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Saturday, 16 April 2016

INTERESTING PERSPECTIVE - Victim Blaming: Childhood Trauma, Mental Illness & Diagnostic Distractions? + LONG TERM PSYCHOLOGICAL ENTRAPMENT - MADINAMERICA WEBSITE

INTERESTING PERSPECTIVE - Victim Blaming: Childhood Trauma, Mental Illness & Diagnostic Distractions? 

Liz MullinarLiz Mullinar

In preparing this blog, I asked a friend and colleague, Matt Britts, who works with traumatized youth for her input. He sent me the response below, a response that yet again left me dismayed with the ways in which so many services end up failing people with mental illness and trauma histories. His response left me asking the same questions I have asked myself many times before:
Why, despite the fact that the vast majority of people diagnosed with a mental illness have suffered from some form of childhood trauma, is it still so difficult to talk about? Why, despite the enormous amount of research about the impact of trauma on the brain and subsequent effect on behaviour, does there seem to be such an extraordinary refusal for the implication of this research to change attitudes towards those who are mentally ill? Why, when our program and others like it have shown people can heal from the effects of trauma, are so many people left with the self-blame and the feeling they will never get better that my colleague writes about below?
I recently had a conversation with a sixteen-year-old client about the origins of her "mental illness". Or, to put it more accurately, I recently held my tongue and denied this young woman an explanation as she cried and helplessly demanded, why? Why was she suffering when no one else in her family had a history of depression? Why couldn't she manage her emotions, except by cutting herself? Why was she so filled with self-hatred and pain that the only solution she could see was suicide? Why her? What's wrong with me, she repeatedly asked. She asked, and I couldn't point to the sexual and emotional abuse she had been subjected to because of deep-seated organisational fears that the mere mention of childhood trauma would open a Pandora's box of further distress. Further dysfunction, probably further diagnoses.
Despite the very large advances that have been made in combating the stigma surrounding mental illness, the stigma of childhood trauma still looms silently in the background. In the 1950's, Bowlby and Ainsworth began the attachment research that would eventually  demonstrate the key role our early infant relationships play in shaping all our future ones. The most important point being that insecure attachment to primary caregivers becomes an enduring interpersonal pattern of dysfunctional relationships that persist throughout the lifespan. In 1998, Felitti et al. published the first peer-reviewed paper describing results from the Adverse Childhood Experiences (ACE) Study. Almost ten years ago, this seminal research analysed data from over 8000 adult participants to demonstrate an undeniable link between childhood trauma and adulthood risk of suicide, depression, alcoholism and drug abuse (Felitti et al., 1998). Since then the body of literature on the subject has grown exponentially. Data from the ACE study has also provided evidence for a dose-dependent relationship between exposure to childhood abuse and poor adulthood mental health outcomes (Edwards, Holden, Felitti & Anda, 2003). More recently, a longitudinal study in New Zealand showed similar relationships between childhood sexual abuse and mental health outcomes, psychological well-being and socio-economic status (Fergusson, McLeod & Horwood, 2013). Notably, 95% of the participants who experienced sexual abuse involving penetration reported, at least, one adverse mental health outcome, compared to only 56% of participants that did not experience sexual abuse in childhood (Fergusson et al., 2013).    
Yet all these scientific advances would appear to have had little impact on the deeply flawed mental illness discourse that is so omnipresent among the general public and scientific community alike. We still live in a society where many believe that hitting a child is an appropriate form of discipline. When these children hit another child on the playground, we don't call it a learned behaviour. We call it a conduct disorder. When these children grow up and physically abuse their spouses, we call it an antisocial personality disorder, an intermittent explosive disorder. The same is true of the child subjected to emotional abuse or neglect. When they inevitably fail to function adaptively within relationships, to regulate their own emotions or develop a coherent sense of self, we don't ask 'what happened to you?'. We ask 'what's wrong with you?', consult the Diagnostic and Statistical Manual of Mental Disorders, and conclude what is wrong is a form of innate characterological dysfunction termed borderline personality disorder. By the way, the prevalence of childhood trauma exposure within borderline personality disorder patients has been evidenced to be as high as 92% (Yen et al., 2002). Within individuals diagnosed with psychotic or affective disorders, it reaches 82% (Larsson et al., 2012). Individuals with psychiatric illnesses and a history of trauma also appear to display significantly higher functional impairment than the remainder of the sample (Cotter, Kaess & Yung, 2015).
This is a conversation that has been suppressed since Freud very briefly suggested the neuroses and hysteria he saw in his clients were a result of familial sexual abuse. In response to immense professional pressure, Freud reformulated his ideas into more socially palatable theories that essentially blamed the victim. The psychology of the 19th century had the Oedipus and Electra complexes as a convenient distraction from uncomfortable truths. Today's psychology has antisocial, narcissistic and borderline personalities. Today's solution should be readily available in a model of trauma-informed care that addresses the core issue behind the symptoms. Because questions of causation aside, the fact remains that individuals diagnosed with mental illness who receive treatment for their traumatic childhood experiences improve more than those who don’t (Bohus et al., 2013; Roberts, Roberts, Jones & Bisson, 2015; Van Minnen, Zoellner, Harned & Mills, 2015).  

Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C., ... & Steil, R. (2013). Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomised controlled trial.Psychotherapy & Psychosomatics82(4), 221-233.
Cotter, J., Kaess, M., & Yung, A. R. (2015). Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature. Irish Journal of Psychological Medicine32(01), 21-30.
Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the adverse childhood experiences study. American Journal of Psychiatry160(8), 1453-1460.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine14(4), 245-258.
Fergusson, D. M., McLeod, G. F., & Horwood, L. J. (2013). Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect37(9), 664-674.
Larsson, S., Andreassen, O. A., Aas, M., Røssberg, J. I., Mork, E., Steen, N. E., ... & Melle, I. (2013). High prevalence of childhood trauma in patients with schizophrenia spectrum and affective disorder.Comprehensive Psychiatry54(2), 123-127.
Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. I. (2015). Psychological interventions for post-traumatic stress disorder and comorbid substance use disorder: a systematic review and meta-analysis. Clinical psychology review38, 25-38.
van Minnen, A., Zoellner, L. A., Harned, M. S., & Mills, K. (2015). Changes in comorbid conditions after prolonged exposure for PTSD: A literature review. Current psychiatry reports17(3), 1-16.
Yen, S., Shea, M. T., Battle, C. L., Johnson, D. M., Zlotnick, C., Dolan-Sewell, R., ... & Zanarini, M. C. (2002). Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: Findings from the collaborative longitudinal personality disorders study. The Journal of Nervous & Mental Disease190(8), 510-518.
Liz Mullinar
Founder and Volunteer CEO of Heal for Life Foundation (Mayumarri Centres), Liz Mullinar is a survivor of incest, sexual abuse and cult abuse. Liz has been utilizing her innate knowledge as a survivor to empower others to heal themselves for 17 years. She has authored two booksBreaking the Silence and The Liz Mullinar Story, published by Hodder Headline.
Matthew Britts
Matt is a survivor of child abuse and has been working with other survivors for ten years. Matt is currently completing a PhD investigating psychological treatments for adult survivors of childhood trauma and has previously attained a Bachelor of Psychology with Honours. Matt also works with traumatised young people in residential out-of-home-care.

Wednesday, 30 March 2016

Sunday, 14 February 2016

EMPOWERING NEW MINDSETS IN YOUNG PEOPLE – A trilogy of hopeful constructs. A new opinion piece by Dave Traxson, Educational Psychologist U.K.

EMPOWERING NEW MINDSETS – A trilogy of hopeful constructs.

“Self should not be the harsh dictator within but rather the gentle facilitator for controlling all the responses to the forces without.”     Dave Traxson  2016

We, humanistic psychologists, look to harness the inner potentials that all human beings possess as we are often all too aware that they are being under utilised. I feel there are three key psychological constructs that help us to understand these fulfilling processes better.


“When we are no longer able to change a situation, we are challenged to change ourselves.” Viktor E. Frankl, in ‘ Man's Search for Meaning.’

