Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary developmental science can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Monday, December 29, 2014

Traumatized Kids Who Were Drugged Offer Lessons for Mental Health Care

Extensive use of psychiatric medication for children in foster care offers a striking example of childism,  or societal prejudice against children.  A powerful five part film “Drugging Our Kids  by Dai Sugano and Karen De Sa documents this issue in a thorough and dramatic way, using interviews with young adults who were in the foster care system, some from as early as 2 years of age. They were  labeled with every psychiatric diagnosis under the sun, when really what they were suffering from was trauma and loss. After experiencing physical, sexual and emotional abuse, they were on multiple psychiatric medications for many years. With the help of a range of individuals who saw through the haze of drug effects to who they really were, those interviewed for the documentary were able to get off all medications.   In a segment entitled “Treatment for a Broken Heart is Not Another Medication,” child psychiatrist David Arendondo says, “The first line treatment not another medication. It is to understand, to listen to the child, to ask, ‘what’s going on, why are you sad in this way?’”

The film offers an even-handed approach, acknowledging that psychiatric medication can help children access other form of therapy, and in certain circumstances be lifesaving. But, they point out, most often that is not the way these medications are used. Many kids in foster care are on multiple powerful medications as their primary treatment, with new ones added whenever there is an escalation in “problem behavior.” Arendondo points to the fact that we do not know the long-term effects of these medications on the developing brain. But at the very least, large quantities of medication “blunt the developmental process.”


Many clinicians interviewed for the documentary describe how psychiatric medications are used as  “chemical restraint” to control a child’s behavior. Another way to describe this phenomenon is a silencing of children. Angry, out-of-control behavior is a form of communication. It says, “ I have never learned to manage my feelings. I have never been held in a loving and safe relationship.” Medication silences that communication.

The film points to the critical role of relationships and creativity in healing. DAnthony, a child in the foster care system whose development took a different path in large part through a relationship with a volunteer,  describes the role of music in his life. “Music keeps me out of trouble. I take anger and make music.” Anna Johnson, a health policy analyst interviewed for the piece, speaks of the therapeutic value of forms of self-expression like music, dance and yoga. She describes “creativity as therapy” helping children to process trauma and connect with others who may have had similar experiences. DAnthony's words exemplify this idea; “Music is about being better, being somebody.” 
The children in these stories have experienced Trauma with a capital "T." However, many children who are similarly diagnosed with psychiatric illness and medicated with psychiatric drugs have trauma in their history.  The CDC sponsored ACES Study offers extensive evidence that a range adverse childhood experiences including not only frank abuse and neglect, but also parental mental illness,  separation and divorce, substance abuse, and domestic violence are highly associated with a range of negative outcomes in both physical and mental health. 

These cumulative experiences are a kind of trauma with a small "t," more ubiquitous than frank physical and sexual abuse.   When we diagnose and medicate, without offering time and space for listening to stories, for healing through human connection and creativity, we are doing something quite similar to what was done to these foster care children, but in a more subtle and pervasive way. 
There is urgency to the problem of medicating children in foster care.  Many of these kids are on large numbers and high doses of medication that are interfering with the course of their development. However, the mental health care system urgently needs to be fixed not only for these most vulnerable kids, but also for the huge numbers of kids experiencing trauma with a small "t." Time for listening, time for creativity, time for meaningful human connection needs to be not optional, not an extra, but rather the cornerstone of our mental health care system. 

3 comments:

  1. It is not just the mental health system that has to change, but the education system. Children who have experienced both Trauma or trauma, are referred to mental health because of their behavior in school. Treatment is to meet the educators' needs, not the child or the family. Many hands get tied that way. If medication is postponed with therapy only, and the behavior doesn't improve quickly enough, the child is at risk of placement anyway.......Our major public institution where children spend most of their days, is not equipped to respond to symptoms that manifest as behaviors. Everything is labeled defiance and treated with punishment. It is a tragedy of epic proportion.

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    1. I agree. "Disciplinary" methods may be frightening and dysregulating for children who have experienced trauma. Psychiatrist Bruce Perry's writing on the Scholastic website, particularly a piece "Keep the Cool in School" speaks to this issue.

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  2. Doctors need to assume FIRST that a child with a problem was born healthy and is experiencing trauma, than assume something has gone wrong with their brain from birth. Once trauma has been ruled out, THEN a doctor should prescribe medicines.

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