Psychiatric medication and schools: Your thoughts?

[BPScooter]

Hi JREFers,

This is my first new thread but one that is of deep interest to me as a teacher, parent, and researcher.

Without my going into the depths of the forum, I'm wondering if the topic of the use of "off label" medications as well as the familiar Ritalin, Adderall, Prozac, etc. been discussed here. An equally important issue is who is capable of prescribing or even strongly suggesting the use of these drugs, under what circumstances, with what qualifications, and at what level of accountability.

There are issues of medical as well as educational ethics involved, and it seems to me likely that many readers of this forum could chime in if the topic became well developed.

Just to chum the waters, people like Peter Breggin and Fred Baughman (both MDs) have for years been claiming that medication is a harmful fraud as a treatment for youthful behaviors that, while irritating, are not indicators of a disease. Ken Kesey made the same point in *One Flew Over the Cuckoo's Nest*, a novel centered around adult psychiatric treatment. And many today, researchers in the hospitals, drug companies, and government agencies hold a different view--Russell Barkley (also MD) is an example.

Can the tools of critical thinking solve this one? We have "hard" and "soft" science claiming utterly different things. We have institutional educators and homeschoolers on different sides of the same coin. We even have disparate interpretations of clinical results, basic evidence like MRIs, general dissatisfaction with research methodologies. Heavy influence of belief and need to weigh evidence.

Only in the last week I overheard that the idea that some severe side effects (suicidal ideation, for instance) which have been discussed widely among the "anti-druggers" are now being seriously considered for a "black box" (ie. included in a boldfaced warning in the medication's packaging) on some of these drugs.

Anybody here know about this stuff, or care? Mrs. BPScooter is active on several sites and there are lots of flame war type debates going on. If this topic is of interest here, please let me know and I'll let her know, and probably get her signed on. PM to me is fine.

Thanks-BP

[Harlequin]

I think I recall reading that young users of Prozac were much more likely to commit suicide than those given a placebo. Given that this sort of defeats the purpose, I'd say there could be some serious side-effects that are not always considered.

[ChristineR]

All anti-depressants can increase sucide risk. Anti-depressants can increase energy and agitation before they decrease depression, and for any given anti-depressant, only about 70% of users will have any positive outcome all at.

Prozac is the most agitating of the anti-depressants, and for reasons not well understood, the effect is more pronounced in children.

Strictly speaking, anti-depressants are only to be used while the patient is closely observed, at least until the drug is seen to have worked.

The real problem with the newer SSRI anti-depressants is that they are so darn safe that general practitioners write prescriptions for them at the drop of a hat. Frequently the GP has no idea what to look for, and the insurance discourages him from referring the patient to a psychiatrist until after the patient has had a few months on SSRIs.

The older tricyclic anti-depressants were so dangerous that a thirty day supply would kill a patient outright, so hospitatilization was the norm for depression. No one has yet managed to kill himself with Prozac alone, even though a few people have taken thousands of them.

[Dark Jaguar]

Now that's something I wasn't aware of.

[kittynh]

I really thought almost any child could handle school with really careful teachers and parents that care. After years of working in schools I finally met a child that HAS to have some medication. The school, parents and psychiatrist have tried every program, every angle, every trick in the book. This kid can not handle any kind of pressure. I'm talking "get your math done please before lunch."

Every teacher in the school, with years and years of experience has been brought in to try whatever they could. I have done days of one on one with him! (being hired just for that to see if one on one would work as on option). After three days of one on one, we saw even that would not work.

He is BRILLIANT. When he reads, he is the BEST reader in his age group. When he can do math, he is way above grade level. This is with him working perhaps only an hour in total all day (in short 5-10 minute bursts). His art work is amazing and thoughtful (when he can do art).

He was finally diagnosed with a serious anxiety disorder. This was probably inherited from his parents (he is adopted).

Medication is his only hope of being able to function in a social environment. It's that or home schooling him with the teacher (mother) going slowly insane from constantly walking on eggshells.

I was never a fan of medication, but if it helps this child I will be so happy. The poor family is at their wits end. They love this kid and they want to NOT medicate him. But in this case it is for the health of the family.