No one should know better than Frankl the importance of choice as a human construct as he witnessed many examples in the darkest depths of man’s inhumanity to man, the concentration camps, where individuals made small but very significant choices that helped to keep them alive mentally and physically in some cases. The sense of personal power this gave them helped them to deal to some degree with the overwhelming hostility and to be better placed to show resilience and thus survive longer term. Choosing when to eat a crust of stale bread, who to share it with and what to maintain of some chosen relationships with those around you in any place. These all demonstrated the essential resilience building power of choice and self-efficacy. Frankl again:

Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” 

So what of the here and now, we also are empowered by exercising many choices personal, family, community and democratic. We all must have sensed at some point the rush of energy that this gives and the new mind-set that this facilitates which can last for extended periods.

As Madiba said so wisely,

Our deepest fear is not that we are inadequate. 
Our deepest fear is that we are powerful beyond measure.
It is our light, not our darkness that most frightens us.
We ask ourselves,                                                                                     
Who am I to be brilliant, gorgeous, talented,fabulous?                                                                
Who am I not to be?” 


“You have power over your mind - not outside events. Realize this, and you will find strength.” ― Marcus Aurelius, ‘Meditations.’

A metaphor, ‘A Car for Life,’  that we have successfully used with many young people may give us a useful insight here. Their ‘engine’ is their wants, needs of all types and their ambitions and when sitting in the ‘driving seat’ they can control their front wheels of ‘thoughts’ and ‘actions’ but it is harder to control their fixed back wheels of ‘physiology’ ( including genes) and ‘feelings.’ They have a real choice to ‘accelerate’ on various courses of action or to ‘apply the brakes’ hence showing some early stages of Self-Control or indeed 'learning to drive more carefully’ and find ‘safe roads’ and interesting ‘laybys’ or resting places. What we have demonstrated conclusively is that when a young person learns to use these metaphorical pedals judiciously then that gives them amazing personal power that can be generalized to other key areas of their future life. So learning to ‘put the brakes on’ in terms of using more acceptable language, for example or more powerfully reducing their levels of physical aggression with others in a range of settings then this can be generalized to controlling drinking behaviour or a range of other self-harming behaviours etc. etc. 

These methods are loosely classified as Cognitive Behavioural Techniques. Cognitive Behaviour Therapy’s efficacy has been endorsed on grounds of evidence based practice by the National Institute of health and Clinical Excellence (NICE), the medical professionals regulating body for drugs and interventions.

“He who controls others may be powerful, but he who has mastered himself is mightier still.”  Lao Tzu
“Ultimately, the only power to which person should aspire is that which they exercise over themself.”  Elie Wiesel


Compassion literally means “to suffer together.” Among Humanistic Psychologists, it is defined as the feeling that wells up when another’s suffering or difficulties are shared and one feels motivated to help to resolve the situation.

Compassion is not the same as empathy or altruism, though the concepts are intertwined. While    empathy refers more generally to our ability to take the perspective of and feel the emotions of        another person, compassion is when those feelings and thoughts include the desire to directly help the other human being. Altruism, in turn, is the kind, very selfless behaviour often prompted by feelings of compassion, though one can feel compassion without acting on it.

We usually think of the focus of compassion being to others, as above, and there is another equally important form of compassion to oneself which we call developing a 'Kind Mind,' to one's actions, thoughts and feelings. It is fundamentally about being reasonable to oneself as well as to others both in terms of expectations, deeds and 'positive self-talk.'
“Take positive care of your mind, and it would surely take positive care of your life.”  Edmond Mbiaka

We have to been kind and tolerant about the unique characteristics of ourself in order to be able to be giving and successful in our interactions with others. So developing a 'kind mind' to ourselves develops a reservoir of positive energy that we can use rather than having it all leach away through the unproductive mental processes of shame and guilt.
While cynics may dismiss compassion as touchy-feely or irrational, scientists have started to map the biological basis of compassion, suggesting its deep evolutionary purpose. This research has shown that when we feel compassion, our heart rate slows down and we secrete the “bonding hormone” oxytocin.

