. perspective, I can do so from a Swedish.

Originally Posted by TrainingDummy

In my opinion, the F.D.A. has been way too lax about child psychiatry. Even if the clinicians ARE right in prescribing medicine, they are still putting the medicine in the hands of parents with no clinical background and expecting them to monitor these kids.

If the medicines are correctly prescribed, but too potent to entrust to parents - what then? Should the kids be put into long-time hospital care (assuming they have chronic conditions) just so that they get their pills on the right time, and in the right amount? I suspect that such a policy, while effective in solving the stated problem would be a huge resource drain, which would negatively affect treatment of other cases. Therefore, it would decrease the total health level.

Originally Posted by TrainingDummy

It's also tough for psychiatrists who are trying to fight the increased use of psychiatric medication in youth; they are painfully aware that a mother denied medication for her child will merely look at the next name down in the yellow pages.

In Sweden, the problem would be that a parent or patient denied medication from one doctor would have very big problems obtaining it from another, even if the condition warrants medication. That is because we have a nationally run health care system, where information input from one doctor is acessible by any subsequent doctors. Unless you have money for the mostly unsubsidized private care (one a small proportion have) you are stuck if the 1st doctor is one of the ardent anti-medication types.

Originally Posted by TrainingDummy

For many parents (like the one in the article), these medications seem to be not a last resort that should be carefully considered but a "get out of responsible parenting free" card.

Maybe there should be a national policy ensuring that only responsible people become parents? No idea on how such a policy could be non-oppressively designed or implemented, though.


Have a nice time!

Peter Gustafsson

[Phaeton]

Originally Posted by TrainingDummy

So what should be done? What responsibilities does the FDA have? What about the APA (American Psychological Association)? Or do you think I am overreacting when I say this has reached the proportions of a social epidemic?

Well the American Psychological Association has absoutely no responsibilites apart from perhaps keeping their PhDs from getting into knife fights with the American Psychiatric Association's MDs.

The story is a sad one, but the fault is clearly the parents. Even if made clear the effects of a medication there still exist parents that will misapply it against doctor's orders. The story speaks much more to the irresponsibility of the parents than those of the doctor. I don't really feel this is a fair launching point for a discussion of the merits of psychatric medication in children.

[MyrddinsPrecint]

I sincerely hope that the other children are taken away from the parents, detoxed and then reassessed...... Parents are so involved in the diagnoses of their children, since some of the clinical symptoms have to occur in daily life, and you can't really get a 2 year old to accurately self assess/report. Since clearly this child was WAY overmedicated without really monitering by the parents, one can assume that there's a good chance the other children are getting screwed over similarly.

[jBirch]

I'm not a big fan of childhood medication for any reason. Behavioural problems ought to be met with behavioural, not pharmacological, solutions.

Were the parents unable to get pharmacological treatment for their daughter, they would not have had access to simple drug therapy solutions. Instead, they would have needed to learn how to train the desired behaviours into her in order to get the reprieve they were looking for. Which would have been a far more effective solution in the long run.

James.

[jBirch]

Originally Posted by Phaeton

Well the American Psychological Association has absoutely no responsibilites apart from perhaps keeping their PhDs from getting into knife fights with the American Psychiatric Association's MDs.

The story is a sad one, but the fault is clearly the parents. Even if made clear the effects of a medication there still exist parents that will misapply it against doctor's orders. The story speaks much more to the irresponsibility of the parents than those of the doctor. I don't really feel this is a fair launching point for a discussion of the merits of psychatric medication in children.

I disagree. Why was the doctor prescribing medication at a rate where abuse was possible?

James.

[PeterGustafsson]

Hi!

Originally Posted by jBirch

I'm not a big fan of childhood medication for any reason. Behavioural problems ought to be met with behavioural, not pharmacological, solutions.

When the problem is one of brain chemistry, behavioral treatments will not work.

Originally Posted by jBirch

Were the parents unable to get pharmacological treatment for their daughter, they would not have had access to simple drug therapy solutions. Instead, they would have needed to learn how to train the desired behaviours into her in order to get the reprieve they were looking for. Which would have been a far more effective solution in the long run.
James.

I personally know of a person who has a diagnosis which earlier was thought to entirely be due to bad parenting. That quack science is by now mostly a distant nightmare, but there still exists places where Freudianists demand to do their at best pointless - and at worst family-breaking stuff - to families where one member has the diagnosis. (OTOH, this diagnosis is not so far known amenable to any pharmacological treatments. The only known treatments are for patients with low IQ to live in an environment with few problems specific to the diagnosis. For those with high IQ - a high proportion - the treatment is to avoid specific problems, and to not be oneself all the time.)

As you might have understood by now, the "talk-treatment as paramount" battle-cry, or rather burp-up, rubs a rew nerve with me.


Have a nice time!

Peter Gustafsson

[Rabid Monk]

I got diagnosed with ADHD as a child (about 9 or 10).
I got stuck on Ritalin for seveal years.
It had side effects I did not like. When I entered high school, I stopped taking the stuff. And I do not notice any abnormality in my behaviour that can be attributed to ADD or ADHD.

