The Medicalization of Childhood?
 

I am watching 20/20's show on foster children being prescribed drugs.

http://abcnews.go.com/Health/doctors...ry?id=15064560

The full episode should be available on the 20/20 website soon. http://abcnews.go.com/2020/

http://abc.go.com/watch/2020/166626


I find prescribing children drugs to be troubling and especially for foster children and other children whose young lives have already been chaotic.

What say you, GCers?

So, I watched 20/20 and thought of the Conrad Murray thread. 20/20 was talking about foster children being given multiple drugs. Some of these kids are being prescribed drugs by the age of 4. 4! 4!

One boy said "I was given drugs for ADHD, I'm not ADHD I'm just naughty...I was given drugs for bipolar disorder, I do not have bipolar disorder...I don't have any disorder...."

:( This little girl who was adopted was given 5 psychopathic(?) drugs for a number of mental disorders. They showed a tape of her "going crazy" and running around the house screaming. These drugs were messing with her head. How can some medical professionals say that CHILDREN have these disorders and need medication? Do they really need to change the brain chemistry of children? Is there no consideration of the side effects?

Another girl gained like 100 lbs from all of the drugs.

They talked about the case of little Gabriel Myers: http://www.cbsnews.com/8301-504083_1...46-504083.html

Generally speaking I think it's ridiculous how people are so eager to take a pill to supposedly solve their (non) problems. Aren't they saying that 60% of kids have ADD now? I'm waiting for the day they start putting Ritalin in the water supply along side fluoride (which by the way is being blamed by some for causing health problems. You apply fluoride, you dont ingest it). I suffer from depression and I've yet to take any anti-depressants or any other mind altering chemicals to "fix" me. Ive heard way too many stories of people getting worse/more depressed/bat shit crazy after getting on a regimen of anti-depressants. I manage it daily with diet, meditation, and exercise and I couldn't be happier with the results.

This is a semi-swerve, but I really notice the "pushing" of prescription drugs when I am watching the Olympics on TV.

When I watch the Olympics on the Canadian feed, the ads are from companies like Tim Horton's Coffee, Petro Canada gasoline, and Royal Bank of Canada (RBC) and whoever else is the sponsor du jour for the Canadian Olympic broadcaster.

When I watch the Olympics on the US feed, the ads are predominantly from pharmaceutical companies for the sole purpose of pushing prescription drugs for depression/ashtma/heartburn/E.D./sleep disorders, etc. "Ask your doctor whether ______ is right for you".

It gave me reason for pause and not in a good way. :(

This is the main reason I left the mental health field. All that anybody wants to pay for is to medicate people (adults and children) and ship them out of the hospital with little to no real therapy. It's ludicrous.

I watched this and it broke my heart. These kids have no advocates for them.

On a personal note, my nephew is now 13 years old and his mother (I think she is bat sh*t crazy anyway but...) has had him on psychopathic drugs since he was about 6 years old. She sees something and will shop him around to doctors until she finally finds one that agrees with her and will put him on some medication. He takes bi-polar meds, sleeping pills, pep pills, and ADHD meds and honestly, I don't think he needs any of it. For example, when he was 7 years old, she said that he never listens to her so he must have ADHD (never mind that she never disciplines him) so she shopped him around from doctor to doctor until someone agreed and put him on a medication.

That behavior is from someone WITH a mom, so I can't imagine what foster kids go through - I'm sure drugs are thrown at them from every angle.

My 25 cents (it started off as 2 cents but I couldn't shut up).