So this important positive trilogy of humanistic constructs are pivotal to assessing if interventions are likely to  be effective for individuals young the people specifically and all human beings generally. Basically will the proposed strategy increase the client’s feelings of having more choice and self-efficacy, increase their ability to use their internal locus of control and also to behave in a compassionate way to the individual.

So a personalized blend of these three humanistic constructs may indeed be able to maximize a sense of empowerment and increase the longer term possibilities of personal growth and hopefully eventual transformation.

Friday, 5 February 2016

VICTORIA DERBYSHIRE SHOW - BBC-2 - 2-02-16 - Dave Traxson,Educational Psychologist promotes multi-agency collaboration and holistic assessment for Autism following NICE Guideline 2009

Dave Traxson,Educational Psychologist promotes multi-agency collaboration and holistic assessment for Autism –

Use slider bar to go 1hr 05 min into programme after 10 am sports news look for the pink shirt!

VICTORIA DERBYSHIRE SHOW  BBC 2 – 2-02-16 - Joanna Gosling presents the daily news and current affairs programme. Jean Mackenzie speaks to 10-year-old Becky, who had to wait six years for a diagnosis of autism

Friday, 29 January 2016

BRITISH MEDICAL JOURNAL - Children who are prescribed a common antidepressant could be at a higher risk of suicide and aggressive behaviour, it has been claimed. - Courtesy of BMJ Website

Children who are prescribed a common antidepressant could be at a higher risk of suicide and aggressive behaviour, it has been claimed.
Researchers said that children and adolescents have a doubled risk of aggression and suicide when taking selective serotonin and serotonin-norepinephrine reuptake inhibitor drugs to combat depression.
The authors recommended “minimal use of antidepressants in children, adolescents, and young adults” after releasing their findings. The researchers stressed that there is not enough patient data available from clinical trials to assess the true risk of all associated serious harms.
The study, published in the BMJ, examined clinical study reports of 70 trials with 18,526 patients. The researchers, from Denmark, found no significant link between antidepressants and suicide and aggression among adults, but in children and adolescents the risk doubled.
“We suggest minimal use of antidepressants in children, adolescents, and young adults as the serious harms seem to be greater, and as their effect seems to be below what is clinically relevant,” the authors wrote.
“Alternative treatments such as exercise or psychotherapy may have some benefit and could be considered.”
The research led one expert to call for stricter prescribing rules. Shirley Reynolds, professor of evidence-based psychological therapies at the University of Reading, said that only specialist child and adolescent psychiatrists should prescribe antidepressant medication to children and young people.
“Obviously these results will make doctors, parents and young people themselves think harder about taking antidepressant medication,” she said.
“But do the results mean that children and young people should never be prescribed antidepressant medication? No. There are alternative treatments and all young people should be offered an evidence-based psychological treatment immediately.
“However, antidepressants should be available when a young person does not respond to psychological treatment or does not want psychological treatment.
“Combining antidepressant treatment and psychological treatment is associated with improved outcomes and can lead to more a rapid reduction in symptoms.
“But only a specialist child and adolescent psychiatrist should prescribe antidepressant medication to children and young people and all children and young people who are prescribed antidepressants must be carefully and regularly monitored.”
However, Dr Mara Parellada, specialist in child and adolescent psychiatry at Complutense University of Madrid, said of the research: “The results from this study do not allow us to state that ‘antidepressants double the risk of aggression and suicide in children’.
“There was no single death by suicide in children and adolescents in the 70 trials reviewed for the article.”
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14

Monday, 11 January 2016

Being Bullied by Age Eight Linked to Depression in Adulthood In The News - MadinAmerica January 8, 2016


