a dis-ease of childhood is not necessarily a Disease of Childhood…

Posted on Sunday 31 March 2013

A disease called ‘childhood’
New York Post
March 31, 2013

Last week, The Post reported that more than 145,000 city children struggle with mental illness or other emotional problems. That estimate, courtesy of New York’s Health Department, equals an amazing 1 in 5 kids. Could that possibly be true?

There is nothing tougher in psychiatry than accurately diagnosing a mental disorder in a pre-teenager. It is so easy to make mistakes both ways — to miss problems that desperately need attention and to attend to problems that are better left alone. Getting the right diagnosis and predicting its future course is especially difficult in kids because their symptoms have such a short track record and are often heavily influenced by transient factors like developmental differences: family, school and peer stress; and the use of drugs. It usually takes a while before an illness declares itself — and often, it turns out that no diagnosis is necessary because the symptoms go away without intervention…

Human nature just doesn’t change that quickly, but the labels follow fashion and can escalate dramatically without there being an actual increase in symptoms. Our kids haven’t suddenly become sicker, it’s just that diagnoses are applied to them more loosely. Some of the broadening usefully captures missed cases, but there has been a big overshoot because of aggressive drug-company advertising. Once the adult market was saturated, pharmaceutical manufacturers turned their greedy attention to kids and began a sometimes illegal campaign to convince doctors, parents and teachers that every childhood problem is a mental disorder, the result of a chemical imbalance that requires a pill solution. Medication use in children has skyrocketed — great news for the shareholders, but potentially quite dangerous for the children.

The biggest offenders are antipsychotic drugs, which cause an average 12-pound weight gain in just 12 weeks in kids who started out weighing 110 pounds. Childhood obesity is a strong predictor of diabetes, heart disease, and perhaps a shortened lifespan. The companies have been fined billions of dollars for marketing practices that especially impacted the most economically disadvantaged and socially vulnerable children…

Parents and clinicians need to accept that there is no evidence to support the effectiveness of preventive psychiatry for children with mild or equivocal symptoms. There is considerable risk that well meaning but premature interventions can cause stigma and excessive medication treatment. Watchful waiting, simple advice, and reduction in stress are better than jumping in with inaccurate diagnosis and excessive treatment, whenever a diagnosis is in doubt.

Perhaps most troubling about all this is how it is changing the definition of normal behavior. Is a kid who is more interested in playing outside than sitting in a classroom suffering from ADD — or simply 7 years old? Is a child who slams his bedroom door and refuses to come to supper suffering from depression — or having a tantrum? We should not medicalize the aches and pains of normal childhood.
"Parents and clinicians need to accept that there is no evidence to support the effectiveness of preventive psychiatry for children with mild or equivocal symptoms." I posted this article for that single sentence. There are essentially two medical models of disease. The medical model proper holds that signs and symptoms are the observable phenomena that indicate the presence if a cause [a disease], and the medical injunction is to treat the disease if possible. Symptomatic treatment is a secondary adjunctive treatment – not the front line. The second model is the preventive model, keeping the disease from either starting or worsening – something that requires some notion of causality. So, immunization prevents a disease producing organism from causing adisease. Even though we don’t know for sure how smoking causes cancer, we do know that it’s causative, some anti-smoking campaigns are preventive medicine. Preventive measures are not aimed at symptoms. They’re aimed at causes.

So what would preventive psychiatry be? We know sexual trauma causes PTSD [and other things]. So preventing childhood sexual abuse is preventive psychiatry. Is treating ADHD preventive psychiatry? Yes, if the kid really has it. But it’s got very fuzzy borders with just plain childhood, and that border has been massively extended into the range of "children with mild or equivocal symptoms." Is there any evidence that using medications to control behavior [Conduct Disorder, Disruptive Mood Dysregulation Disorder, Pediatric Bipolar Disorder] prevents anything? I don’t know of any such evidence. Do medications treat a cause? I know of no such evidence. It is a symptomatic treatment given to help parents or caretakers, not the children themselves – so it fits neither model. Is it possible that 1 in 5 children in New York has a mental illness of some sort? That flies in the face of common sense and scientific reality.

One of the clearest and most basic ideas in our understanding of childhood is usually attributed to Erik Erikson – that children develop through a series of stages characterized by developmental crises – normative developmental crises. I know of no refutation of this very useful concept. Childhood just isn’t easy. There’s plenty of dis-ease along the way. That’s not only normal, it’s a required part of building a personality structure that’s suited to the challenges of adult life. The oppositional two year old isn’t sick, he’s negotiating with the universe about who is in charge. The homework averse fourth grader isn’t lazy or depressed, she’s working out a building block towards the persona she’ll later take into the world.. Developmental crises are uncomfortable for children and parents alike. But the discomfort is in the service of a higher cause – not necessarily an object for diagnosis or treatment.

