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How Medication is Used to Treat Mental Illness In Children



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Sat Mar 04, 2017 2:47 am
Mea says...



In my AP English class, we've just begun a semester-long research and advocacy project on the topic of our choosing. Currently, my broad topic is as stated in the title of the thread: the efficacy of medication in the treatment of mental illness in the US, with a focus on children.

I know that is a very broad topic, but I'm planning on narrowing it down a lot, probably to one specific mental illness and possibly even one specific medication. I'm both fascinated by this topic and care about it a lot, but to be completely honest I don't know that much about it, which for the moment precludes me from narrowing it down more.

I've gotten ahold of a couple textbooks on Abnormal Psychology and am hoping to use them to get an overview of the subject, but they don't specifically focus on children. What I'm looking for is more sources that specifically focus on children, and also on the balance of therapy and medication in treatment.

I'm open to suggestions as to which mental illness I should focus on, and ways to narrow my topic in general. The other thing I really need to understand is the process of a) being diagnosed with a mental illness (particularly as a child/teen) and b) getting the medication. How difficult was it? What were the requirements? (Bear in mind this is about the US.)

I know all that varies wildly depending on where you are and which mental illness it is or what medication you need. What I'm mostly asking is: where can I go to find this type of detailed information?

Thank you all. <3
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Sat Mar 04, 2017 3:30 am
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GoldenQuill says...



I would try TED Talks to find that sort of detailed information, or look into Dr. Amen's studies -- he's a psychiatrist who specializes in "alternative ways" of healing people with depression and the like. That's really all I can offer in the research area.

However, to your other question about how easy it is to get diagnosed with a mental illness: in my experience, it was ridiculously easy. RIDICULOUSLY.
I am biased, however, because I've been going to the doctors for over 20 years trying to get a disabling illness diagnosed, so maybe others would not see it as easy.

My first visit to a psychologist, they made me do a test and they diagnosed me. I actually wrote a journal of the whole thing -- I'll send you a link in case you're interested.
http://farwalking.tumblr.com/post/64804 ... write-this

It's also VERY quick to get in to see psychologists. With most doctors, you're waiting months or years. With psychologists, you're waiting weeks, if that.

If there's anything else I could help with, let me know!
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Sun Mar 05, 2017 3:28 pm
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Carlito says...



I think you already know this, but I'm a therapist and I work with children (5-12)! :D I can't prescribe medication, but several of the kids I work with take medication for their mental illness.

In terms of diagnosing - like GoldenQuill said, it's actually pretty easy. The most obvious way is to go to a mental health provider. The first step is doing an intake assessment which usually takes 1-2 hours. In the intake assessment the mental health provider takes a detailed medical history including current and past health and mental health problems, information about the pregnancy/delivery/milestone achievement, and family history of health and mental health problems. The provider also learns about the presenting problem, what the areas of concern or symptoms are, how long they've been occurring, how often they're occurring, what kinds of setting/situations they're occurring, etc. I ask about every major symptom group to make sure I don't miss anything (psychosis, depression, anxiety, attention/concentration/hyperactivity, oppositional/conduct/anger, trauma, eating, sleep). There are close to a million questions, but the goal is to get a big overall picture of who this person is and what the biggest areas of concern are. From there, providers consult the DSM-5 (Diagnostic Standard Manual) to come up with the diagnosis (or diagnoses) and boom you have a diagnosis.

Sometimes just going to your family doctor can yield a diagnosis - I think most commonly ADHD, depression, or anxiety. Some kids go through neurological testing and receive a diagnosis that way. Some diagnoses like autism have to be diagnosed by a medical provider before the child can get services like ABA. More serious mental illnesses in children are rare (I'm talking schizophrenia, bipolar) and are usually diagnosed by doctors of psychology but can be diagnosed by any mental health provider. The vast majority of kids I see have ADHD, depression, anxiety, PTSD, or some combination of those.

In terms of medication, depending on where you go, it's also not too hard to get it. In my experience, primary care doctors will dole out ADHD meds like candy if you ask for it. Most primary care doctors will prescribe anxiety or depression medication for children if asked. For more serious situations, a psychiatrist or a neurologist gets involved. Where I work, we offer medication services and if I were to refer a child for that they would need to have a psychiatric evaluation first and then the prescribing doctor would recommend certain medications. Then they have check-ups at least every three months to make sure there are no side effects and the meds are doing what we want. Some of the more intense psychiatric medications require the child to be seen by a therapist as long as they're on it.

Now, the research I've read shows that for the vast majority of mental illnesses, therapy works super well and therapy plus medication works super, super well. For child psychiatry, there is a scary lack of research. For many of the drugs that are prescribed to kids, we don't know what the long term effects are or even if they're 100% safe for kids. I'm not against prescribing medication for kids because I think in some cases it's super helpful, but I do think kids are over-medicated and that freaks me out. There's a really good documentary about this that I had to watch for one of my classes. I'll try to find it for you :)

In terms of ideas to focus in on, ADHD would be a classic choice. By far the majority of kids I work with that are medicated are medicated for ADHD. I could go on and on about ADHD because I think it's way over-diagnosed and probably over-medicated (but that's another topic). There are tons of different ADHD meds and they're super common in the US.

