Featured Discussion

The Rx Generation

Prescriptions written for children with mental health conditions are at an all-time high. Yet, the effects of these FDA-approved drugs on children are not well understood. It wasn’t until 1997, when President Clinton granted financial incentives for drug manufacturers to perform pediatric studies requested by the FDA that many pharmaceuticals were even tested on those under 18. Results of this new research are just coming in with mixed outcomes, leaving experts and parents alike confused as to what are the best treatment options for children with mental health disorders.

A recent Frontline episode, The Medicated Child, features the stories of three youth—all diagnosed with bipolar disorder—and the role prescription medication plays in their lives. As their stories unfold, it becomes clear that some fare better than others while their families struggle to figure out the best way to care for their children. Throughout the episode, experts weigh in on the dilemma. Some, such as David Axelson, M.D have chosen to refuse funding from pharmaceutical companies as they try to find the best solutions for children with serious emotional disturbances. Others, like Kiki Chang, M.D., are conducting research to assess the use of medications in children as preventive measures for conditions such as bipolar.

The Medicated Child offers a balanced view of what little is known about the risks, benefits and unanswered questions surrounding prescription drugs for troubled children.

Questions for discussion:

• Are medications being used too frequently to control children’s behavior?
• Should we wait for all medications to be approved by the FDA for use on children before prescribing them?
• When do you think children should decide for themselves whether or not they want to be on medications?

Your thoughts…

Comments:

It is actually very important in how you see things if you are on the inside or the outside or turning upside down at any point in time. LOL

I think that the point is that the parents are the experts and we forget that sometimes, not the professionals they are only a supportive hand in it if they are in it at all.

Seeing all the different ways that my work as I call it or my writing even if I haven't been paid for it and my life as it has been involved in this and being a change agent makes me feel grand at times. I don't know how I have made it.

I am thinking about possibly getting a Ph.D. in philosophy or the humanities, I have only put one feeler out so far I am not going to go too fast with this. My baby is soon to be 14 yrs and my adult child is just over 30.

My life has changed so much and I keep on keeping on and trying to beat the odds the best I can rather then to just be a statistic, but that is the survivor in me. One teacher I had said something like statistics are just numbers, the people are the ones with the tears in their eyes that are behind them or something.

I still can't say that it is always easy or that I don't make any mistakes we all do make mistakes in life none of us are god or perfect if we like that or not, I was told this that this is why the first thing we get in kindergarten is an erasor.

Is that enough dialog for you yet, my job is finding my way through the playground of life as challenging as it can be at times. Thanks you all for being here and hosting this.

By the way I am in KY and now own my own home and am not on HUD any longer having to move just about every year, but hard too is keeping up one's own home believe that, especially as a single parent, and I do have my Masters degree. But I am getting to be an old lady I am going to be 48 in March.

The one and only meeting that I was at of your organization I can remember one of the sessions was on eneagrams. LOL now I know that the pretty little paragraphs I made here won't show up so hope this is readable any way. Posted Tuesday, February 5, 2008 by Janie Lee, M.Ed. at 07:41 PM

This dialogue is so important for all of us working in the behavioral/mental health fields and for those receiving services!

I was recently employed in a children's acute psychiatric hospital. One of the most discouraging aspects for me was learning that children are often admitted to acute facilities because there just aren't the community support systems available to adequately help the child within the family/community system. Once admitted and stabilized in an acute setting, all too often children were discharged only to be readmitted in a short time because of the difficulties in assuring adequate follow-up. Services fell through after discharge, insurance wouldn't pay for the level of services needed, families didn't keep appointments, insurance denied payment for medications, etc, etc, etc.
As Doctor Huffine pointed out so clearly, we have a broken system. Until the real issues are addressed and attended to, use of medication will continue to be a risky business in many situations. If more patients had access to the integrated approach that Dr. Huffine describes, children would be the recipients of the benefits of compassionate and competent care. Don't all children deserve this?







