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Monday, 28 July 2014

PRACTICAL PROTOCOL FOR PSYCHOLOGISTS TO PROFESSIONALLY CHALLENGE MEDICAL PRACTITIONERS WHERE THEY HAVE CONCERNS ABOUT THE OVER-PRESCRIBING OF PSYCHOTROPICS TO CONTROL BEHAVIOUR IN CHILDREN - by Dave Traxson, Chartered Educational Psychologist.

Dave Traxson, Chartered Educational Psychologist.


PRACTICAL PROTOCOL FOR PSYCHOLOGISTS TO PROFESSIONALLY CHALLENGE MEDICAL PRACTICE THEY HAVE CONCERNS ABOUT WITH THE OVER-PRESCRIBING PSYCHOTROPICS
TO CONTROL BEHAVIOUR.

Psychologists as members of the Health Care Professions Council in the U.K. have the 'ETHICAL LEGITIMACY ' to challenge medics when we have a concern about the mental health and wellbeing of a young person with whom they jointly work.

This is provided by the HCPC Code of Conduct which states, "You must not do anything, or allow someone else to do anything, that you have good reason to believe will put the health and safety of a service user in danger. This includes your own actions and those of other people. You should take appropriate action to protect the rights of children and vulnerable adults if you believe they are at risk."
(Page 8 of the HCPC's 'Standards of Conduct. Performance and Ethics - your duties as a registrant.')

The way that many concerned EPs are doing this around the country is to ring the medic who is involved in writing the prescription,which is usually a Child Psychiatrist or Community Paediatrician and giving them some feedback about their level of concern, which may fall into one of the following:

- PRESCRIBING PSYCHOTROPIC DRUGS TO UNDER FIVE YEAR OLDS IS TOTALLY AGAINST NICE GUIDELEINES AND CONDEMNED BY NICE SPOKESMAN PROFESSOR TIM KENDALL BUT IS STILL COMMONPLACE IN THE U.K. (150+ cases alone in the West Midlands from an informal survey of psychologists.)

- behaviour pattern for which the child is being given drugs is not apparent in school to staff or EP( so there is no triangulation of data as NICE recommends)
- no 'Drug Holiday' has been given for an extended period of time which is another clear breach of NICE guidelines.
- severe side effects are resulting from the drug regimen which are causing concern to staff in school and their EP e.g. tremors, loss of appetite or lethargy.
- concerns about the 'drug cocktail' a child is on i.e. the combination of drugs may be 'life threatening.' (Pharmacists can intervene in these cases and have in a reported number of cases)
  • adverse drug effects of sleep disturbance and weight loss which are having an adverse psychological and/or physical impact.
  • sudden collapse in school which results in hospitalisation (not as rare as might be thought - two occurred in one small area of the West Midlands in 12 months)
  • concern amongst professionals that parents are reporting behaviours to access Disabled Living Allowance at medium or high rate.(£300 or £600 per month respectively)
  • acute anxiety is a contra-indicator to using psychostimulants, as we know anxiety is very common in children who present with behavioural difficulties.Also if the psychostimulants do the job they are designed to do the child will have an awful nights sleep and certainly be anxious the next day, as all parents know, which continues a vicious cycle.





SO WHAT DO WE DO IN THESE CASES?

-Simply ring and share your professional concerns with the medical colleague. This is a basic protocol to: 
SAFEGUARD CHILDREN FROM POTENTIAL HARM DUE TO POTENTIALLY TOXIC DRUGS.

WHAT IS THE RESULT?
-They invariably thank you for taking the time to ring them to share your concerns / information and they consequently review the medication.

THIS IS A SIMPLE AND EFFECTIVE PROCEDURE WHICH BETTER SAFEGUARDS THE CHILD.

PLEASE CIRCULATE THIS TO TEAMS PLEASE AN CONTINUE THE PROGRESS OUR PROFESSION IS ACHIEVING COLLECTIVELY AND NATIONALLY- THANK YOU.



These guidelines were collated by Dave Traxson, Chartered Educational Psychologist and Member of the Division of Child and Educational Psycholgists' (BPS) national committee.

Sunday, 20 July 2014

Cultural Amelioration of Negative Social Constructs of Difference – in the Context of Holistic Psychological Formulation - a new Opinion Piece by Dave Traxson



https://www.linkedin.com/today/post/article/20140720202539-126658618-the-cultural-amelioration-of-negative-social-constructs-of-difference


The Cultural Amelioration of Negative Social Constructs of Difference –
in the Context of Holistic Psychological Formulation.

