When statistics regarding the significant
rise in prescribing of antidepressant and
antipsychotic medication for
children under age 2 made its way into a New York Times article, the outpouring of
comments revealed an understandable outrage. World-renowned child development researcher Ed
Tronick, who was quoted in the article, accurately summed things up with his
comment, "it's just nuts." Efforts were made to figure
out where blame for this clearly unacceptable situation lies. Is it
big Pharma? Is it the doctors who write the prescriptions? Is it teachers who
pressure doctors to medicate? Or perhaps parents who beg doctors for help?
Interestingly
my colleagues and I from Tronick's InfantParent Mental Health Post Graduate Certificate program were at
the time having a conversation about the non-productive, and possibly
destructive notion of assigning blame. When people feel blamed they become
defensive and shut down. They stop listening.
In
Tronick's program, individuals from a wide range of disciplines come together
to learn about current research in supporting healthy development of
the brains and minds of our youngest members of society. We learn
the tremendous value of listening with curiosity. This kind of listening
promotes development of emotional regulation, social adaptation, and overall
mental health.
Fellows
who participate in this program - there are now going
on five generations of the Boston-based program and many more from
its California-based
counterpart- are all well versed in the wealth
of evidence-based treatments, other than psychiatric medication, available to help
struggling young children and their families. We all look hopefully to the day
when these treatments are the standard of care.
The
reasons these prescriptions are written for very young children are
far-reaching and complex. Explanation requires space well beyond
a comment on an article, or even a blog post. In my new book The Silenced Child: From Labels, Medications, and Quick-Fix Solutions to Listening, Growth, and Lifelong Resilience I offer
evidence that listening grows healthy brains and minds. I call attention
to the convergence of social forces that have let medication
replace listening.
It
is likely that each individual clinician who writes a prescription for an
antidepressant or antipsychotic for a child under 2, while certainly
misguided, is sincerely interested in helping that child. Parents
often feel overwhelmed and desperate to help their children. Accepting a
prescription makes sense in the absence of other options.
Aggressive
marketing by the pharmaceutical
industry, along with publication in medical journals of research funded by
drug companies, has a role to play. A powerful health insurance
industry that does not reimburse for time spent listening contributes to
the problem. The complexity of the health insurance industry including,
for example, enormous effort needed to obtain "prior
authorization" for a range of treatments, restricts the amount of time
primary care clinicians can spend listening. The shortage of
qualified mental health professionals who offer this kind of listening is
intimately intertwined with our condoning of medication as the primary
treatment, without protecting time for listening.
The
prevailing medical model of disease and the DSM system- the status quo in
mental health care- work against listening. This system looks to name a
problem and then eliminate it, without opportunity to discover its cause.
It places the "problem" squarely in the child, without consideration
of the relational and social context. Due to factors in the medical education system,
most psychiatrists and primary care doctors who prescribe these medications are
not aware of the rapidly expanding research and knowledge in the discipline of infant mental health.
Forces
in the early childhood education system put tremendous pressures on
teachers. They may be faced with classes of 20-30 children, and
have minimal training or support in working with children with
problems of behavioral and emotional regulation. Preserving safety of the
classroom is a legitimate priority, and one of the reasons teachers recommend
medication.
Behavior
is a form of communication. Medication can silence that communication.
Until we place a renewed value on protecting time for listening, we
will continue to see an increase in this kind of prescribing. In effect we
will be silencing the voices of the youngest members of our society.