1. LOL How'd you get from this to Murray? Just the overprescription piece?
2. The term is psychotropic drugs and they are WAY overprescribed IMO. I'm glad to work with psychiatrists who are very hesitant to prescribe anything to children, despite the push from insurance companies. That is a big part of it--those who are actually in need of psychiatric hospitalization often are not covered by insurance if the doctor does not prescribe anything so I often see prescriptions for very low doses of things (like doses so low they fall out of the range of what's even effective) just so they can show insurance they are on something.
3. @ the bolded: It's a tough call but there are definitely those who are in need. I have had severely depressed teens on my case load whose conditions did not improve with diet/lifestyle changes. The very scariest thing I have seen in my career so far was a psychotic 3-year-old. He was not prescribed anything because of his age but I would not have been against it because his condition was that bad. I had never seen anything like it and haven't since so I know it's not "the norm" at all but I no longer believe that kind of thing can't exist.
iAgree. Both bipolar and ADHD (among other things) are WAY overdiagnosed for numerous reasons, including because those are the ones the general public "knows" so once people learn of it, they think they see the signs everywhere. What are often results of inappropriate diet, lack of structure, normal hormone surges now merit medication and I think that can mess a kid up. Not just their brain chemistry but what message are we sending by telling someone their anger outbursts are abnormal but this pill will fix it? Being socially awkward =/= autism. Having bursts of energy followed by sleeping like a log =/= mania followed by a depressive episode. It's hard because there are children who really do need actual psychiatric help and parents ignore or disregard the signs and tell them to suck it up. Then you have the ones who are being pumped full of every drug on the planet and there's nothing wrong with them at all.

I wanted to touch on this, too. We (my co-workers and I back when I had a full case load) are trained "therapists" who offer "therapeutic dialogue" (i.e., talk to our patients using some of our skills) but it's hospital policy that we don't provide "therapy." While I agree that therapy would be a much better help then meds in like 90% percent of cases (if not more), providing it in a hospital setting really isn't feasible. Being in a hospital is meant to be short-term stabilization for about 3-7 days, at least here. That's not a fast rule, just an average. I can do some brief, crisis-centered therapy with that but that leaves very little time for any real work. Therapy is a process that pulls out a lot of hurtful stuff then gives tools to heal it back up again. I keep trying to explain to patients' families (who are livid that we don't provide therapy), "Would you want to be responsible for ripping off a person's mask and exposing all the hurtful things inside of them then ship them back into the world before teaching them how to pull it back together?" The thing that would be most helpful is something that needs to be done outside the hospital which is why we will give a referral for an outpatient therapist to anyone who says they want to go. I hope that makes sense--I wish we could do more than that but that could lead to some dangerous situations.

Yes, the Conrad Murray thread is about overprescription and medicalization.

I don't know who "they" might be, but I've never seen or heard a figure -- at least from a reputable source -- higher than 10%.

Our son is on two different medications for ADHD. We tried everything we could think of before going the medicine route. We didn't consider medication until we had a diagnosis from a psychologists based on two days' worth of testing and extensive reports from us and teachers. After a horrible reaction to the first medicine we tried (depression) our pediatrician referred us to a pediatric neurologist, whom we see every 3 months to check on things. We consider the use of these medicines to be an aid while he develops other skills and coping mechanisms, not a permanent solution.

I'm in no way denying that overmedication happens or that some parents are sure their kids need drugs and shop around until they find a doctor willing to prescribe them. But I'm a bit bothered when the reaction to that is to slam the use of these medications or doubt the need for AD(H)D medications in children altogether. That's an overreaction that can foster an environment of shaming the kid who truly do need these medicines or dismissing what they deal with as not really real.

Some consider prescribing medicines to children to be an overreaction that shames kids into thinking that their mere existence is problematic.

What is the middle ground?

The average family can barely afford medical services and neither has the time nor the money to seek different medical opinions. This is especially the case for foster children. I refuse to believe that so many children actually need these prescriptions. The prescription drug industry has boomed in the past 20 years. A review of the history of illicit and prescription drugs speaks to the different reasons for such a boom, including capitalism.

I think you're right in terms of formal/official diagnoses. Informal/unofficial diagnoses may be a different story.

I think these are valid points, and I think they point to bigger problems. And I'll also agree that as a culture we've bought into the promise of pills fixing everything.

But still, I think the conversation needs to be about the problem of overprescribing, not about the terribleness of prescribing at all. Sometimes, it is appropriate.

Prescribing at all is arguably overprescribing if we are talking about a 4 year old, for example.

