SAFEGUARDING A GENERATION - These psychotropic drugs pose a Safeguarding risk for children. - by Dave Traxson Chartered Educational Psychologist - Courtesy of - www.teachingtimes.com n Vol 3.6 - Every Child Journal

"PSYCHO-ECONOMIC IMPERIALISM"(DT) 
-The biochemical colonization of young developing minds for huge profit and social control.

The drugs don’t work and do long term harm

www.teachingtimes.com n Vol 3.6

Conditions Every Child Journal

Our children are our collective messengers to a future that we will neither see nor inhabit. What messages do we, as a progressive society, want to transmit to future generations about the way we have chosen to treat children with

behavioural differences today?

Our society – in the form of an increasing number of Members of Parliament,

Professional Bodies, plus a growing number of concerned professionals and parents – is

now asking questions of the government and the psychiatry establishment about this

critical issue and raising concerns about our agreed collective responsibility to safeguard

children from the rapidly growing risk of harm from prescribed psychotropic drugs.

I posed the question in the introduction of this article at the end of a recent debate in

a committee room of the House of Commons, aimed at drawing parliamentary and public

attention to this area of the increased medication of children to control their complex

emotional and behavioural needs. The meeting was the culmination of two years of75

intense national awareness-raising by concerned psychologists about the growth in

the use of these mind-altering and potentially toxic drugs on school-aged children in

the UK.

This campaign – an effective but loose alliance between the Association of

Educational Psychologists; the divisions of Educational and Child Psychology

and Clinical Psychology of the British Psychological Psychological Society; the International Response Committee to DSM-5 (IRCD); professors of psychology and psychiatry; individual psychologists, like myself; along with representatives from psychiatry – has achieved considerable progress by mobilising professionals and their associations to lobby MPs and by writing articles such as this in a range of publications. Holding this debate with prominent American and British representatives of Psychiatry and Psychology in Parliament in June was a

major step and has added considerably to the public and professional debate since.

The campaign has now successfully challenged the rationale of some of the more

dubiously diagnosed disorders for childhood behavioural difficulties – now rebranded

as disorders – which once would have definitely fallen within the normal range of

societal expectations for children.

The role of schools

Clearly, schools provide an interface between children and society and as such they

have a pivotal role in safeguarding young people from the documented problems

of a mental health system which is unduly focused on diagnosing the supposed

‘mental illnesses’ which are proliferating. It is not easy for schools, but their pastoral

care teams in particular need to be aware of the pseudoscientific diagnostic and

classificatory systems which are in common use in Britain and the dangers that poses

to children in their care.

This is a view shared by the British Psychological Society in its recent submission

to the American Psychiatric Association’s (APA) international consultation. The APA

publishes the influential DSM (Diagnostic and Statistical) manuals, and the BPS paper

was entitled ‘The Future of Psychiatric Diagnosis’ (2012). The National Institute

of Health and Clinical Excellence (NICE) current guidance is that psychological

interventions should preferably be used first and that psychotropic drugs should only be

used initially in severe cases of Attention Deficit and Hyperactive Disorders (ADHD). This sadly

is far from the case in the actual paediatric practice on the ground across the country where

psychotropic drugs are still too readily prescribed. But the increase is being noted and more and

more schools are now questioning the wisdom of classifying increasing percentages of their

intakes with questionable disorders requiring psychotropic medication.

Pastoral care staff are asking questions of the prescribing doctors to clarify why drugs are

required when the children concerned have often not shown specific patterns of behaviour which

the unsatisfactory checklists require in a school setting. Often medics accept parental responses

to certain checklists and do not contact schools to verify that the behavioral patterns exist beyond the family setting as well, as good practice requires. One survey showed that doctors had checked children’s behaviour with their schools in less than half the cases in which drugs were prescribed. The findings are backed by anecdotal reports from chartered psychologists belonging to the Health Professions Council.

“Pastoral care staff are asking questions

of the prescribing doctors to clarify why

drugs are required when the children

concerned have often not shown

specific patterns of behaviour which the

unsatisfactory checklists require in a

school setting.”

