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A Review Of America’s Medicated Kids

April 19, 2010

This is a guest post by Chelle Johnson. Chelle blogs here, where this was originally posted earlier today. Thanks to Chelle.

I have long been a fan of Louis Theroux. For me, he is one of the most fascinating journalists out there, and I very much admire his willingness to find the human element in the most controversial or ridiculous of stories and situations. His ability to gently coax stories out paedophiles, murderers, drug addicts and reclusive celebrities alike is incredible, and I have learned a lot about human nature by watching the stories of people who society may otherwise find reprehensible.

The end of his investigations do not always provide conclusions – something which does not always make for good TV – and his more dangerous subjects are not necessarily tackled with the ballsiness of film-makers such as Simon Reeves, but Theroux never fails to widen a debate. As The Guardian’s Euan Ferguson said, “none of his conclusions are glib: often they are simply more questions.”

His latest BBC2 programme, Louis Theroux’s Medicated Kids, aired last night (April 18th), and explored the increasing use of psychoactive drugs to temper children’s behaviour in the USA. Theroux travelled to Pittsburgh, Pennsylvania, where he followed three families with children being treated at the Western Psychiatric Institute, described in the programme as one of America’s “leading treatment institute for children with mental health disorders”.

Like many viewers, I was amazed by the range and strength of medication offered to families, and by the severity of the diagnoses in children. Hugh, 10, had been diagnosed with Asperger’s Syndrome, Bipolar Disorder, Attention Deficit Hyperactivity Disorder (ADHD), and Oppositional Defiant Disorder (ODD). It was impossible for Louis – and so the viewer – to experience the severity of Hugh’s condition without his medication, but his feelings of grandiosity and mood swings were apparent through the filming.

There was no doubt that the boy suffered with Asperger’s, but ADHD? ODD? Was it not possible that his attention deficit could be a part of his Asperger’s diagnosis? Could his defiance and boundary testing not be linked to his desire to control his environment? Were these conditions serious enough – and independent enough from his other illnesses – to warrant a separate course of treatment?

It was unclear as to how far Hugh’s parents, Bob and Barbro, had explored alternative and/or behavioural therapies for dealing with ADHD and ODD before they opted to follow Western’s pharmaceutical suggestions; though Barbro’s admission that even the family dog was on anti-anxiety medication suggested her family was more open to the use of psychoactive drugs than most.

The most surprising case was Jack, who at six had been diagnosed with Obsessive Compulsive Disorder. His doctors explained to Theroux that, now they were beginning to get his condition under control, they were starting to examine him for other conditions such as ADHD and Bipolar disorder. It again seems worrying that a child so young was being considered for such severe disorders without appearing to consider other options – such as placing specific boundaries or using alternative therapies.

Jack’s biggest issue seemed to be his inability to accept failure. Losing a game or activity caused him great anxiety, which translated into violent tantrums that had resulted in his being “kicked out” of school. In an attempt to witness this behaviour, Theroux challenged Jack to a game of marbles and won.

The resulting fit was slightly over the top, but not overtly abnormal for a six-year-old seeking attention. I felt that the strangest element was not necessarily Jack’s behaviour, but his mother’s quick reassurance that this was a good reaction. As Jack threw himself to the floor and bashed his head against the sofa, she said seriously: “he’s taking it really well.”

I don’t suggest for a moment that Jack’s diagnosis is incorrect or unimportant, but I was incredibly surprised by his mother’s apparent reluctance to encourage a more appropriate reaction from her child – rather than use his anxiety as an excuse for behaviour that might lead him to injure himself.

Although we met Jack while he was in a therapy class that used a series of ‘exposures’ to build up his tolerance, viewers did not have the benefit of seeing how these tools could be employed by such a young child in real-life situations, and there was no discussion of the non-prescriptive tools that his parents used in the home.

There are many ways for children and adults with mental health disorders to adapt their approach to situations in order to cope with or minimise the impact of certain conditions on their life, and the majority of people suffering with mental disorders do so wonderfully. It’s something that I feel should be more encouraged.

During my secondary school work experience placement at a Harlow pre-school, one of the children there had problems focusing his attention. He had not been diagnosed with ADD at the time, but his teachers and parents suspected it. I was taught a technique designed for adults with ADHD, which could encourage him to take part in ‘boring’ tasks (such as cleaning and lunch) by alternating between several ‘boring’ and ‘fun’ tasks in ten minute bursts.

It’s a great technique for office work, where you can, for example, spend ten-fifteen minutes writing a report, followed by playing a few games of solitaire before spending ten-fifteen minutes researching for an upcoming paper, and then returning to the original report. This technique is suitable for many people, with ADHD or without (I often use this technique myself when faced with work I don’t want to do).

I believe that skills and techniques like this one are crucial to help equip children for academic and working environments. Monitoring how well such techniques work over time can only help doctors negotiate the right balance between therapeutic and pharmaceutical approaches – and there must be a balance.

Western’s doctors did not make it clear at what point they consider unruly or undesirable behaviour to be ‘pathological’, but it is estimated that 8% of America’s children (5-6 million) are medicated for ADHD (Sinha, G. (2001, June). New evidence about Ritalin: What every parent should know. Popular Science, 48-52.). I find this figure shocking.

I can’t help but question whether, while a child is still developing, psychoactive medication should be anything but the last resort.

Psychoactive drugs are totally different from MMR jabs or cold medicines; they can have extreme effects on the body, mind, and personality. Is it wise to give these drugs to children who, some argue, have not fully developed in any of those areas? Shouldn’t specialist classes/teachers/schools, charity groups, and activities centres be contacted first, if only to discover if there are any ways for children to learn how to interact with their peers more satisfyingly?

As Theroux says, though he came away from the documentary more sympathetic to the plight of the families involved, “…there’s a lot of trial and error and having a mental illness, something like bipolar disorder, is not like having the mumps. You can’t isolate the virus or the bacteria or whatever it is and so, in fact, things like bipolar and schizophrenia blur into one another.”

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