Monday, February 23, 2015

Are Toddlers Taking Too Many Drugs? Fear-Mongering by the WSJ and NYT.

I'm way up on my soap box here, but I can't leave this without comment.I just read this load posted on a friend's facebook. My friend is awesome, and very smart. I suspect it was a knee-jerk that made her post this with a "what the what?" comment.

First of all, CCHR (the org that performed the analysis cited by WSJ in paragraph two of the above link) is a Scientology front group. This organization would naturally attempt to frighten the public into further distrust of the psychiatric field, due to its anti-psychology, pro-Scientology auditing/tech faith.

Second, if you skip the CCHR "analysis" and read the NY Times article cited in the WSJ blog post, it becomes clear what the real issue is, and it is an issue of privilege and lack of public funding for programs supporting low-income, high-risk families: children on Medicaid, our poorest, least privileged children, and those most likely to be victims of abuse and/or living in unstable homes, are being prescribed these medications at much higher numbers than children with private insurance, who are most often more privileged and in more stable homes than children on Medicaid, and are more likely to receive treatment and support that does not include medication.

Third, the article claims an extrapolated number of 10,000 toddlers on Medicaid nationwide being prescribed stimulant medications. Considering that there are approximately 25 million toddlers in the United States, that means ~.04% of toddlers total. Not as scary as the article and the "analysis" would have us think, though it does point out problems in our health and human services system that should be addressed, namely the need for behavioral training and support (and not just medical care support and early intervention programs, but also requirements for affordable quality daycare, paid time-off, adequate paid sick leave, etc.) for parents, as well as for caregivers and doctors who provide that support to the low-income, high-risk children. From the article: "Dr. Visser said that effective nonpharmacological treatments, such as teaching parents and day care workers to provide more structured environments for such children, were often ignored."

A personal anecdote might illustrate the problems parents face today that might encourage them to allow their children to be prescribed ADHD medications without trying other things first. We were fortunate when our premature triplets were born to have an excellent state-funded early childhood intervention program that provided a developmental specialist weekly, an occupational therapist and physical therapist bi-weekly, respite care at a hugely discounted rate weekly, and, at age three, state-funded preschool programs with excellent and highly qualified teachers. Developmental problems were discovered and addressed immediately with the latest ideas and techniques; we were trained, encouraged, and supported in doing what needed to be done to help get our children up to speed from a very early age; we were allowed respite from caring for our very high-maintenance children for a few hours each week, which saved our own mental health.

Over the years since then, funding for all of these programs has dried up and the early intervention program we received so much from has shrunk from that lack. There is a huge waiting list for services. The program depends more on dwindling private donations now than it can count on from state or federal grants or funds. The children on the waiting list are often living in low-income, high-risk households and neither they nor their parents or caregivers are receiving any of the help, training, teaching, or support that my family received 12 years ago. Nor do most of them have access to high-quality medical care and neuropsychology and PT/OT specialists that we were able to use for evaluation and diagnosis once our children grew out of the state-funded programs, thanks to our excellent private insurance.

Even without the additional challenges of parenting in a chaotic or violent household, when a low-income parent has to choose between staying home with his or her impulsive or aggressive child who can't get into a quality daycare because of behavior issues and medicating the child so the parent can earn a paycheck to keep the heat on and food on the table, the choice is pretty clear.

This WSJ blog post seems irresponsible to me, and is simply fear-mongering without either pinpointing the actual problem or suggesting possible solutions. Nor does it provide citation for some of its claims, such as the sharp rise in anti-psychotic drugs for infants and very young children. Some sort of citation might help us figure out if that is actually the case and if there is some reason for that rise. The NY Times article cited by the WSJ isn't much better, although you *can* at least see the actual problem isn't the medication of the toddlers, but the underlying reasons why parents might fall back on medication in the first place. The "analysis" by CCHR is not trustworthy at all and should not even be considered.

If you want to help families with children experiencing challenges that can often be managed in ways other than medicating, consider contributing to a local organization that provides services and support to low-income families with toddlers or to families with developmentally delayed children. Any pediatrician can give you a name. Also bug your state representatives, your US representatives, and your senators to encourage them to increase funding to these types of organization and to work to make it easier for families to do what is best for their children while working to keep them fed, housed, clothed, and healthy.

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