76

This mounting pressure has prompted the Department of Health to collect for the

first time comprehensive data about the prescription of psychotropic medications to

children by psychiatrists and some paediatricians. The problem is exacerbated by the

recently published and influential diagnostic and statistical manual DSM-5 classificatory

system (May 2013) which identifies more childhood conditions than ever before.

As a result of these developments, an estimated three quarters of a million individual

prescriptions will be issued to children for psycho-stimulant medication such as Ritalin

alone, this year. This represents a near four hundred fold increase over the last twenty years. In

1991, only 2,000 prescriptions were issued. Clearly, children have not become 400 times more

problematic in that time – indeed some social commentators would argue that children in the 21st

century are more emotionally literate and have a wider range of coping strategies than

previous generations. So one has to conclude this response to children’s complex needs

is a function of society and business drivers of profitability and advertising. We urgently

need to reflect on this before it does physical and psychological harm to broad swathes of future

generations of young people.

The psychiatrist’s bible

There is great concern that this newly republished and enlarged manual, DSM-5, known

as ‘the psychiatrist’s bible,’ has pathologised an ever larger number of previously normal

range patterns of behaviour. For example, what some would call normal shyness has been

relabelled as Social Anxiety Disorder (SAD), common mood swings have become Juvenile

Bipolar Disorder (JBPD), typical temper tantrums have been reclassified as Intermittent

Explosive Disorder (IED) and a natural grief reaction to losing a close family member

has become Temporary Grief Syndrome (TGS). The latter scandalously removes the

‘bereavement exclusion’ which previously blocked anti-depressants being used for two

months after the loss of a loved one. This risky step has been criticised by many medical

bodies including the Lancet journal. Doctors are now allowed to medicate children and

adults alike from a fortnight after their traumatic loss with antidepressants which in the

early stages of treatment have been shown by research to regularly increase the risk of

suicidal thoughts.

This has lead to successful class actions in the courts in the US citing the harm done

to young people. In the US, each of the plethora of conditions has a four figure code

without which the prescribing doctor and psychiatrist do not get paid by the Insurance

Company scrutinising the claim form. We are not an insurance-based health system in

the UK and therefore do not need these codes here and the stigmatising labels that are a

consequence.

I view the trend towards mass medication of children with mind altering and

potentially toxic drugs and ‘drug cocktails’ as a form of psycho-economic imperialism.

By that I mean that young peoples’ developing minds are being colonised, using

biochemicals, for huge commercial profit and in effect, increased social control. This has

resulted from carefully constructed ‘business plans’ in boardrooms which some years

ago saw the population of children in the western world as a great market expansion

opportunity. The pharmaceutical companies have reaped the huge financial rewards of

this rich and very bitter harvest ever since. The scale of this toxic harvest is indicated by a

number of class actions taken out by parents in the US which have resulted in out-of-court

settlements of several billion dollars, one for not releasing the research evidence that

would have indicated the potential level of serious physical harm that had indeed resulted.

As Ben Goldacre author of Bad Pharma (2012) states, these multi-national pharmaceutical

companies are prepared to ‘cherry pick’ from research data and discount studies that

are unfavourable to their longer term financial interests. This is not a conspiracy theory

but a current profit-driven international business project which risks short-term physical

harm such as major sleep disturbance or neuro-muscular irregularities such as tardive

dyskenesia (uncontrollable and sometimes irreversible muscular spasms) in children with

the potential for long-term psychological dependency. As Baroness Susan Greenfield,

the ex-director of the Royal Society has stated, the use of psychotropic drugs will result

in young people who will end up returning to the repeated pattern of using  psychopharmaceutical interventions whenever they face a problem in life, thereby continuing this very profitable vicious cycle of pharmaceutical dependency.