Being Bullied by Age Eight Linked to Depression in Adulthood

There is a growing body of evidence suggesting that being exposed to bullying in childhood can contribute to mental health problems later in life. In a new study, published in JAMA Psychiatry, the researchers found that children who reported being bullied at age eight were significantly more likely to seek treatment for mental health problems by age twenty-nine.
“The findings of the study are important for mental health research, prevention, assessment, and intervention,” the researchers write. “Frequent exposure to bullying at 8 years of age was associated with later adult psychiatric disorders, even in the absence of childhood psychiatric symptoms.”
The study is the largest to date to look at childhood bullying in both boys and girls and includes the longest follow-up period for tracking the participants mental health. It is part of the multicenter Finnish Nationwide Birth Cohort Study which began with a nationwide sample of eight-year-old children in 1981. The connection between bullying and adult mental health problems, while previously examined, is strengthened considerably by this study's size, design, and ability to control for health and demographic factors.
“To our knowledge, the present study provides the strongest evidence todate that frequent exposure to bullying in early childhood increases the risk fordepressive disorder later in life,” they write.
The researchers point out that these findings strengthen psychological explanations of depression. Specifically, the interpersonal theory of depression suggests that our close relationships act as a buffer against depression and that negative relationships in early childhood, through bullying or other types of trauma and humiliation, can disrupt the ability to build and maintain quality relationships.
In their conclusion, the study authors urge parents, teachers, and doctors to take preventative measures to prevent bullying.

Sourander, A., Gyllenberg, D., Klomek, A. B., Sillanmäki, L., Ilola, A. M., & Kumpulainen, K. (2015). Association of bullying behavior at 8 years of age and use of specialized services for psychiatric disorders by 29 years of age.JAMA psychiatry, 1-7. (Abstract)

Sunday, 3 January 2016

Children Still in a Crib, Yet Being Given Antipsychotics by the Thousand - Coutesy of The New York Times - Dec 15th 2015

Andrew Rios’s seizures began when he was 5 months old and only got worse. At 18 months, when an epilepsy medication resulted in violent behavior, he was prescribed the antipsychotic Risperdal, a drug typically used to treat schizophrenia and bipolar disorder in adults, and rarely used for children as young as 5 years.

When Andrew screamed in his sleep and seemed to
interact with people and objects that were not there, his frightened mother researched Risperdal and discovered that the drug was not approved, and had never even been studied, in children anywhere near as young as Andrew.
“It was just ‘Take this, no big deal,’ like they were Tic Tacs,” said Genesis Rios, a mother of five in Rancho Dominguez, Calif. “He was just a baby.”
Cases like that of Andrew Rios, in which children age 2 or younger are prescribed psychiatric medications to address alarmingly violent or withdrawn behavior, are rising rapidly, data shows. Many doctors worry that these drugs, designed for adults and only warily accepted for certain school-age youngsters, are being used to treat children still in cribs despite no published research into their effectiveness and potential health risks for children so young.


Angela Davis, a speech-language pathologist, working with Andrew at home in Rancho Dominguez, Calif. CreditJenna Schoenefeld for The New York Times