Posted Friday, February 1, 2008 by Beth Allen, RN, BS,Care Coordi at 07:44 AM

Does anyone really care out there? How is your day going, what are you doing good for yourself or others in your life? What is bad about this day? What could you do to change that besides give somebody a pill to take? What kind of laugh or kindness have you shared today. Are you as afraid as I am sometimes? What do you do with that fear? Is life a struggle for you and how do you get through that? Why don't we ask each other real questions that real friends ask, why is it that most Americans have less then 2-3 close friends or family members that they can even count on to be there? Is such life? Suppose it is and suppose that if we face all of our struggles with hope and care and proper support and didn't call it treatment or label people because they needed some assistance, suppose the world would be a better place? What do you think? Janie Posted Wednesday, January 30, 2008 at 11:18 AM

I would like to ask how I could better use this forum as it seems easier when one can use page breaks and such. I don't know how to make that happen here? Perhaps one might want to figure that out and explain it to the rest of us? It seems that some do know how, and some of us don't. I think it would make the board look better and be more readable? Just my thoughts.


Thank you for your concern. We are working to resolve this issue. Posted Sunday, January 20, 2008 by Janie, former consumer, now a at 01:26 PM

I think we need to honestly answer the following questions:

1. Is there any solid and conclusive evidence that clearly establishes the validity of any major learning or emotional issue or difficulty as indeed being from a "mental illness" that it is in fact a biologically-based "brain disease"?

2. If so: What is it? Where is it? How can parents view a one or two page explanation of it? What about doctors and medical professionals and the government that is being asked to sponsor this theory rather then any preventative type assistance, financial support, or other resources or supports for these families? Why aren't families getting more of the funds then those that are raking the funds in on behalf of them?

3. Is their any reliable evidence for any factual physical diagnostic exam such as a scan or test of the brain, blood, urine, genes, etc that can reliably distinguish children with these diagnoses prior to any type of treatment recommendations especially with psychiatric drugs, from children without these diagnoses.

4. What is the actual evidence for any base-line standards of what a neurochemically balanced "normal" child is versus what a neurochemically imbalanced child is? How are these imbalances being specifically measured for or shown?

5. What evidence is there that any psychotropic drug can actually correct the "chemical imbalance" attributed to the psychiatric diagnoses or medical labels that these children are getting, or that these drugs are any thing more than a non-specific alterer of the physical being of the child?

6. What is the evidence that any mind altering medication can reliably decrease the likelihood of violence or suicide in children with these labels? Has it not been show that in fact it may be just the opposite in some of these kids? What about beliefs or self fullfilling prophecy, how is this being measured for as to how it is affecting the results and outcomes?

7. Hasn't it been proven that no one can in fact determine beforehand how these drugs will affect anyone taking them, especially over a long period of time, physically or any of their behaviors either positively or negatively?

8. Hasn't it in fact been proven that peer pressure via bullying to use drugs and fit in the crowd is one of the biggest reliable indicators as to what a child's behaviors and drug use will be? So isn't this idea that these drugs are the best treatment mainly building patterns for drug use as a cure all or fix, when it is simply a bandaid for control in many cases?

9. If it has been shown that peer pressure leads to one doing more of something or less of it, do we really want to increase the possibility of illicit drug use in our children, drug use that causes even more problems?

10. If this is true isn't it important that we not teach our children to push the use of these medications on each other, give them mixed messages about the use of drugs as to the fact of them making one more normal by using them, not push the use of these drugs as the first line of defense instead of looking for the real causes, and that we start to look at some issues differently?

I think that these questions are important and need to be answered.

Isn't it a fact that the numbers are rising and not dropping of children that are being labeled and treated? Why is that?

Sure some kids might need some extra support and assistance, but labeling them and proposing self fullfilling prophecies on them isn't going to get it, and it isn't going to help, and that is just wrong! Denying them of any truth or feelings that they may have about all that they are going through isn't going to get it either.

Since these treatments often seem to do much more harm then they do good and cause many more of the problems than they are said to alleviate seems to be a problem. Giving children "chemicals" that are full of great possibilities of lifetime physical problems rather then what they actually might need, is very problematic in my eyes.