“A negative focus on difference damages an individual human being’s ability to make relative progress in a range of important skill areas.”

Reframing negative constructs of difference to being more positive manifestations of a human being's right to individuality, creativity, and potentiality is a process that is well under way in society but there is still along way to go. Aprocryphal tales abound of young people whose special talents were missed by the adults around them including educators and then suddenly when unleashed led to a transformational levels of progress. One of my own, is a young woman who was two days away from permanent exclusion as a fifteen year old, when I asked an obvious question about what she could see herself doing in her mid-twenties. Without hesitation she said, “ I am going to be a semi-professional footballer and a car mechanic.” No one in the circle of professionals and parents, including the careers guidance officer, knew that, but when the necessary curriculum adjustments were made to achieve this, she thrived and even stayed on to the sixth form to improve her chances further. We also noted profoundly that she was co-operating previously in all subjects that, she could see, related to her ambition and was not co-operating in subjects that she could not see the relevance of , in achieving her clear goals.

It seems that there may have always been a part of the human condition that fears and often demonises difference in others compared to ourselves. This may have had a Social Darwinistic function for protection, to ensure that ideas and values of our own particular closed subgroup survive and even thrive.

The problem and question for us all is, can this be challenged and can tolerance of social variation 'genes' be woven intentionally into our collective values DNA?

I am optimistic that they can be and already the 'radiation' of ideas from the recent inclusion agenda, that have been emerging for the last thirty years, indicates that a dramatic evolution of societal values can occur e.g. the Tsunami of change occuring in front of our eyes with the massively improved tolerance and understanding of same sex relationships and the consequent legislative changes.

So what if we learn from this journey and apply the same 'selective pressure' to wider areas of intolerance to difference such as mental health or as 'medical modellers' would prefer, mental illness. If we can choose and promote a more socially and psychologically inclusive perspective on the normal range of human behaviours, that we mainly work with, then just imagine the long term benefits to us all:

  • less stigmatisation of children and subsequently adults.
  • many more people feeling a gteeater sense of belonging.
  • a massive reduction in the pathologisation of normality.
  • subsequent reduction to the costs of labelling for society.
  • a massive gain in individual and collective self-esteem.
  • empowerment of people with 'ups and downs' to succeed.
  • and a huge improvement in our collective Wellbeing.
  • And last but not least massive savings in NHS costs.















The acronym below tries to convey some of the key principles of ameliorating difference as a discriminatory construct:


D-ifference is beneficial to the community in which we live
I-ndividuality should be highly valued in schools and society
V-alidate childrens’ unique contributions to empower inner creativity
E-xpect relative progress by caring target setting and feedback
R-eview the progress achieved regularly and reinforce creativity
S-afety and security are fundamental to mobilising creativity
I-nclusive ethos promotes the value and benefits of diversity
T-reat all childrens’ strengths and abilities as being equal in status
'Y-ou are important and deserve personalised planning and outcomes.'

Schools as institutions are driven by uniformity and not creativity based on the wonderfully different skill sets individuals. Sir Ken Robinson in one of his seminal TED TALKS entitled “Schools kill creativity,”(2006 on Youtube) takes this argument to a logical conclusion. To progress successfully into a twenty first century of rapid change and challenge we need to discover the ‘Gold Nuggets’ of creativity that exist in everyone and maximise their abilty to follow their heart and soul in becoming a dancer, artist, sculptor, poet sportsperson or entrepreneur all of which are not as highly valued in our Education System as Maths, Science and English skills.

Cultural amelioration of difference is the systemically valued driver of wanting a school that you work in to collectively promote the importance of the unique human contributions that all children can make to any aspect of a hugely broad menu of curricular pursuits.

It is based on a triad of Ethos/Beliefs driving change in Actions/ Behaviour which in turn promotes collective Emotional Wellbeing/Mental Health.

The 5 Ms of Cultural Amelioration of Difference are :

  1. Moderate the use of labels of disability/disorder based on ‘Medical Model’ thinking.
  2. Modify educational programmes to allow a ‘Punctuation of the Day’ with creative activities that a young person demonstrably enjoys and engages fully in as a healthy learning process that promotes coping and resilience.
  3. Manage the individual’s needs /wants and the necessary resources to release their inner creative energies.
  4. Make appropriate adjustments to achieve success.
  5. Mollify conflict and prejudice against certain creative activities.

