Suffer The Children

In a decade of practice as a clinical social worker in an outpatient community mental health setting, working predominately with children and families, I have borne witness to the increasing propensity of the psychiatric establishment to treat children like guinea pigs raised in sterile laboratories. The bias toward adjudging chronic and severe emotional and behavioral difficulties as largely the product of nature (i.e., brain chemistry, genetics) while ignoring or minimizing the significant impact of nurture—or, as is often the case, the lack thereof (e.g., neglect, abuse, trauma)—in producing such symptoms has led to a state of affairs that verges on malpractice. With the avaricious complicity of the pharmaceutical industry, emotionally and behaviorally disturbed children are being subjected to multitudes of psychotropic medications with little apparent consideration of the long-term effects on their developing brains and bodies or concern for the experimental nature of such treatment. Benedict Carey, writing in yesterday’s New York Times, confirms what I have known to be true for some time: children are being heavily medicated.

Use of Antipsychotics by the Young Rose Fivefold

The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday. The researchers, who analyzed data from a national survey of doctors’ office visits, found that antipsychotic medications were prescribed to 1,438 per 100,000 children and adolescents in 2002, up from 275 per 100,000 in the two-year period from 1993 to 1995.

The findings augment earlier studies that have documented a sharp rise over the last decade in the prescription of psychiatric drugs for children, including antipsychotics, stimulants like Ritalin and antidepressants, whose sales have slipped only recently. But the new study is the most comprehensive to examine the increase in prescriptions for antipsychotics.

The explosion in the use of drugs, some experts said, can be traced in part to the growing number of children and adolescents whose problems are given psychiatric labels once reserved for adults and to doctors’ increasing comfort with a newer generation of drugs for psychosis. Shrinking access to long-term psychotherapy and hospital care may also play a role, the experts said.

The findings, published yesterday in Archives of General Psychiatry, are likely to inflame a continuing debate about the risks of using psychiatric medication in children. In recent years, antidepressants have been linked to an increase in suicidal thinking or behavior in some minors, and reports have suggested that stimulant drugs like Ritalin may exacerbate underlying heart problems.

Antipsychotic drugs also carry risks: Researchers have found that many of the drugs can cause rapid weight gain and blood lipid changes that increase the risk of diabetes. None of the most commonly prescribed antipsychotics is approved for use in children, although doctors can prescribe any medication that has been approved for use.

Experts said that little was known about the use of antipsychotics in minors: only a handful of small studies have been done in children and adolescents. “We are using these medications and don’t know how they work, if they work, or at what cost,â€? said Dr. John March, a professor of child and adolescent psychiatry at Duke University. “It amounts to a huge experiment with the lives of American kids, and what it tells us is that we’ve got to do something other than we’re doing nowâ€? to assess the drugs’ overall impact. more…

The article goes on to identify “an increase in the diagnosis of bipolar disorder in children as a contributing factor.â€? For a number of years now, this diagnosis has been in vogue among psychiatrists to describe children who present with extreme emotional and behavioral dysregulation, e.g., moodiness, irritability, explosiveness, aggression towards self and others, difficulty self-soothing, relational problems, etc. However, these same symptoms can also—and, in many cases, more accurately—be accounted for by complex trauma experienced early in life. Bessel van der Kolk, a world-renowned psychiatrist who is the founder and Medical Director of the Trauma Center in Brookline, MA, describes complex trauma as “the experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within the child’s caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood.â€? Children who have experienced such complex trauma can be among the most challenging to parent (or foster parent, as is often the case) and to treat. Mislabeling them as bipolar and foisting an experimental cocktail of medications upon them adds insult to injury. And, as suggested by Jennifer Harris, a clinical instructor at Harvard Medical School, “giving a child this diagnosis may diminish stigma by not making the child’s condition anyone’s ‘fault’….[and] is far easier than examining family interactions that contribute to behavior.â€? She goes on to say, in an opinion piece in the May 2005 issue of Psychiatric Services:

[T]reatment planning is simplified if the problem is conceptualized as being largely biological, which results in medications and alliance building to ensure compliance. These interventions are difficult, but they are simpler than trying to stop a parent from drinking or from getting involved with violent partners; the biological approach is an attractive route when a child seems untreatable because of conduct difficulties and a hopelessly entangled set of social problems. Clinicians who care deeply about children often find it enormously painful to witness the lack of nurturance and the instability and cruelty that many children live with. A clinician may succumb to unconscious temptations to stop asking or to stop listening. The enormity of the problems many children face makes the simplicity of a biological explanation tremendously appealing. It allows us to feel we are doing something so that we can avoid feeling helpless with our most difficult patients.

When a psychiatrist accepts juvenile bipolar disorder as a diagnosis before it has been shown conclusively to be valid, he or she is forced into a host of shaky assumptions about treatment, particularly medication treatment: “Medication is needed.� “Antidepressants are likely harmful.� “Mood stabilizers are necessary.� “Medication treatment should be aggressive.� Medications are not benign agents. They have both short- and long-term effects that have not yet been thoroughly studied. Thus we should be cautious about initiating psychopharmacologic approaches. It is important not to deny treatment that might benefit children who are truly suffering. However, we must not allow personal, financial, societal, and professional pressures to impede our ability to be thoughtful and cautious with our patients. [full text]

Sadly, such thoughtfulness and caution seems to be the exception rather than the rule, of late. It is my contention, based on anecdotal experience, that the rise in use of antipsychotic medications in children as reported in the New York Times has not lessened but grown dramatically in the intervening years, as has the use of bipolar disorder as a diagnosis. The explosion of such has taken on bizarre proportions, as evidenced by a recent Australian Broadcasting Company science report entitled “Toddlers diagnosed with bipolar.� It is maddening. And it is misguided. The most vulnerable and dependent among us are being treated as guinea pigs by a pharmaceutically-influenced psychiatric establishment that, by and large, cannot see the forest for the trees or the child for the cluster of symptoms. What untold harm are we doing to future generations?