My parents got divorced shortly afterward, for unrelated reasons. My father went on a crusade against the doctor who diagnosed me, and strongly objected to the pills. He read a lot of literature on ADHD, and had me read some of it, too. That was part of what lead to me stopping the ritalin.

But it seems that more and more children nowadays are being dignosed as "overly hyperactive or unable to concentrate on one problem fro long periods of time".
Am I the only one who thinks this sounds like childhood, not a disease?

Being Canadian, I can't really comment on American regulations.
I am not even sure what the Canadian regulations are. All I know is that there are "doctors" who have the reputation of having prescribed ritalin to every single child they see, without fail. And the evidence for it? A docors say-so. It's not something I've been able to dedicate much time to tudying, but it is something that irks me, everyime I hear about another child (a greater number every year) being put on drugs.

[Phaeton]

Originally Posted by jBirch

I disagree. Why was the doctor prescribing medication at a rate where abuse was possible?

James.

Keep in mind that abuse of any medication is possible if you are given more than one dose. If I'm given a week's supply of vicodin I could just as well pop in the proper dose for 3 days at one time as I could the proper dose for the set time frame I'm taking it for. There's always potential for abuse in medication. Give someone enough cough drops and they'll manage to kill themselves (see Colorado) and even people mismanage food for their children (maybe we should punish the kid by making him eat a bunch of salt?).

The question lies within how well a doctor can assess the mental capability for parents to administer medication and the potential for abuse. It is quite possible that the parents had told the psychiatrist in question that they completely understood how the medication should be administered. Unless there's evidence of parental abuse or neglect denying someone treatment on the basis that their parents seem incompetant isn't justified, and if there's sufficient evidence then steps should be taken (for example state custody of the child) to ensure that proper medical care can be given. It's giving doctors the responsibility to judge a situation in which they are neither trained nor qualified.

In this I am no way supporting the excessive psychiatric medication the American public is being perscribed, including children. I am not supporting the psychiatrists choice to diagose bipolar disorder and ADHD. I however feel that the psychiatrist is not directly responsible for the death of the child.

[jBirch]

Originally Posted by Phaeton

Keep in mind that abuse of any medication is possible if you are given more than one dose. If I'm given a week's supply of vicodin I could just as well pop in the proper dose for 3 days at one time as I could the proper dose for the set time frame I'm taking it for. There's always potential for abuse in medication. Give someone enough cough drops and they'll manage to kill themselves (see Colorado) and even people mismanage food for their children (maybe we should punish the kid by making him eat a bunch of salt?).

Absolutely. However, I've always wondered why we are given that much medication instead of having to return the pharmacist on a regular basis. See, it goes back to the whole "Pain in the Arse" factor that lies at the heart of most medical treatment: diagnose, prescribe, dismiss. Repeat ad nauseum.

The question lies within how well a doctor can assess the mental capability for parents to administer medication and the potential for abuse. It is quite possible that the parents had told the psychiatrist in question that they completely understood how the medication should be administered.

Of course they did. Have you ever nodded your head at something you didn't understand just to save the embarrassment of being perceived as a dummy?

Unless there's evidence of parental abuse or neglect denying someone treatment on the basis that their parents seem incompetant isn't justified

I'm not talking about denying treatment. I'm talking about considering treatment that is nowhere near as instant as prescribing medication. Have you ever seen a diabetic decide between diet + exercise or insulin?

It's not that doctors want to hurt people. It's rather that drug effects (in the short term) are easy to show and they generally provide immediate relief. The doctor looks like they've done something and the patient feels better. Everybody wins.

I however feel that the psychiatrist is not directly responsible for the death of the child.

I do not agree. I feel that BOTH the psychiatrist AND the parents are almost equally responsible for this death.

On a slightly different tangent, I'm really concerned about the ads I see on TV for certain prescription medication. It seems really wrong somehow.

James.

[TrainingDummy]

A few things...

1. Yes, by APA I meant American PSYCHIATRIC Association. My bad.

2. As to ADHD, well, there could quite possibly be a real epidemic of a new behavioral disorder caused by genetics, a childhood virus, or a slew of environmental factors. According to my behavioral neuroscience professor, high levels of heavy metals (I believe lead) found in organic calcium supplements have been found to cause severely treatment-resistant ADHD in the fetuses of pregnant women who take them. It seems quite likely that other environmental factors (perhaps other exposure to lead or heavy metals) could be the culprit. In the meantime, I am skeptical of the high rates of diagnosis.

3. Subscription-only medicine on TV... yes jbirch, this worries me too. Until the 90s this was illegal (here in the U.S.). I'm not sure why it changed, pressure from Big Pharmaceutical would be my guess. I am torn: it is very important for people to know about medical breakthroughs that could really help their health, but...

Well, for example, I was told by my physician that a good strenuous workout in the sunshine daily will boost the average person's serotonin levels about as much as an average dose of a common SSRI (such as Prozac or Zoloft). Will this ever make TV? Of course not! Who makes money off you when you run out in the sunshine instead of pop a pill? Certainly not Pfizer or Eli Lily!