“Deliberately demoting difference effects can maximise the normalisation of childrens’ responses, as strengths and not difficulties.”

The ‘Medical Model” promotes ‘within child’ explanations of difficulty whereas the ‘Social Model’ promotes a holistic understanding of causation and possibilities for positive change. We as professionals are duty bound to see and recognise the rich palette of colourful skills as capacities, strengths and contributions which can enrich the sometimes apparent dullness of our communities and society as a whole.

Psychiatry applies the Medical Model conceptualisations to mental distress and anxiety whereas the new field of Psychological Formulation expounds an optimistic approach that maps the ‘Ordnance Survey Map’ of a young human being’s multi-various attributes, potentials, personality variables, interests and strengths and plots them in a way can help them determine the exciting journey that they are keen to embark on.

What is important is not to focus on arbitrary and prejudicial labels that are proliferating currently but to understand the complex web of interactions that results in an individual's mental distress. Understanding the interactive nature of a person's difficulties is a more progressive and inclusive way of finding how we can help them to succeed fully in an evermore complex world.



Reducing the continuous focus on difference and threat,that we see daily in our chosen media, axiomatically helps us to realise how similar we are and by focussing more on our 'common ground' we will develop the humanistic potentials of all individuals in our improved societies.

In essence creativity at all levels is the vibrant solution to our current shared ills and appreciating uniqueness and difference is the shared vehicle for progress.






Saturday, 12 July 2014

FIDDAMAN BLOG: Two Boys, Two Suicides, One Antidepressant.

FIDDAMAN BLOG: Two Boys, Two Suicides, One Antidepressant.: Two inquests looking into the deaths of two 14 year-old boys bear striking similarities that should be a stark warning to all parents......

Friday, 11 July 2014

“Medicalisation of Normality”, the new leader of Britain’s psychiatrists has declared. COURTESY OF THE TIMES WEBSITE



http://www.thetimes.co.uk/tto/health/news/article4125848.ece

Last updated at 12:01AM, June 21 2014


Middle-class parents and teachers are pressing doctors to label children as mentally ill in a worrying “medicalisation of normality”, the new leader of Britain’s psychiatrists has declared.

 Drugs such as Ritalin and Prozac have been massively abused because of the desire to label problems as medical disorders, said Professor Sir Simon Wessely, who takes over as president of the Royal College of Psychiatrists next week.

Huge rises in the use of antidepressants and drugs to treat attention deficit hyperactivity disorder (ADHD) show that they are being given too freely in response to social pressure and not to those who could really benefit, he said.
Professor Wessely also criticised the prejudice against mental health among other doctors, adding: “You could not have designed a health service less able to join up mind and body, physical and mental, than the health service that we’ve had in the past 20 or 30 years.”
The use of ADHD drugs has tripled in a decade and the use of antidepressants has doubled. Professor Wessely said that this was unlikely to be explained purely by more disease or better detection.
“Medicalisation is not often done by doctors. In areas that are more accessible to public debate it’s almost the other way around. Now we see a huge rise in support groups, we see pressure brought to bear to bring in labels,” he said.
“Certain behaviours carry stigma and there’s less stigma if it’s associated with a disorder. Often it’s about the avoidance of guilt. You get obvious pressure from parents: we’ve all been to middle-class dinner parties where so many parents seem to say their kids are mildly autistic and yet they’ve just got into Oxford. And you think, ‘I don’t really buy that one’ . . . It’s interesting that many of these disorders are more common in the private sector of education.”
He added: “When did you last hear a kid called bookish or shy? At what point do those normal traits become social phobia or Asperger’s, or when does a naughty kid become ADHD? Now those are socially defined, and where psychiatry sits on those is often not where the public think.
“We are the most conservative in those areas because we know how awful autism is, we’re the ones who don’t want to extend the boundaries to include every shy, bookish, odd child. It’s psychiatry which is against the medicalisation of normality.”
Arguing that there are “perverse incentives” in the system, he said: “The more children that are labelled ‘special needs’, the more resources a school gets. If you just have a difficult kid in your classroom, you’ve just got to cope. But if you have a kid with ADHD you might get a classroom assistant. So you get pressure from teachers.”
Justine Roberts, from Mumsnet, disagreed. “Getting a diagnosis or educational statement for your child is fantastically difficult and the stigma associated with behavioural disorders can be a powerful disincentive, so it seems unlikely that [parents] are driving any significant increase in diagnosis rates,” she said. “Disparaging parents and teachers who are seeking support for children in their care seems misplaced.”
Professor Wessely said that ADHD and other conditions were real disorders, for which drugs did work. “It’s likely that stimulants [such as Ritalin] have been massively abused, but we know for children who have ADHD the evidence that stimulants are good, effective treatments is overwhelming. Therefore what we’re trying to do is ensure that the right treatment goes to the right person,” he said.
“We should be concerned about it, just as we should be concerned with the rise of antidepressant prescribing for the same reason. We know that many people who should be on antidepressants aren’t, we also know that people are getting antidepressants because of the lack of any other available alternative.”
While some critics suggest that psychiatric drugs do more harm than good, Professor Wessely said it was nonsense to say that antidepressants did not work. “It’s the same with Ritalin. It’s probably over-prescribed, but it’s also under-prescribed because we don’t have good enough [child and adolescence mental health] services,” he said.
Professor Wessely also said other doctors looked down on psychiatry because “we don’t have very big machines that buzz”, but it could teach the rest of medicine about the importance of communication with patients.






