The Medicalization of Childhood?

[MysticCat]

Originally Posted by DrPhil

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 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.

[DrPhil]

Originally Posted by MysticCat

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.

[MysticCat]

Originally Posted by DrPhil

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:

Originally Posted by PiKA2001

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.

[PiKA2001]

Originally Posted by MysticCat

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.

[MysticCat]

Originally Posted by PiKA2001

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.

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.

[AGDee]

Originally Posted by christiangirl

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, 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.

[christiangirl]

Originally Posted by AGDee

Yes, that is how it is now...

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

[PiKA2001]

Originally Posted by MysticCat

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.

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.

[AOII Angel]

Originally Posted by PiKA2001

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.

You'd be surprised.