To play on Dr. Frances’ title, a dis-ease of childhood is not necessarily a Disease of Childhood. And medicating the dis-ease my well be a cause of future Disease unto itself. Plenty of families need help with these childhood negotiatons, but symptomatic treatments aimed at the discomforts and dis-eases are often well off the mark. This is an area where the descriptive system of our diagnoses is in mighty big trouble – childhood and child development.
    March 31, 2013 | 7:28 PM

    Kids might not have gotten “sicker,” but I would venture to guess that more of them are less “well-behaved” than they were a generation or two ago. Whether you attribute that to increased single parenting, the rise of narcissism, decreased physical disciplining, decreased socialization from increased time in front of screens, or some other cause, it certainly is a real phenomenon.

    Unfortunately, the response has been to pathologize (a.k.a. “bipolarize”) the children and medicate them with antipsychotics, rather than to educate and help parents become better at handling their kids’ behavior.

    March 31, 2013 | 8:20 PM

    It appears that on the whole the system is doing too little to address the more obvious causes of disturbances, before blaming “patients” as being hopelessly faulty according to an increasingly narrow definition of normality.

    Adolescence is a biologically chaotic time, and as a class, adolescents spend most of their time immersed in a high school culture in which they are surrounded by their biologically chaotic peers with few adult role models.

    Adolescents are also targets for marketers of products and trends that feed on teen angst and the identity confusion that is inherent in being a child becoming an adult by trying to convince them that they are more adult than they are.

    Routinely undermining young people’s agency before they understand what that is hobbling a generation. I have no doubt that there are children and teenagers who do suffer from mental/emotional pain significant enough to warrant intervention; but not investigating social neglect/abuse as a cause is just blaming the victim— piling on as an oppressor.

    April 1, 2013 | 2:40 AM
    April 1, 2013 | 2:46 AM
    berit bj
    April 1, 2013 | 4:00 AM

    Children behave as children, “symptoms” of childhood that tamed, dull, conventional adults dislike and may seek tamed, dull, conventional doctors for advice, to have normally behaving/reacting offspring diagnosed and “treated” so as to have them tamed, dulled, conventional … iatrogenically damaged, dead too, at five … I’ve read one carefully worded article in The Psychiatric Times, volume Volume 29, number 3, February 28th, 2012, by doctors Stacy S Drury and Mary Margaret Gleason: A Delicate Brain: Ethical and Practical Considerations for the use of Medications in Very Young Children

    berit bj
    April 1, 2013 | 4:28 AM

    I am at loss for words … it’s barbaric … medicating children for being childlike, medicating young people for being unfinished, uncertain, anxious, all over the place in adolescence, medicating grief after losses of innocence, love, lives, anger is a visceral, normal, necessary reaction to harness the energy necessary to effect practical, political changes. Revolution is what we need and the world. Revolution in mentality, in practice, in government.

    April 1, 2013 | 5:16 AM

    1BOM, Think I exceeded the link limit in the comment above. Please allow comment to post.

    April 1, 2013 | 8:59 PM

    Medicine, Psychiatry, and the Pharmaceutical Industry’s unapologetic attack upon childhood has run completely out of control. Now 1 in 5 teenage boys diagnosed are with ADHD. 11% of all school aged children….That’s not only insane…it is without a single doubt a horrible crime being perpetrated against our very humanity…

    Our society has become so apathetic, lost, and blinded to the even simplest & basic principles of truth & concerns for are fellow man; that they are willing to accept even these diagnostic torture absurdities as a norm & truth. It’s sad & beyond words, beyond going back, & quite possibly beyond a correction. Evil Reins….We all will justly reap what we have sewn….


    April 9, 2013 | 7:07 PM

    Amen, Stan and berit bj. “Help” means being told you are “mentally ill” — unfit, defective, and just “other”. And the reason children and teens end up needing help? Because their families have failed them. In my case, I was reduced, stripped of my dignity by my negative family. My parents and I then turned to the “experts” in our desperation and in the name of “helping” those experts labeled me with more than one “mental illness” -placing the nails in my coffin, shattering my world, sentencing me to life in prison for a crime I didn’t commit. I was a straight-A student who wanted to save the world. What I got in exchange for my hard work, my compassion for those in faraway countries, and my lofty ambitions was to be deemed utterly screwed up. Oh, and while they were calling me mentally ill out of one side of their mouth, out of the other side they were telling me I had a problem with “low self-esteem.” Um, how is my self-esteem supposed to improve if my society has just told me that my struggles are essentially caused by defects within myself and not by being born into a completely screwed-up family in a completely screwed-up world?

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