 

Professor Sir Simon Wessely, the president-elect of the Royal College of Psychiatrists - shares concerns about over diagnosis of childhood behavioural conditions and describes it as a, "Perfect Storm." COURTESY OF THE TIMES WEBSITE




http://www.thetimes.co.uhood behavioural conditions.k/tto/opinion/leaders/article4125804.ece
THE TIMES
updated at 12:01AM, June 21 2014


Professor Sir Simon Wessely, the president-elect of the Royal College of Psychiatrists, yesterday made a timely and measured contribution to the debate over two trends that have come together. The first is the growing tendency to attach medical labels to human behaviour previously regarded as outside the medical remit. The second issue is that, as a consequence of such-and-such a condition or syndrome or disorder being identified, doctors then prescribe drugs in an effort to treat it.
The rich western world has, Sir Simon argues, become too keen — even dependent on or addicted to — the business of categorising every last foible, every crease and crinkle of an individual personality. Once a thesis, diagnosis and prognosis are advanced, the pharmaceutical industry is only too willing to conjure up the plausible chemical corrective, a product that health professionals are then only too willing to supply. Such a “medicalisation of normality”, as Sir Simon terms it and rightly says, is not a healthy development.
Sir Simon is right to argue too that, while his profession must bear some responsibility for the situation he describes, and doctors have become too willing to prescribe, the wider public cannot escape all blame. Parents — middle-class parents especially — are complicit. Unwilling to accept their child’s normal deviation from the tightly-drawn parameters of the normal personality, many parents lobby the relevant agencies for a medical explanation instead. It does not help that pupils and schools attract extra resources once certain conditions have been diagnosed. The idea that even minor problems must all have a cause and therefore a solution has become dominant.
The current fashion to label and try to treat aspects of human behaviour is not only unsustainably expensive, it may also prove injurious to the health of society as a whole. Many people who make hugely significant contributions to mankind’s well-being in adult life endured unusual, troubled, even harrowing childhoods. At a minimum, the talented are, almost by definition, in some way different from their fellows. Some people, especially during their early years, can act in ways that others — teachers, parents, peers — find eccentric, irksome, embarrassing, regrettable or just plain irritating. Some children are shy, naughty, obsessive or peculiar. Some are, sadly and with no obvious cause, unhappy.
That is not to say that suffering should not be alleviated. Any victim of a quirk of character sufficient to cause distress must be treated with kindness and sympathy, as well as being offered whatever encouragement, discipline, stimulation or other help they need as is judged appropriate.
What such individuals should not be subject to, however, is a pseudo-diagnosis that does little more than stigmatise the particular personality trait they happen to possess and which a prevailing majority view happens to deem unacceptable. Many conditions are created in the naming and the diagnosis often does no good at all.
Nor, other than as a last resort, should a child suffering no apparent physical ailment be routinely placed on long-term medication, whatever difficulty that child’s actions may create for those adults charged with his or her care. A chemical response may well be convenient but convenience seldom makes for the correct or the civilised course of action. Anxious parents and overzealous doctors are making a problem worse.

