Last night BBC2 broadcast a new Louis Thereoux documentary that dealt with the topic of prescribing psychaitric drugs to children in America. A controversial practice both within the psychiatric and clinical psychological professions and from a laypersons point of view. The documentary itself was thoughful but ultimatly unfufiling: while it was interesting from a “human interest” perspective to see Louis meet some families whose kids had been diagnosed with the likes of OCD, ADHD and Aspergers and BI-polar disorder the documentary missed a trick. It could have looked more at the diagnostic process and how the children were assessed – perhaps talked to psychiatrists who advocate the prescription of psychiatric drugs to children and those who opposse such measures. There was also the potential to explore the potential role of an insurance driven system on the prescription of psychiatric drugs in general (After all CBT and other non-pharmalogical interventions are time and resource intensive and expensive as well as costing a lot…).
I suppose the main complaint that can be levelled at the documentary is that it really deserved to be part of a whole series of programs on the subject – each exploring a different aspect of the issues in detail. It was afterall a Louis Theroux documentary and “human interest” is really what he is known for (the weird and the mundane) and it was a thoughtful and sensitive piece. However it did feel more like an after dinner conversation on the subject rather than an indepth debate or exploration of a complex and contraversial issue.
Some people can have a “knee-jerk” reaction to the idea of medicating children with psychiatric drugs and many more can have a growing unease at the use of drugs to treat childrens behaviour. I would count myself in the latter of these two camps – there may be people who do not feel even uneasy at children being prescribed psychiatric drugs but I have yet to meet anyone how wants “a pill for every ill”.
However I do accept that in some cases medication may well be nessecary and indeed have a positive impact on a child or adolescents life. In the documentary the only things I would question the benefit of medication were for the six year old boy who was diagnosed with OCD. It seemed that the rest, relying on the parents accounts, had all benefited from the experience of being medicated. (Although I do wonder if some watching the documentary who are unfamiliar with flat-effect in aspergers will confuse Evan’s manner and interactions with people as being “doped up”).
This raises two issues: that of parental power and influence over their children in the diagnostic process and later on in continuing consultations
If the drugs benefit the children can we still object because we feel uneasy?
The latter issue is one that seems easy to resolve – the answer is clearly yes but this perhaps seems quite counterintuitive given how we tradiaitonally view the effects of drugs and our traditional conceptions of free will and agency. It is perhaps the thought that by helping an inidividual with psychoactive medication we are perhaps changing something that makes them an individual: and while we are social animals who expect members of our groups to conform to certain social norms and standards of behaviours we also (at least in Western cultures – Eastern cultures can be said to be more collectivist) hold the individual as almost sacrosant. Clearly this is not a discomfort that is easily resolved.
On the subject of parental control it would have been interesting to se the paretns roles in determining the “history” of their childs “disorder”. Also the process of diagnosis and what interventions are tried before drugs are prescribed would have been interesting to explore. Are other behavioural interventions sought first? Is there a focus on what could be malfunctioning in the family unit as a while or just the child with the problem?
Parents likely have a great deal of disproportionate influence in consultations and at subsequent case reviews: which if it is the case I find it quite worrying. I’m not suggesting parents would deliberatly or conciously try to get their kids a diagnosis and medicated. But rather that they may, as interested parties, be biased reporters. Anemphasis on observation as a means of coming to a diagnosis would go some way to put my mind at rest.
There will be worries that some diagnoses featured in the documentary “aren’t real”: well Aspergers certainly is and I would definatly advocate the use of medication (if proven to be of benefit and shown to work for an individual) to address some of the symptoms that can be associated with it and other ASD conditions. Having worked with adults who are on the autistic spectrum and have been known to display violent and aggressive tendancies I can also understand why anti-psychotics could be prescribed. Although I really do question the use of the term “BI-polar” in order to justify prescribing these.
My main bugbear however was the diagnosis of OCD in children – there may well be a psychiatric issue with some children but labelling it as OCD seems… well at odds with the diagnostic criteria in the first place. How do you know if a child has the intrusive thoughts that OCD is associated with? I have some doubts about the nature of OCD and the nature of OCD diagnosis in children. Perhaps more robust and reliable research is required – or perhaps I have simply to locate it and read it.
ADHD was controversial for many years (and still is in some quarters) but is now generally accepted as a diagnostic criteria: mainly seen in children but also being diagnosed with greater frequency in adults. I wonder perhaps if it might turn out to be a problem with digit span in working memory. But I don’t really think there is a huuge question over prescribing drugs to cope with ADHD.
Operational defiant disorder is however a differetn kettle of fish. I suspect it may be symptomatic of another disorder or isssue rather than a diagnostic criteria all of its own.