Almost 20,000 prescriptions for risperidone (commonly known as Risperdal), quetiapine (Seroquel) and other antipsychotic medications were written in 2014 for children 2 and younger, a 50 percent jump from 13,000 just one year before, according to the prescription data companyIMS Health. Prescriptions for the antidepressant fluoxetine (Prozac) rose 23 percent in one year for that age group, to about 83,000.
The company’s data does not indicate how many children received these prescriptions (many children receive several prescriptions a year), but previous studies suggest that the number is at least 10,000. IMS Health researched the data at the request of The New York Times.
The data did not indicate the condition for which these prescriptions were written. Doctors are generally free to prescribe any medication for any purpose they see fit, so some drugs can occasionally be used in unproven and debatable ways. But the volume and rapid rise in psychotropics such as antipsychotics and antidepressants in children 2 and younger suggest a trend.
In interviews, a dozen experts in child psychiatry and neurology said that they had never heard of a child younger than 3 receiving such medication, and struggled to explain it. They presumed that parents and doctors, probably desperate and well meaning, were trying to alleviate thrashingtemper tantrums — the kind that get children kicked out of day care — or an overly depressed disposition, like being strikingly inhibited, nonverbal or lethargic.
“People are doing their very best with the tools available to them,” said Dr. Mary Margaret Gleason, a pediatrician and child psychiatrist at Tulane University School of Medicine. “There’s a sense of desperation with families of children who are suffering, and the tool that most providers have is the prescription pad.”
But Dr. Gleason said that children with ages measured in months had brains whose neurological inner workings were developing too rapidly, and in still unknown ways, to risk using medications that can profoundly influence that growth. She said the medications had never been subject to formal clinical trials in infants and toddlers largely because of those dangers.
“There are not studies,” Dr. Gleason said, “and I’m not pushing for them.”
Dr. Martin Drell, former president of the American Academy of Child and Adolescent Psychiatry, said he was “hard-pressed to figure out what the rationale would be” for the prescriptions. Similarly taken aback, some experts wondered if the medicine was never actually consumed by the child, or if it was issued in the name of a child covered by Medicaid but in fact taken by an ill parent who was uninsured.
“But where there’s smoke, there’s fire,” Dr. Drell said. “For the protection of kids, we should evaluate this. We should identify who these cases are. Maybe it’s not 10,000, but I’ll be unhappy if it’s even in the hundreds.”
Most experts suspected that the trend of medicating younger and younger children for suspected psychiatric disorders was trickling down to very young children. Last year, a report from the Centers for Disease Control and Prevention found that health care providers had given a diagnosis ofattention deficit hyperactivity disorder to at least 10,000 children age 2 or 3 and then prescribed medications such as Adderall outside American Academy of Pediatrics guidelines.
“I think you simply cannot make anything close to a diagnosis of these types of disorders in children of that age,” said Dr. Ed Tronick, a professor of developmental and brain sciences at the University of Massachusetts Boston. “There’s this very narrow range of what people think the prototype child should look like. Deviations from that lead them to seek out interventions like these. I think it’s just nuts.”
Prozac is approved by the Food and Drug Administration for depression in children 8 and older and for obsessive compulsive disorder in those age 7 and older. Most antipsychotics, which treat schizophrenia and bipolar disorder, are indicated only for children 10 and older. Risperdal is approved for children as young as 5, but only for irritability associated withautism.
Some other psychiatric medications, such as the antianxiety drugs Valium or Klonopin, are widely accepted to control intractable seizures in the very young. Although their effects on the young brain remain unknown, stopping a child’s seizure warrants their occasional one-time use, said Dr. Amy R. Brooks-Kayal, the head of pediatric neurology at Children’s Hospital Colorado and president of the American Epilepsy Society.

Antidepressants and antipsychotic medications, however, have no established use in young people beyond tempering chronically disruptive behavior, experts maintained, suggesting that the drugs were probably used for that purpose.
The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Neurology have no guidelines or position statements regarding use of antidepressants and antipsychotics in children younger than 3.
Finding specific examples of such children taking the drugs can be difficult, because of family privacy concerns or because the practice remains controversial. IMS Health records but does not release the names of prescribing physicians.
Mrs. Rios said that after Andrew began taking the epilepsy medication felbamate, he became strikingly erratic and aggressive: He pushed his siblings down and destroyed toys. She said that Andrew’s neurologist, at Children’s Hospital of Orange County, Dr. Lily Tran, then prescribed Risperdal, medication that can temper severe mood swings in older children.
Andrew took the medication for four months before his mother decided it was causing harmful side effects — behavior he had never shown before — and took him off it. “Everything became worse,” Mrs. Rios said.
Dr. Tran declined an interview request.
The use of Risperdal for children has been hotly debated among child psychiatrists, with some experts — many financially backed by the pharmaceutical industry — citing positive effects among suffering young people, and others criticizing their use as shortsighted responses to complex problems.
“There are behavioral ways of working with the problems rather than medication,” said Dr. Tronick, who runs a program that teaches health care providers to assist families with troubled children. “What is generating such fear and anger and withdrawal in the child? What is frustrating or causing stress in the parent? These are the things that have to be explored. But that takes time and money.”
Many experts say that the rise in the use of all psychotropics in children of all ages derives from the scarcity of child psychiatrists — only 8,350practice in the United States, many of them with long waiting lists and higher cost than a family’s established pediatrician. Those pediatricians receive little training in child psychiatry but are then asked to practice it.