International use of psychotropic drugs

Patterns of prescribed psychotropic drug usage vary dramatically between cultures and

countries. In Italy, where prescribing psycho-stimulants for children has been restricted

since 2006, the drugs are used by only 0.13 per cent of children. In the US, eight per cent of

the total school population are on psycho-stimulants alone and as many as 20 per cent on

one or more drug including anti-psychotics and anti-depressants. The range in the UK of

1.5 to two percent is thankfully closer to our European neighbours than our transatlantic

cousins but is rising. France also has lower rate of 0.5 per cent because psychotherapy or

increased engagement in sport is preferred as a viable alternative to using psychotropic

drugs. Some Scandinavian countries are also well below a one per cent level of the school

population prescription rate. For example, Sweden is at 0.15 per cent because of its

commitment to intensive psychological interventions.(1)

My belief is that we in Britain belong to a more progressive and less aggressively

intrusive medical tradition to Canada and the US, with a stronger leaning towards

socially constructed explanations of behaviour ‘disorders’. In the UK

and Europe, we also value individual differences even if some of those

behaviours are challenging to us. This theory is supported, in my view,

by the fact that American psychiatrists are still using Electro Convulsive

Therapy regularly with adolescents who are unresponsive to antidepressants

while the use of this contentious approach has significantly

reduced or even been restricted in some countries here in Europe and

Scandinavia.

Many psychologists working with children have started using the ‘ethical

legitimacy’ afforded to them by the ‘Duties of Registrants,’(2009) of the Health

Professions Council, to better safeguard children on their caseload. This

usually involves making a phone call to the prescribing medic and sharing

concerns about the pattern of behaviours in various settings and how this

may not comply with published guidelines or to clarify information about

the side effects of the drug or their interactions with other drugs in the drug

cocktail.

It is interesting that in most cases, medical colleagues thank the psychologist

concerned for sharing the information and usually make some appropriate adjustment to

the prescribing schedule. This has been particularly true in relation to cases where children

under the age of six were prescribed psycho-stimulants or antipsychotics – a practice that

runs against the advice of the NICE.

“Many psychologists

working with children have

started using the ‘ethical

legitimacy’ afforded to

them by the Duties of

Registrants”

78

Safeguarding a generation by appropriate challenge.

Professional bodies of educational and clinical psychologists are united in their concerns about the diagnostic schedules, like DSM-5, which they feel lack the necessary scientific validity

and are not fit for the purpose of 21st century holistic assessment.

Many case studies illustrating the dangers to children involved could be shared but a typical example is a thirteen year old boy who was already on maximum dosage levels of a psychostimulant and high levels of an antipsychotic drug. His mother asked for

him to be put on an anti-depressant to deal with his low mood. In this and a few other reported cases, such changes were made without seeing the child concerned, which is against General

Medical Council (GMC) regulations.

Others involve psycho-stimulants being regularly given to children with high levels of anxiety which again is againstNICE guidelines on ADHD.

We psychologists are not saying that drugs should never be prescribed and on occasions, we have seen the benefits of selective use. We do though urge the government to ensure that the well-researched NICE guidelines should be followed, particularly by prescribing doctors, and that psychostimulants should never be used with under fives and should also not be given to a child whose primary presenting problem is anxiety.

Surely when our precious NHS is under threat from swinging cuts, the time is right

to review practices which are expensive and fundamentally flawed. More and more

psychologists in Britain have principled concerns about labelling a still developing child

in such a pejorative way and the harm done to them by the internal attributions of

abnormality that may well result. Rather than a within child biomedical explanation of the

difficulties experienced, they prefer a more holistic and socially contextualised hypothesis

that includes a range of the complex web of interacting factors that usually explain

challenging behaviour.

A variation of the old maxim holds true – for every child’s complex presenting

behavioural pattern there is a simple and easy explanation or solution which is invariably

not good enough. Let us move as a society from a ‘quick fix’ mindset to one with a more

interactionist perspective that leaves the child better placed to use their personal power

and confidence to make better choices in a life over which they have more control.

Dave Traxson is a Chartered Educational Psychologist. (traxsondave@gmail.com)

For more information on the campaign outlined in this article, visit : copeyp.

blogspot.com (Challenging Overprescription by Professionals in Education for

Young People).

References

1.      Comparison of Psychotropic Medication in Youth (2008) by K.Jahnsen et al on BioMed Central Website

2.       and “Opening the White Boxes,” (2009)by L.Aafgard et al.Wiley.London.