Drugs shouldn’t be first response to children’s problems, speakers say

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VATICAN, June 18, 2013 (CNS) — When children exhibit behavioral problems, doctors and families should consider social and psychological support and not immediately try to address the difficulty with prescription drugs, said a number of speakers at a Vatican conference.

Caution should be used not only because many prescribed medications can cause serious side effects, but because often the child’s behavioral problems are rooted in anxiety, stress and other psychological, not biological, causes, many speakers said.

Pediatricians, pharmacologists, psychotherapists, psychiatrists, social workers, counselors, ethicists and members of religious orders active in the field of health care were among the dozens of speakers at an international meeting hosted by the Pontifical Council for Health Care Ministry June 14-15.

Speakers at the conference, “The Child as a Person and as a Patient: Therapeutic Approaches Compared,” presented their findings and preferred practices for dealing with disturbed, distressed or troubled children and adolescents.

Several speakers noted an increase, especially in North America and parts of Europe, in the use of anti-depressants and so-called psychotropic medications for children who have been diagnosed with depression or who exhibit hyperactive, anti-social or aggressive behavior.

Jacqueline Sparks, a professor at the University of Rhode Island’s department of human development and family studies, said prescription rates of anti-psychotics have “dramatically increased” in the United States. Worse hit are poorer or vulnerable children who receive Medicaid and have seen a “seven- to 12-fold increase in prescriptions,” she told Catholic News Service.

But one “very disturbing trend” for this group of children is they are “four times more likely to be prescribed an anti-psychotic” for irritability or behavioral problems which are not the psychotic episodes — such as hallucinations and extreme mental disturbances — the drugs are meant to treat, she said.

Anti-psychotics are being used to help “restrain” or calm troubled youths “because of their somnolence effect,” she said. However, she and others said doctors should consider whether the serious physical side effects, which include weight gain, sexual dysfunction and suicidal thoughts, outweigh the sometimes questionable short-term benefits.

Speakers didn’t discount the importance of pharmaceuticals in providing needed medical care and relief; rather the criticism lay in claims that many of the medications being prescribed don’t adequately tackle the root causes of many mental health problems.

Jaakko Seikkula, a psychotherapist and professor at the University of Jyvaskyla, Finland, said that mental health problems, including anxiety, depression and psychoses, represent the body’s reaction to unbearable or unmanageable situations. “It’s a question of being in an extremely stressful situation,” he said.

While medicinal treatment can be appropriate depending on the severity of the emotional reaction, many problems can be managed in the long term with dialogue, he told CNS.

He said this so-called “Open Dialogue Treatment,” which he helped develop, brings patients, family members and peers together with the help of trained professionals to learn to talk about their struggles, understand each other’s feelings and develop healthier ways to deal with problems.

Seikkula said it’s important to “stop the isolation process, which is very dangerous,” and reconnect patients with loved ones and peers because people “left alone in their struggles of life develop a kind of survival strategy in which odd behavior emerges.”

Depression in children has increased, he said, in part because “demands are heavier” both on children and families, and because social relations seem to be more precarious in individualistic societies. Children today can “easily feel excluded and that is very harming.”

Some mental health professionals at the Vatican conference expressed concern that a “pill culture” also teaches children the wrong lessons in life.

Dr. Joanna Moncrieff, who teaches in the department of mental health services at University College London, told attendees that one message such a culture sends children is that “they need a drug to control themselves; they need a crutch or they can’t learn.”

Father John M. Bonavitacola of Our Lady of Mount Carmel parish in Tempe, Ariz., said that when kids are on medication and get no therapy, “their coping skills atrophy or they never learn how to deal with life” and with handling various personalities and situations.

The diocesan priest, who works with teens who have eating or cutting disorders, abuse drugs or suffer from other problems, said often the spiritual approach to life’s difficulties has been abandoned “as archaic, a product of Medieval times.”

“Problems are emotional, solutions are spiritual. People need spiritual tools and the best spiritual tool is having a relationship with God,” he told a working group at the conference.

Dr. Pat Bracken, a psychiatrist in Cork, Ireland, said in his speech that religion and prayer used to play a larger role in helping people deal with sadness, loss and distress.

“While religion is not the answer to everything, different societies have different ways to respond” to the emotional reactions triggered by life’s challenges and pains, he said.

Sparks, the Rhode Island professor, said that by labeling a child or adolescent’s problem as an illness “carves the kids out as deficient right when they are forming their identities.”

This can worsen some behavioral problems as kids may “use their illness to get out of responsibilities” and blame their unwillingness to do homework or treat others respectfully on their diagnosis.

“It’s a vicious cycle and parents are often at a loss as to how to hold their child accountable,” she said.

Archbishop Zygmunt Zimowski, president of the health care ministry council, said in his opening remarks that medical approaches should be holistic — taking care of the child’s physical, psychic and spiritual well-being.

Practitioners need to employ not just “clinical techniques” in medicine, but also address the child’s social surroundings, relationships and access to spiritual support and care, he said.

Msgr. Renzo Pegoraro of the Pontifical Academy for Life told CNS that the church advocates a “multi-disciplinary approach” that stresses the importance of building a sense of hope based on respectful and caring relationships between professional staff, family and patient.

Treatments need to be about “finding meaning, not just a medical outcome,” he said. (Carol Glatz)

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