Prescribing at all is arguably overprescribing if we are talking about adults and children who may not have the conditions that they have been diagnosed with.

I agree, but look at what PiKA2001 said, which is what I was responding to:

Quote:

Originally Posted by PiKA2001 (Post 2109993) Generally speaking I think it's ridiculous how people are so eager to take a pill to supposedly solve their (non) problems. Aren't they saying that 60% of kids have ADD now? I'm waiting for the day they start putting Ritalin in the water supply along side fluoride (which by the way is being blamed by some for causing health problems. You apply fluoride, you dont ingest it). I suffer from depression and I've yet to take any anti-depressants or any other mind altering chemicals to "fix" me.

The underlying message here is that any medication in and of itself is bad, whether needed or not. There is also the underlying message that AD(H)D may be a non-problem. Sure, too many people label some kids as having it without any basis, but that doesn't mean that some kids actually do deal with it and are sometimes significantly affected by it.

I think it's great when anyone can manage AD(H)D, depression or other issues without any medications. I truly do. And when possible, I think that should be the goal. But some people can't do that, either in the long-term or in the short term while they develop other strategies for dealing.

I will readily agree that overprescribing -- prescribing medicines for children or adults who don't need them -- is a wrong and is a problem. But I think it is equally wrong and problematic to under-prescribe -- to not provide medicines that are needed and are helpful.

No, thats not what I'm saying at all. If you have high cholesterol there's nothing wrong with taking medication to lower it but a doctor isn't going to prescribe meds there because he thinks you may or has a hunch that you have high cholesterol. He's going to actually draw blood and test the level of lipids or whatever it is they check. I feel the attitude is completely different when it comes to psychological disorders especially when your family practitioner or care provider might only have 5-10 minutes for diagnosing and coming up with treatment plans for the patient.

I'm also not saying that ADD or ADHD is a non issue but I do believe it's over diagnosed and over exposed and someone putting their kid on meds for it just because he goes nuts after slamming a Mt. Dew is absurd.

^^^Not to take this off track, but a child who truly has ADD and ADHD would actually focus better if given a Mountain Dew. ADD and ADHD drugs are stimulants (that normally begin in very low dosages). When we had kids who were on meds for ADD or ADHD and forgot to take them, we'd give them 1/2 a Mountain Dew. Isn't the same effect obviously, but it helped them get through.

Other than that - everything MysticCat said - ditto.

My sincere apologies for reading more into your post than you intended. I see what you're saying, and don't really disagree. I noted above that we had a few days of testing, and reports from numerous sources, that the psychologist conducted and reviewed before providing a diagnosis. I think that's how it should work, and I would also have a problem with either a diagnosis or a prescription based on a a 10 minute session and anecdotal evidence.

And ditto what AXOMom said -- we've found that a Diet Mt. Dew or Coke can very helpful. (You get the caffeine without the sugar that way.) And now son has discovered coffee.

Yes, that is how it is now. When I started in the field as an Occupational Therapist in 1988, adults stayed in inpatient for about 6 weeks and adolescents and children could be as long as 3 months. That's weeks of daily group therapy, two hours of OT, two hours of Recreational Therapy, time with a teacher to do their schoolwork (for kids), daily individual sessions and family sessions a couple times a week. There was time to really work with them and to get medication levels right. And, the revolving door syndrome didn't happen. When it got down to 3-5 day lengths of stays and we'd see the same bi-polar patient 8 times a year, I was done with adult inpatient. Medicate them, push them out the door without giving them any skills to cope with their new situation (and sometimes no way of getting more meds), and they are back in 6 weeks. Occupational Therapy involves teaching life skills, working through activity to improve functioning, relaxation skills, self esteem building activities, expressive therapies, activities of daily living, etc. In the old days, we had time to teach them how to use the bus system, where to find healthy activities to do, how to fill out job applications, how to work in a group. You can't do that in 3-5 days. You can't do that once a week for an hour. Back then, once deemed fairly stable, a patient would go on a day pass to home to see how things were when they were at home. Then they'd come back to the hospital and work through issues that had come up. Then they'd go on a two day passes over a weekend and come back to process. THEN they'd go on a weekend pass, overnight, and do the same and if all went well on the weekend pass, they would be discharged. THERAPY happened, people got better.. the statistics showed it. Readmission rates were very, very low. They did start up day treatment programs after inpatient became so short, but those got shorter and shorter too. And you had no control over what patients were doing at home every night so they often did things that ended up sabotaging all the work you did during the day.