[introspective]

I went into psychology for a while - and I have to agree that they go off into the neurobiology thread too much - placing too much emphasis on medicating rather than spend the time to discuss. I would like to see more time spent on understanding the stages of childhood development. That's what we all did before. Most teachers and parents simply understood kids better and parents were satisfied with their simple appearances. They weren't interested in appearing glamorous, beautiful or rich. The simple wool coat - the old car that we clunked around in to get to work.

Alot of the problem starts with mothers who want to medicate their kids to control their behavior and the 'doctors' who go along with them and just write out presciptions like its nothing. I have a feeling that very few kids actually need to take meds. and that 'stage' moms want the attention that it brings them to have a 'special' child.

There's a term for the women who drag their kids arounds to doctors: Munchausen Syndrome. It's a bid for attention. My feeling is that as women compete for attention - they lose ground when their physical appearance changes due to pregnancy. They 'project' their feelings of inadeqacy to their children, claiming that somethings' wrong - but they are sometimes not specific about what the problem is. So the doctor goes searching for the problem to treat.

-`)---------
On the aside: recently I saw a program called 'Supernanny' Wherein the nanny tries to help parents understand their children better. When one the story ran, the parents confessed that they do all of their grocery shopping in a "Natural" food store. [they thought it was better for their children] but.....! If we were to check the ingredients listed in the foods sold there we would see that nearly all of it contains herbal additives the effects of which we know practially nothing about.

[larkmaj]

She said she based her diagnoses of ADHD and bipolar disorder on the family's mental health history, as described by Carolyn Riley, and Rebecca's behavior, as described by Carolyn and briefly observed by her during office visits.

To me it seems that the psychiatrist made the diagnosis too easily. However, as has been stated before, if this doctor didn't give her what she wanted, she would just find one that did. She also knew exactly what to say to get the diagnosis I would guess since her other kids apparently have it.

Now, if the doctor knew that both of the other children "apparently" had ADHD and BPD (which she should have) then the validity of those diagnoses should have been brought into question. Especially after the mother tried to get more pills from the pharmacist (which the psychiatrist allowed).

None of their concerns was enough to save Rebecca.

The principal, the nurse, the neighbors, especially the uncle all should have done something as well. A problem should have been obvious to all of them based various points in the article. Isn't the school SUPPOSED to meddle in such affairs?

The parents, shrink, neighbors, principal, nurse, uncle, they're all to blame for this.

[introspective]

It really was Munchausen Syndrome [by proxy - I forgot to type in by proxy, but its commonly called Munchausen - for expediency sake].

I read about this syndrome many years ago when I came across it as a student and forgot about it for a long time, but every once in a while I recall it when I see a story like that. Her age was the tip-off. No kid that young should be diagnosed with ADD; or Manic Depressive Disorder; it just doesn't make sence. All kids throw their dolls or trucks on the ground when they want to rebel. That is why I loved my Childhood Development Class so much. It clearly explains the stages of mental, emotional and physical development of people. I remembered a kid I went to school for for years and years with psychotic disorder but he was never treated until highschool after he bit a teachers ankle. In other words, back then, we didn't medicate kids, or throw them into hospitals - he blended in with the rest of us. If you start to medicate kids everything is jeapordized. That little girl went into respiratory distress [which escalated later into fluid in her lungs] and it was her mothers fault. I would charge her with negligent homicide. And I would pull the doctors license - and grill her until she tells us exactly why she would prescribe heavy antipsychotics for a four year old.

p.s. You know, in retrospect I realized that Jeffrey Daulmer for example used to dissect small animals in his backyard, clean and collect their bones and keep them in his room.....and his parents did not regard this as being antisocial....while a little four year old girl is brought to the doctor for using her limited volcabulary of "no" and "blah" and "donwanna" and her quack of a doctor blindly obliged her parents with a prescription. I have seen kids just push their elders to the limit....and still I don't see antisocial I see kids pushing to the limit - It is considered to be a normal stage of development

[Shi no Tenshi]

For that one I have to wonder...the article states that the psychologist diagnosed the toddler based on the family's mental health history. Given that the disorders diagnosed require at least 6 months observation to accurately diagnose, and bipolar is practically indistinguishable from a handful other disorders until much later in life than this child was...what the hell was the psychiatrist thinking? Yes, the parents are obviously incompetent, and should be taken to task for their actions instead of decoying the blame to somebody else. I can't believe, however, that this psychiatrist is being as supported as the article says.

As far as behaviour modification goes...Cognitive therapy works quite well with a variety of disorders, including ADHD and it's derivitives. It is harder to do, however, hence why many prefer the easy way out with medication. Also, as Peter pointed out, brain chemistry disorders, such as bipolar, cannot use such methods.

[Lucifer]

Yeah,, it looks like the kid was diagnosed by association. "Your family are all coke fiends, so you are too. Go to Narcotics Anonymous."

The think spooking me about this article is trying to imagine what the little girl's life must have been like. Man, that's some freaky stuff.