For generations now of mass societal control there has not been enough to do the right things to assist others even when they ask for the assistance that they may need. They are denied and turned away because that program or that resource or that person isn't available to them, or they are seen as lazy, uncontrollable, and the problem.

If one is conscientious and do their part and look not for, but at the reality and do their job the best they can, one can mostly tell when kids are actually struggling and really need some supports. I have heard many a teacher and professional talk about how frustrated they are because they can not do what actually needs to be done to assist that family or that child to get things right.

I think the biggest issue is "if" the assistance the child needs or their parents actually ask for on their behalf is available or not? To promote theories over reality is never going to be the way to get things right, individuals are all different in some ways and have different needs and often different values and realities to live under, and they have the right to be respected.

I think more parents would feel better about getting assistance for themselves and their children if the systems were different, if there wasn't the threats of removal involved in the system, if there wasn't as much system coercion and force or pushing of it, if it was simply made available with no false shame or blame. None of us are God, and there are no crystal balls, all we have is our best intent. It is not that the family is the village, because each individual family is an individual, but rather that a family lives within a village and the village is an individual as a whole.

Stigmatizing with lifetime labels that do not in fact serve to solve any of the real issues won't change things in any better direction. I think if the children were asked what they actually wanted or thought they needed, then that was in fact considered and respected and was what was done for the children and the families in as much as was possible more kids would ask for the support they need. Scare tactics seem to only scare people off.

I think if confidentiality matters were respected it would be different, if a good thing was available most parents would want it, you would have to start turning them away. I have seen this vision done in respectable ways before, where the people of a community at their leisure and with proper support could decide if they wanted to learn more about parenting and their child's needs.

That takes transportation, child care, sometimes temporary housing or food if it is more then a day or any distance away and things of this nature. Many parents would find that they would learn to and want to promote the right behaviors in caring ways and be voluntarily involved in these type of things. When they can contribute to them and have some ownership over them, they want to make them a better thing for them selves.

In this way they are able to make new friends and support people, share and learn from one another, build hope and support mechanisms, no one looking for the others faults or problems, rather just making new friends, learning on an equal footing as a part of a community, sharing skills and abilities. No one doing it against their will because someone said they had to and it was enjoyable to them, not demeaning.

I think prevention is better then treatment any day, but then you may have to be ready to deal with what you actually find and have the needed resources and supports in place for these kids and their families.

Most parents actually care about their children and what is in their best interest, and they want things to be better or the best that they can be for them. Many parents will even beg for others to assist them in different areas.

That assistance doesn't often happen until after the behaviors or issues being seen become really problematic and then the courts and systems are involved and become overcrowded and unhelpful, and things that parents don't like and don't want are being done to their children and them. This causes tension and mistrust over all and of the system that is supposedly there to protect our families. This is really detrimental to the whole bases of self esteem, a cause of our society being so out of control as a whole.

I think that the concept of prevention, assistance, and support has long since gone by the wayside. Simply because there is never enough money or time or resources to do these types of things it is all being spent on the treatment side of it, and those that might ask for any needed assistance or support are shamed and blamed and turned down and away rather then supported.

I think the system is broken and any mutual support or respect between those that are so called being treated and the ones that are so called treating them is amiss, that is problematic, really it is. One is getting a service and the other is getting paid to provide a service, but how we look at that makes the whole world of difference.

Labeling children with lifetime "brain diseases" and not just seeing the simple or actual problems and issues that are leading to all of this is just the wrong way to go about it! Jails and prisons only make criminals they do not make people feel good about themselves or do better.

So many of our laws now are being based around the ideas that they are making things better. That it is better to use coercion and force via threat of jails or prison then to do prevention and give real care and concern in some mutual ways and that is not helping, it is making things worse over all. Look at the numbers and ask if we know that they are going to increase, shouldn't we know that what is being done now and the way it is being done is not the right way to go about things.

We need some real change, skills finding and sharing, and hope. Posted Sunday, January 20, 2008 by Janie Lee, M.Ed. a former con at 01:17 PM

The increase in drug usage coincides precisely with the anxiety of mental health workers due to their ignorance of what to do with those they are supposed to treat.

