Thursday, June 07, 2007

Saletan's Bias Against Pediatric Psychiatry

In Saletan’s latest edition of “Weird News about Humans”, he gives a little blurb on a Canadian study looking at children from divorced families and prescription rates for ADHD meds. The upshot – kids whose families get divorced are about twice as likely as those from other families to be prescribed a stimulant medication. His theories:

A) Divorce causes behavior problems, which leads to prescriptions. B) Doctors and parents assume divorce causes behavior problems, so they drug the kids. C) The same parental behavior that caused the divorce messed up the kid. D) The kid's behavior problems contributed to the divorce.

I have a problem with this: nowhere does he mention the possibility that a) ADHD runs in families, and b) adults with ADHD are likely at increased risk for divorce. Anyhow, we exchanged a couple of comments, which culminated in the following rant. If you’re curious, you can visit the thread here.

I get irritated with the controversy revolving around kids and psychiatric medications. There’s no lack of criticism for prescription rates, but a real dearth of discussion about the reasons why rates are so high (other than parent blaming, that is, but what else is new?). Didn’t I see you highlight the case of the 8-year-old in Florida who was arrested for school misbehavior, at the school’s behest? It’s a single case, but it’s consistent with a definite national trend towards increasingly punitive responses to behavioral problems exhibited by children and adolescents.

So on the one hand, we have the masses decrying a mental health system who failed to provide someone like Cho a strategic pharmacological intervention, and on the other hand, we have the horde criticizing the rates at which psychiatric diagnoses are made (autism, pediatric bipolar, ADHD) and medications prescribed. The parents of children with emotional and behavioral problems are truly stuck between a rock and a hard place, being forced to choose between pathologizing their children with a diagnosis and medication, or watching their children be identified instead as budding delinquents, and treated with all of the tenderness and compassion associated with the overburdened juvenile justice system.

And there’s the kids, of course, who resist taking medication as part of their broader effort to develop and maintain a positive self-concept, which turns out to be quite a challenge, in a world where people are damn quick to point out everything that’s wrong with them, but offer damn little in the way of helpful guidance and advice.

Utilizing external props to modulate emotions or arousal is as old as alcohol, and as ubiquitous today as Starbucks. But the same kids who actively choose to consume energy drinks containing obscene amounts of a phosphodiesterase inhibitor, and of individual amino acids that multiply by the thousands what one might encounter in natural sources (with unknown long-term effects) – the same kids who’re smoking BC bud at potencies their parents never dreamed of in their own rebellious teens, refuse to take demonstrably helpful medications at established therapeutic doses, manufactured in quality-controlled, regulated laboratories, in part because they listen to the anti-pharmaceutical propaganda of people who find it much easier to criticize than offer alternative solutions.

As far as the children of divorced parents are concerned, well, they turn out to be at increased risk for a whole host of problems. The reasons for this are undoubtedly both legion and interactive. If a psychiatric medication turns out to effectively mitigate some of these difficulties, reducing the amount of ego-challenging environmental feedback they have to cope with and thus helping them develop and maintain a self-concept that’s both positive and sufficiently adaptive to help adequately modulate their behavior, then who are you to criticize, even at such a distance, the efforts of their parents and allied professionals to provide whatever they can to help these kids cope?

The problem isn’t the ubiquity of pediatric psych prescriptions, Will; that’s merely one of a number of symptoms that there is something seriously awry with the world in which we are raising our children. Writing about that is hard work, though – it requires complex conceptualization and broad awareness of the impact environmental influences exert on behavior. Much easier to write blurbs like yours today (or even research articles like the one on which your blurb was based); they allow us to feel righteous and superior, without implying any unpleasant obligation for us to actually do anything about any of it.

Oh the plus side, however, it is very nice to see you on the board. Thanks for taking the time to read and respond to my post.