If you want to get a little more controversial or into a more challenging area, I would go with depression or anxiety. In my experience, they're prescribed for kids (especially depression meds as mood stabilizers for aggressive/explosive/angry kids) but less commonly than ADHD. If you want to get super controversial I would go with anti-psychotics for kids. It happens, and I have strong feelings about it :P

I can probably dig up some titles or some documentaries of things I read in grad school once you narrow it down a bit more too. And I'd be happy to go into more depth or answer any clarifying questions if needed too. I <3 all things child mental health :D
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Sun Mar 05, 2017 6:54 pm
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Zolen says...



I'm an ADHD guy who was medicated most of my childhood -that was quite a horrible thing for me-, if you want detailed information from someone who experienced that sort of thing.
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Sun Mar 05, 2017 8:06 pm
Mea says...



@GoldenQuill - Ooh, yes, TED Talks are a good idea. Thanks for the suggestion!

@Carlito - Thank you so much, that's really helpful. I knew a bit about ADHD and the controversy surrounding that. I'll probably wind up either doing that or depression/anxiety if I want to take the less beaten path. Lack of research on the effects of the drugs I think will be a key factor in my argument.

And a documentary would be awesome. <3
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Wed Mar 08, 2017 1:18 am
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Carlito says...



Mea wrote:@Carlito - Thank you so much, that's really helpful. I knew a bit about ADHD and the controversy surrounding that. I'll probably wind up either doing that or depression/anxiety if I want to take the less beaten path. Lack of research on the effects of the drugs I think will be a key factor in my argument.

And a documentary would be awesome. <3

I looked at one of my old syllabi and found some of the things I was thinking about in terms of the treatment of ADHD and ADHD meds:
An epidemic of attention deficit disorder
The selling of attention deficit disorder
The documentary I was thinking of - It talks about medicating children in general and if I remember correctly (it's been a year or so since I saw it) it talks about ADHD meds and anti-psychotics.

If you can find these articles, they might be useful too:
Tarver, J., Daley, D., & Sayal, K. (2015). Beyond symptom control for attention-deficit hyperactivity disorder (ADHD): what can parents do to improve outcomes?. Child: Care, Health & Development, 41(1), 1-14 14p.doi:10.1111/cch.12159
Cortese, S., Holtmann, M., Banaschewski, T., Buitelaar, J., Coghill, D., Danckaerts, M., & ... Sergeant, J. (2013).
Practitioner review: Current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents.Journal Of Child Psychology And Psychiatry, 54(3), 227-246. doi:10.1111/jcpp.12036

I can do a little more digging too if need be, especially once you start to get into your research. I know I have a lot more stuff :D
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Fri Mar 10, 2017 1:15 pm
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StellaThomas says...



I can't really top @Carlito's answer, but the documentary she's talking about might be Louis Theroux's Medicated Kids (I typed it into Google and this is the second link that popped up, however it's on Netflix which would be much better quality so watch it there if it's available in your country!) Of course the documentary is a little hyperbolic but it is interesting.

I know in my country they're fairly reticent about putting kids on anti-depressants/anti-anxiety meds unless it's felt absolutely necessary. This is because, as Carlito says, there's a severe lack of evidence in kids. This isn't just in psych meds but for any meds - because you can't conduct clinical trials on children, it's not considered very ethical unless it's a really commonly used drug in children, so most of our evidence for kids is based off of adult evidence. So that's an issue not just in psychiatric medicine, but in all branches of medicine. The psych drugs are just maybe slightly more controversial because some of them can have quite bad side effect profiles. Particularly anti-psychotics. But psychosis generally doesn't turn up until teenage years - though sometimes anti-psychotics are used in other conditions in adults too, but probably less likely in kids.

For everybody, but especially for children, there is a big emphasis on therapy; I can't imagine your character having medication without concomitant therapy of one type or another.

I don't know how clinical psychologists diagnose, but for psychiatrists/doctors in general, we like diagnostic criteria like the DSM-V or ICD-10 (DSM-V in America, ICD-10 in Europe as a general rule). This is basically a list of symptoms that you can check off and see where the person falls in terms of diagnosis, but they are guidelines. Especially in children, mental illness can present atypically, and diagnosis can be based much more off of the clinician's own clinical acumen and experience than what the criteria dictate.

EDIT - wow that video embedded which I didn't expect. It's called Louis Theroux's America's Medicated Kids.
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Fri Mar 17, 2017 11:40 am
Mea says...



@Carlito - You've already been a huge help, but now I'm looking into the current state of mental heath support in US public schools (things like the psychologists/social workers available and whether or not there's any requirements or regulation about them in place) and I'm not finding a lot of concrete information on what's already there. Do you know anything about that, or do you not really work in schools?

Thanks again. <3
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Fri Mar 17, 2017 9:02 pm
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Carlito says...



@Mea well aren't you in luck because I actually do work in a school. I'll PM you :)
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