Tuesday, 24 June 2014

YOUNG CHILDREN OVERDIAGNOSED WITH 'DISORDERS' FOR DISPLAYING LESS MATURE BEHAVIOUR!! - Canadian study shows - Courtesy of the CMAJ -“The potential harms of overdiagnosis and overprescribing and the lack of an objective test for ADHD strongly suggest caution be taken in assessing children for this disorder and providing treatment,”




Younger children in the classroom likely overdiagnosed with ADHD

Immaturity may lead to diagnosis of disorder

The youngest children in the classroom are significantly more likely to be diagnosed with attention-deficit/hyperactivity disorder (ADHD) — and prescribed medication — than their peers in the same grade, according to a study just published in CMAJ (Canadian Medical Association Journal).

ADHD, which is often treated with prescription medication, is the most commonly diagnosed behavioural disorder in children. Two recent studies have shown a link between the relative age of children and diagnosis of ADHD and prescription of medication. Younger children in the same grade as children who may be almost a year older may appear to be immature compared with their older peers. This apparent lag in maturity has been called the “relative-age effect” and influences both academic and athletic performance.

Researchers from the University of British Columbia were interested to see whether this relative age effect was present in Canada and looked at a large cohort of 937 943 children in British Columbia, a province where the cut-off for entry into kindergarten or grade one is Dec. 31. The research included children who were between 6 and 12 years at any point during the 11-year study conducted from Dec. 1, 1997 to Nov. 30, 2008.

Researchers found that children were 39% more likely to be diagnosed and 48% more likely to be treated with medication for ADHD if born in December compared to January. Due to the Dec. 31 cut-off birth date for entry into school in British Columbia, children born in December would typically be almost a year younger than their classmates born in January.

“The relative age of children is influencing whether they are diagnosed and treated for ADHD,” said lead author Richard Morrow, University of British Columbia. “Our study suggests younger, less mature children are inappropriately being labelled and treated. It is important not to expose children to potential harms from unnecessary diagnosis and use of medications.”

There are significant health and social ramifications of inappropriate diagnosis of ADHD. Medication to treat ADHD can have negative health effects in children such as sleep disruption, increased risk of cardiovascular events and slower growth rates. As well, younger children who have been labelled ADHD may be treated differently by teachers and parents, which could lead to negative self-perception and social issues.

“This study raises interesting questions for clinicians, teachers and parents,” noted coauthor and psychiatrist Jane Garland, University of British Columbia and BC Children’s Hospital. “We need to ask ourselves what needs to change. For example, attention to relative age of children for their grade and more emphasis on behaviour outside the school setting might be needed in the process of assessment.”

Although the prevalence of ADHD diagnosis and treatment is about three times higher in boys than girls, the effect of relative age applied to both. In fact, girls born in December and typically younger within their grade were 70% more likely to be diagnosed with ADHD than girls born in January.

“The potential harms of overdiagnosis and overprescribing and the lack of an objective test for ADHD strongly suggest caution be taken in assessing children for this disorder and providing treatment,” conclude the authors.

The ADHD medications included in the study were methylphenidate, dextroamphetamine, mixed amphetamine salts and atomoxetine.

MEDIA NOTE: Please use the following public links after the embargo lift:

http://www.cmaj.ca/lookup/doi/10.1503/cmaj.111619

Sunday, 22 June 2014

The Pharma Chronicles: Prof Peter C Gøtzsche BMJ response re antidepressants increasing the risks of suicide in young people....

The Pharma Chronicles: Prof Peter C Gøtzsche BMJ response re antidepressa...: Peter Gøtzsche BMJ response by Prof Peter C Gøtzsche , Nordic Cochrane Centre, Rigshospitalet, Copenhagen:   'Re: Changes in antid...

'Re: Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study'

"The study is not reliable  

Lu et al. reported that suicide attempts in young people increased after the FDA warned in 2003 and 2004 that SSRIs can increase just that: the risk of suicidal behaviour in young people (1). They found substantial reductions in antidepressant use after the warnings and believe that this caused the increase in suicide attempts.  

This is contrary to what would be expected. The FDA’s large meta-analysis of 100,000 patients who had participated in placebo-controlled randomised trials found that antidepressants increase suicidal behaviour up till about the age of 40 (2), and in young people, the risk was doubled, as Lu et al. also report (1). This result was found despite the fact that many suicides and suicide attempts on active drugs were missing in the FDA analysis (3).   

It is therefore a highly convincing finding that antidepressants increase the risk of suicide in young people, and randomised trials are far more reliable than the before-after analysis that Lu et al. presented, which seemed to find the opposite result. There must therefore be major problems with their research ..."