It was very different and it was very successful. And nobody wanted to pay for it.

Honestly folks, the way insurances set critical pathways now, they tell the doctor to do a minimal amount of screening and then try a medication to see if it works. That is the standard pathway they are supposed to follow so they don't spend too much on tests.

Our society is so messed up, it's depressing to me. I'm a little passionate about this topic, as you can probably tell...lol.

Mountain Dew is the best soda. That's all.

I heart you. You just described what I wish inpatient treatment looked like. I forget that once upon a time, it did.

No worries. Unfortunately many children aren't in the situation that yours is in with parents or guardians that can afford to or care enough to take them to specialists/get second opinions, etc.

Across contexts, misdiagnosis and overdiagnosis seems to have been more of a problem than underdiagnosis in the past 10 years.

http://www.businessweek.com/news/201...sis-rules.html

I wonder to what extent this coincides with both malpractice pressures (in my experience, a misdiagnosis via the wrong assigned malady is much less problematic for juries than a non-diagnosis, or inaction), and the changing view of doctor as solution, rather than as an aid in management/prevention.

In short, are doctors themselves thinking they 'should' be diagnosing more, leading to overdiagnosis?

Excellent question.

I know that it is difficult to come across children (and people) who do not have some diagnosis or some prescription for something.

I think that is doctors overdiagnosing combined with the booming prescription drug industry and combined with parents thinking that their child has every illness under the sun.

I agree.

On the other hand, I have noticed that some parents are resistant to having their children checked out because of the overdiagnosing. I have noticed this with parents of my friends and with my friends becoming parents. Since so many children, or the parents themselves, are (were) being so overdiagnosed they resist taking their children to be diagnosed even when they have problems. Some of my friends will not listen to their doctor (or doctors) when it comes to potential health issues with children. I am all for getting a second opinion, in fact I'd strongly recommend it at times. One friend who is currently pregnant child 2, refuses to take advice from her doctor even though she almost lost child 1 due to complications that most likely could have been avoided if she had taken the doctors advice. She refused to allow her first child to take antibiotics when the baby had an infection. This was until the baby's father and the grandmother basically forced her.

I realize that many people are more interested in taking a pill to fix all. I do wonder, however, how far the resistance goes.

What I'm wondering is if it's now seen as better to label someone with a problem they don't have than later find out you missed something. Theoretically, it might be easier to defend oneself in a malpractice suit if one can say "Oh, I gave the wrong diagnosis but at least I took action and was sort of on the right track" then to say "Yes, the patient came to me for help prior to [insert catastrophe here] and I completely missed this." I think it used to be (and to an extent still is the case) that doctors were afraid of diagnosing someone when they did not have to because of the stigma surrounding mental health diagnoses and the effect that label could have on a person's life. However, this concern has taken a backseat to a number of factors including fear of not getting paid by insurance companies.

You'd be surprised.

That all depends on who's doing the labeling. One of my friends refused to have her children put into the special ed program (they are supposedly mildly autistic, but I personally think it's because their blob of lard father who was at home with them when they were toddlers did nothing but sit and watch tv) at their school because once you are on that track (and bringing in funding for the school) it's nearly impossible to get off. I'm sure she signed some sort of waiver when she made this decision.

On another note, a friend's daughter got kicked out of preschool for being loud and jumping on things. Isn't that called...being a 3 year old?? This is the thing that worries me the most...that even though teachers do know better, they'll start thinking of medicated, overly docile children as the norm.

This is the thread I referenced in the ADHD thread.

Thanks, DrPhil.