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Don’t Blame the Drugs, Blame the Doctors

CC Alec Couros
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Though they are overused, some children do need psychiatric drugs

The verdict of the press is in, and it does not favor psychiatric drugs for children. Perhaps they should be banished, many suggest. The ills caused by these drugs, critics say, are legion. They include side effects from highly potent and often unnecessary medications with harmful side effects given to angry children, where the cause of the anger is in the environment and can be changed.

Medicines for attention deficit disorder receive vast criticism. Many are basically a form of amphetamines, an old standby of long-haul truckers and baseball players of decades ago. When given to children, do these drugs dispose the youngsters to more frequent drug addictions in adolescence and beyond? Do they harm growing bodies? They are even sold to students taking high-stakes tests such as the SAT.

Anti-depressant medications known as Selective Serotonin Reuptake Inhibitors have even received a warning on the label called a black-box warning. This cautions that suicidal thoughts/plans may be more frequent in children and teens who are prescribed these drugs.

Yet those clinicians, such as myself, who have worked with a wide range of children, sadly learn that mental illness in children does exist. Sometimes it can't be talked away, nor can environmental changes and positive reinforcements bring back psychological health and wholeness. Sometimes it even causes death. Effects of psychiatric illness often reverberates throughout the family.

It is time to look, not just at the drugs themselves, but at the professional persons who are prescribing them. The gold standard of treatment is a Board-Certified Child and Adolescent Psychiatrist. To obtain this specialty, a doctor must first take a residency in adult psychiatry, and then another one working with children and teens. There are only about 1,000 Board Certified Child Psychiatrists in the country.

These specialists have seen the wide range of problems in children–many not requiring medication, such as acting-out and defiance, a result of marital dysfunction or alcoholism in the family. For these, the problem is not the child, but rather people in the child's environment. Similar problems can occur when a child's learning style does not match his or her teachers's, or the predominant educational fad of a given year. Relief from these problems does not occur by prescribing medication for children, unless there is also a psychiatric condition present. A very difficult kind of assessment.

Minor and even moderate cases of depression and/or anxiety can often be helped with cognitive behavioral therapy–a talk/behavior therapy helping the child reduce the kind of negative thinking that can pull one down. There can be homework assignments between sessions, and adults within the child's life can be helped to modify expectations and the manner in which they relate to the child. Within the Old Testament, Saul's depression was lessened by David's music (1Sam 16:16-19), and music therapy continues to be one form of help for those with depression and other conditions.

The vast majority of mental health professionals who see these children and who prescribe medication are not child psychiatrists but rather general doctors, pediatricians, adult-trained psychiatrists, physicians assistants, and nurse practitioners. A few of these may have attained the depth of experience of a board certified child psychiatrist. But in most cases this training and experience are lacking, so in many cases medication is prescribed when it shouldn't be, or side effects can't be diligently and adequately monitored. It is true–many children are medicated when they shouldn't be.

This is also true: many children who need medication do not receive it or they do not receive it in proper dosage. Situations involving severe depression are one instance. Moderate to severe obsessive compulsive disorder is another one. Although attention deficit disorder may be over-diagnosed, it does exist, and it would be cruel to withhold this from a child after all other options have been tried. In fact, withholding of such medical treatment when it it truly needed can come into the realm of child neglect laws in many states.

Many times getting to a board-certifed child psychiatrist will require a trip. The fee many not be covered by insurance, and it may be hefty. (Yet professionals note many families even balk about a co-payment–all the while discussing the last vacation to Disney World or driving up in a new and expensive car or SUV).

Mental illness in children is a serious illness. As do other medical illnesses, it may require the services of an experienced specialist, and treatment may be intense and costly. Would we want someone of lesser qualifications operating on children? Or handling a complex orthopedic situation? Sacrifices may have to be made.

As noted, there are other professionals with the practical experience and competence to prescribe psychiatric medications for children. You might have to search for one of these persons. Or, one of these may be your pediatrician.

There may be religious issues as well. Using the right medication after a careful assessment is made by an experienced professional may be a blessing. Bishop Howard J. Hubbard, Ordinary of Albany, NY, had this to say about medications for obsessive compulsive disorder, and I think his words apply to the topic we have been examining:

"Emotional and psychiatric problems can be due to a causation that is beyond one's ability to control by the will, but can be assisted either through drug therapy or drug treatment of these, I think these therapies are not only acceptable, but are actually something very good, and it should be seen as one of God's gifts to humanity that we now have resources like this available."

The key is finding a medical professional with the right background and training, not blaming the drugs in a knee-jerk reaction.

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