EBD Blog

Many children youths are taking combinations of prescribed medications for Emotional and Behavioral Disorders, despite the lack of scientific evidence that these “cocktails” are helpful, according to a story in the New York Times by Gardinder Harris. Mr. Harris notes that there is evidence that some individual medications have beneficial effects.

But a growing number of children and teenagers in the United States are taking not just a single drug for discrete psychiatric difficulties but combinations of powerful and even life-threatening medications to treat a dizzying array of problems.

Last year in the United States, about 1.6 million children and teenagers — 280,000 of them under age 10 — were given at least two psychiatric drugs in combination, according to an analysis performed by Medco Health Solutions at the request of The New York Times. More than 500,000 were prescribed at least three psychiatric drugs. More than 160,000 got at least four medications together, the analysis found.

Mr Harris quotes selected psychiatrists, including well regarded experts such as Steven E. Hyman, as saying there is no evidence of efficacy with multi-medication prescriptions. Clinically, there is agreement that sometimes extreme cases require less-than-scientific experimentation, often based on parent- and child report-data, in hopes of finding a good mix of medications. Clearly, the field of EBD needs more data and more high-quality data on these issues.

Link to Mr. Harris’ article (free subscription may be required).

Bernard Rimland, long-time advocate for individuals with autism, died of cancer Tuesday 21 November 2006 in El Cajon (CA, US). Mr. Rimland, who received a Ph.D. in psychology in 1953 from Pennsylvania State University, is considered by many to have had a fundamental role in promoting the neurophysiological view of autism and, thus, helping to discredit mistaken notions about faulty parenting (“refrigerator mothers”) as the cause of autism.

Although he sometimes championed controversial ideas about autism (e.g., large doses of vitamin B-6), Mr. Rimland had a substantial impact on the scientific understanding and treatment of the disorder. Among Mr. Rimland’s many accomplishments are these: He

• Wrote the ground-breaking book Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior in 1964;
• Edited the Autism Research Review International
• Founded the Autism Research Institute
• Co-founded Defeat Autism Now!, which provides the DAN! Conference and DAN! Webcasts

Mr. Rimland was born 15 November 1928 in Cleveland (OH, US). He is survived by his wife, Gloria, and three children. Jack Williams, of the San Diego Union Tribune, published an obituary. There is more information available on the Wikipedia, too.

Children receive diverse psychiatric diagnoses of Emotional and Behavioral Disorders that leave parents and the children bewildered, according to a story entitled “What’s Wrong With a Child? Psychiatrists Often Disagree” by Benedict Carey, in the New York (NY, US) Times. Mr. Carey recounts multiple examples of children who have been characterized as having bipolar disorder, attention deficit disorder, oppositional-defiant disorder, pervasive developmental disorder, depression and anxiety.

At a time when increasing numbers of children are being treated for psychiatric problems, naming those problems remains more an art than a science. Doctors often disagree about what is wrong.

A child’s problems are now routinely given two or more diagnoses at the same time, like attention deficit and bipolar disorders. And parents of disruptive children in particular — those who once might have been called delinquents, or simply “problem children” — say they hear an alphabet soup of labels that seem to change as often as a child’s shoe size.

In my opinion, this is a pretty predictable consequence of approaching these problems as something that should be handled by medical practices, when many of them would be better managed by environmental manipulations. We need to identify the specific needs of the children and design methods for teaching them how to do things. If the problem is “argues with adults,” we should analyze the conditions under which the behavior occurs—the antecedents and the consequences of arguing—and either modify those events or teach the child a self-management strategy (or both). If the problem is fidgeting (is that really a problem?), we need to determine what fidgeting does for the child and address that function; I suspect that most children can learn non-fidgets activities and, when we make them more rewarding than fidgeting, the salience of the problem will be reduced greatly.

What happens too often, in my view, is that we go through a checklist of “symptoms” looking for a secret, hidden pattern that represents an underlying disorder. We’re still trying to do Freud here. What we actually get, of course, is a cluster problems. Evidence may show that these problems do, in fact, cluster together, but such clustering doesn’t necessarily indicate that they reflect an underlying organic base for the individual problems.

I also recognize that providers of mental health care for children must use a diagnostic system so that costs of providing services can be charged to insurance companies. Just because someone has to pay for therapy doesn’t mean that therapy has to be medications nor that we should ignore simple and practical means of addressing problems.

Link to Mr. Carey’s article (free subscription may be required).

A person who identifies herself as Andrea maintains a blog called Andrea’s Buzzing About in which she covers a bundle of issues. These are some of the categories she uses: ADD and ADHD, advocacy, auditory processing disorder, autism and Asperger’s, aversives, behaviour management, developmental disabilities, epidemiology, eye contact, IEPs, inclusiveness, injustice, invisible disabilities, Judge Rotenberg Center, Learning Disabilities, learning styles, logical fallacies, medical quackery (and quackery in general), meltdowns, parenting, prosopagnosia, pseudoscience, punishment and rewards, special education, “stimming,” teaching, Tourette’s, and tutoring.

Andrea’s buzz is thoughtful and literate. Although I disagree with some of her views (e.g., her take on aversives doesn’t align with mine), I find her posts worth reading as they provide a good glimpse into her interpretations of her experiences. Because she experiences some pretty interesting events, it’s often enlightening.

Read Andrea’s Buzzing About.