When 95% of mental health workers have no idea what the MIND is, how it works, and what needs to be done to properly address conflicts within it... anything will be used to prevent the public from becoming aware of their ignorance. Even if it means frying the brains of children. Posted Saturday, January 19, 2008 by James Patterson, Ph.D., Esogis at 03:46 PM

I think we are seeing many issues with children that didn't exist before. That said, I think we are also not prepared for the art of raising children. The days of extended family and community support are waivering and parents panick when they can't manage their children. Rather then trying nanny 911, they resort to medications. I think behavior modifications, parenting guidance and other means should be tried first. We live in a society that doesn't want to be patient for children to grow up and let them experience their lives, their feelings. And we don't want to bear the burden of saying no. That said, I've seen children from a young age with behavior that was challenging. But have also seen these children change dramatically when they saw a DAN doctor to address food issues, etc. What happens to these kids when they grow up? If we medicate their growing brains, what does that do to them? Posted Friday, January 18, 2008 at 08:27 AM

As a child/adol psychiatric clinician I have a very ambivalent response to articles on the paucity of research on medications in children. On the one hand I would be greatly releaved to see a vibrant discussion in the literature based on many studies on psychopharmacology in children. As a clinician I am a consumer of research and use research as a guide. On the other hand research data is ONLY a guide. To say that I, my patients and their families are helpless in making reasoned decisions regarding medications is insulting and grossly overvaluing of research as a determinant of clinical decisions. Each individual I work with is unique and never fits the "mean" prototype individual data describes. Prescribing is not a cook book formula. Even with the best data a decision to start any medication is a best guess based on research data, the patient's past history with medications, the peculiarities of the patients unique symptom picture, their preferences, the families preferences, ability to adhere to a medication regime, vulnerability to certain kinds of side effects and a host of other factors. In every case a physician is making a best guess as to what medication will be the a fit for an individual patient. There is no way to predict results even with the very best research data. Good clinical work can only be done with frequent contacts, partnering with patients and their families and making frequent refinements in medication plans based on the patients experience. This process is NOT troubling to me as a clinician, it is what I am trained to do. If one attends to one's patient this way the risks of medications for kids are minimal. Medical clinicians are NOT IN A DILEMMA due to lack of research!!! We appreciate research data, but have never been dependent on it. In all aspects of medicine it is rare that research evidence gives us the undisputed answer. Even the protocals like TMAP (a guide to how to incorporate evidence into prescribing) presume that one will have initial successes and failures. So what is the problem as the media continues to raise the alarm regarding children/youth and medications? I think that the emphasis in this article mirrors the hysteria in the public media which causes us to dodge a real issue. That issue is psychiatrists in public agencies and clinics DON'T HAVE THE TIME OR THE INFRASTRUCTURE TO DO NECESSARY FOLLOW UP! What I describe above in my private practice work illustrates that I have the "luxury" of knowing my patient very well. I can take the time to develop a relationship where the patient and their parents are comfortable in sharing what is really going on. Patients so frequently do not get this type of attention even in effeciency driven practices. Despite some sterling exceptions there is no longer any expectation or tradition of psychiatrists being truly incorporated into clinical teams in mental health centers. They are often seeing patients solely reliant on clinical notes that are often non-substantial. Agency files are often designed to meet legal or administrative requirements and do not convey the gist of a clinical encounter. Most psychiatrists are not inclined to "hang out" with the young professionals who inhabit the clinical positions in CMHC's and rarely have any formal consulting roles. They really don't know what is happening with their patient. What we know is that a major percentage of precriptions are not even filled. Many psychiatrist never even will see the patients they started on medications as they will be in deferent jobs by the time the patient returns. Frequently the time to the next appointment is 3 months or longer. It is these types of conditions that make prescribing for children and youth unsafe - or, for that matter, unsafe for adults as well. I wish that these "real" issues would be addressed when the hazards of prescribing for children and youth is discussed. Posted Thursday, January 17, 2008 by Charles Huffine, MD at 11:04 AM

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