[Soapy Sam]

Kittynh- I'm sure you've tried everything to take the stress off the child. Which has failed. Has anyone tried cranking the pressure up?

I'm serious. My aunt was a primary teacher for 30+ years , starting just before WWII. She maintained she never had a kid she couldn't teach. I know families who had three generations in her class and they pretty much agree. There were no drugs in school then. (There may not have been so many profoundly disturbed kids either, as those with major problems probably went to specialist schools.)

She worked her classes hard. (Like I say, I know a lot of her pupils. They remember her with affection, but also respect. Nobody got away with anything. She had eyes in the back of her head. Caught me out a few times too.

Her technique varied with each child. She taught in a small village school with only about 100 kids. But one rule was invariant. If a child was doing nothing, he was not being worked hard enough. So she turned up the heat. The bright kids entered junior high up to a year ahead in some things. The slow ones at least left able to read and write. I recall her shock when I said we had two kids unable to read in my class , when I was ten.
A close friend, a primary teacher approaching retirement, tells me she is convinced the problems many children have these days, particularly with "attention disorders" are in most cases due to not having enough to keep them occupied and having no disciplinary option to back it up. By discipline, she means primarily a show of disapproval- a clear message to the child that he is failing to meet expectations based on his known ability. In short, that the softly-softly, always positive approach, is actually harmful to kids both at the top and the bottom ends of the smarts spectrum. Those in the middle, she maintains, are robust enough to survive any educational policy, no matter how misguided, but the failures show at the edges.

I'm not a teacher- (Alhamdull'illah!), but that's the opinion of two good ones I've known.

[BPScooter]

Thanks for the interesting and thoughtful replies. I don't have a giant axe to grind, personally, and try to take the various sides of this for the value I can gain from them.

Re: the safety of the SSRIs and MAOIs (I think that is right) I found Peter Breggin's "Talking Back to Prozac" and another book by a Canadian MD who pointed out some of the oddities of the FDA approval process for those drugs suggest some caution. Ritalin and Adderall are quite close to amphetamines (Adderall contains amphetamine). So when it comes to tinkering with brain chemistry I tend to think we simply don't know enough to be able to refer to behavioral issues as "diseases," at least in the sense of a pathologist or neurologist. As one of the phrases goes, just because a treatment changes something, it doesn't imply a "lack" of that element. Aspirin's effect on headache doesn't mean that a headache is caused by "aspirin deficiency." And some of the advocates for drugs use a quick analogy-to-guilt by comparing with something like diabetes. But diabetes is a disease, with clear diagnostic indicators--abnormalities of tissue, organ, blood chemistry. These behavioral situations are not the same, and I tend to think that people who interpret the impact of drugging as somehow "correcting" brain chemistry are over-simplifying.

The scary thing is the huge upsurge of prescriptions, at least in the US. Europe seems to be more cautious. If there really were some underlying pathology, my gosh it would seem this is a greater epidemic than anything we've seen before.

I think the key point is that yes, there really are kids with irritating and potentially maladaptive behavior patterns. But it seems easier for many people to seek a medical solution and therefore explanation than by looking at other things. Another book that made me think was called "Ritalin Nation" which is less about Ritalin and more about the social impact of modern life, technology, and values on young people.

I'd recommend a look at some of these sources if you're interested. There are websites, too, but you can probably find them easily enough.

[kittynh]

BAsically this kid just rolls into a ball and shuts down. You have to pick him up to move him. Short of beating him, there isn't anything one could do. He has faced the staying in from recess (his one love is playing sports), this seems to make him so upset that he doesn't eat. Anything. For days. Most often he is to be found in the fetal position, sucking his thumb and rocking.

He often starts the day out fine, but then soon collapses.

Your heart just goes out to the kid. It seems to be something beyond his control.

The teachers said they guessed in the "old days" he would be beaten! Instead, we just feel such compassion, and such confusion.

I just hope there is an answer for this family.

[Bodhi Dharma Zen]

kittynh, have they tried biofeedback? it can be used for ADD and ADHD.