8 thoughts on “Suffer The Children

  1. David, As a fellow clinical social worker for the past decade, I have also witnessed the shocking increase in diagnosing children with bipolar disorder and I am equally alarmed. I have also struggled with the lack of restraint and ethics in the way the drugs are prescribed. When I worked in an inpatient setting, pressure from the insurance companies for us to “do something” basically translated, 90% of the time, that the psychiatrist had to put the kid on a medication, otherwise the stay would no longer be approved.

    Now things are no different, and are, in fact, worse. Many kids are now being prescribed Seroquel — a drug to treat bipolar and schizophrenia that was only introduced in 1997, has major side effects, and is totally untested on children! Some kids don’t like taking it because it significantly alters the way they feel.

    The Clinton administration was supposed to have started major studies into the overmedication of children, but who knows what happened to that initiative — I’ll look into it and find out.

    The change in the culture of this needs to come from the psychiatrists standing up to the pharmaceutical industry and exercising much more restraint in prescribing. But who is going to push them to do that? Leaders in their own profession are the only people who might have the clout to do that. We as social workers can make the case that environmental and family issues are central, but the culture of medicating children has grown astronomically in acceptance, and most psychiatrists are willing to go along with it.

  2. And further than that, Kiersten, the SCHOOLS are pushing parents of students, who do not conform, into 504 plans, which feed directly into the pressure situation you described above. The ‘implied’ alternative is that the child will fall hopelessly behind, making the adult a ‘bad parent’. It could never be a ‘bad teacher’ or ‘bad curricculum’ – that would require self-examination, where the school system notices that creating a giant “Special Ed” generation may be profitable when looking for Fed money, but it is not good for the children.

    In as much as I see the insurance industry as an invasive and terminal cancer in our society, it grieves me to see so many parents cave-in to unqualified and, often, unsolicited school pressure.

  3. Oh, man, don’t get me started. Please refer to a couple of BusinessWeek articles from the past month. There was one called “Medical Guesswork” in the 5/29/06 issue, and another called “Hey–You Don’t Look So Good” in the 5/8/06 issue.

    Taken together, they paint a very unsavory picture of how the medical system works, especially when it comes to drugs and drug prescriptions. The upshot is that MD’s get most of their ‘education’ on drugs, their benefits, their potential problems, etc from the Pharmaceutical Industry. So you’ve got the profit motive getting these drugs into the MD’s kit bag, and then there is a serious lack of follow-up from anyone.

    In short, the 5/8/06 article flat-out says people are accusing the drug companies of disease-mongering, and the 5/28/06 article says that diagnoses and treatments are often fads. That is a really ugly combination of unwholesome profit motive and leaving no one responsible for oversight.

    And let’s also not forget that drug companies spend more on marketing than they do on research & development. In other words, we have this drug, so let’s medicate as many people as possible with it. That’s called ‘increasing market share.’

  4. I was one of those children, my mother was the issue there, was diagnosed as a hyperactive child at age 3 and 1/2, forced ritalin every 2.5 hours, the dexedrine syrup and spansules in applesauce, after the restraining me to the floor got old, been on every psychotropic from Lithium to Prozac to the Prescription version of actual methamphetamine for my mom to “stabilize” me and it really gets sad when I have absolutely no concept on how to behave properly as a result. I guess it feels like torture in a way. I am a 26 year old adult.

  5. As a handwriting remediation specialist, I’d like to offer some insight to other professionals who are unaware of what a powerful influence multi-sensory handwriting has on the young brain. Handwriting has a physiological/psychological link in the brain. That is, the neural activity creates influences individual psychology,i.e., impulse control. As an intentional process, it is especially effective in helping stabilize the emotional brain to develop impulse control and the capacity to focus and attend. (obviously, it avoids the use of amphetamine drugs) Since educators dropped strongly stressing good old fashioned penmanship some 50 years,young brains today have been gravely deprived of essential regulated stimulation while experiencing a vast increase in other kinds of unregulated stimulation. I can’t begin to explain the depths of the influence in this small space, but suffice it to say that because it involves the hand, nothing else done in the classroom can been to compare with the rhythmic, repetitive influence that the manipulation of the thumb and fingers has in its impact on the young brain. Its neural impulses profoundly impact the young brain as they are sent throughout the entire brain. Combining h/w exercises with therapeutic music creates a non-threatening format. This concept has been used across the US and in 20 foreign countries with remarkable results. A Denver lst grade class of emotional disturbed lst graders scored in the 72% in reading with 20 mins a day of this concept. My web page offers much more info–

    Jeanette Farmer

  6. Interesting, Jeanette. I am watching my seven-year-old who is now developing her cursive penmanship and you can see how this work can have a focusing and soothing effect. Also, I worked with a troubled adolescent who got much relief by doing artistic “graffiti” which involved tracing and retracing intricate handwriting patterns.

    Thanks for bringing this to our community.

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