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Thursday 17 October 2013

SAFEGUARDING A GENERATION - These psychotropic drugs pose a Safeguarding risk for children. - by Dave Traxson Chartered Educational Psychologist - Courtesy of - www.teachingtimes.com n Vol 3.6 - Every Child Journal

-The biochemical colonization of young developing minds for huge profit and social control.

The drugs don’t work and do long term harm

www.teachingtimes.com n Vol 3.6
Conditions Every Child Journal

Our children are our collective messengers to a future that we will neither see nor inhabit. What messages do we, as a progressive society, want to transmit to future generations about the way we have chosen to treat children with
behavioural differences today?

Our society – in the form of an increasing number of Members of Parliament,
Professional Bodies, plus a growing number of concerned professionals and parents – is
now asking questions of the government and the psychiatry establishment about this
critical issue and raising concerns about our agreed collective responsibility to safeguard
children from the rapidly growing risk of harm from prescribed psychotropic drugs.
I posed the question in the introduction of this article at the end of a recent debate in
a committee room of the House of Commons, aimed at drawing parliamentary and public
attention to this area of the increased medication of children to control their complex
emotional and behavioural needs. The meeting was the culmination of two years of75
intense national awareness-raising by concerned psychologists about the growth in
the use of these mind-altering and potentially toxic drugs on school-aged children in
the UK.

This campaign – an effective but loose alliance between the Association of
Educational Psychologists; the divisions of Educational and Child Psychology
and Clinical Psychology of the British Psychological Psychological Society; the International Response Committee to DSM-5 (IRCD); professors of psychology and psychiatry; individual psychologists, like myself; along with representatives from psychiatry – has achieved considerable progress by mobilising professionals and their associations to lobby MPs and by writing articles such as this in a range of publications. Holding this debate with prominent American and British representatives of Psychiatry and Psychology in Parliament in June was a
major step and has added considerably to the public and professional debate since.
The campaign has now successfully challenged the rationale of some of the more
dubiously diagnosed disorders for childhood behavioural difficulties – now rebranded
as disorders – which once would have definitely fallen within the normal range of
societal expectations for children.

The role of schools
Clearly, schools provide an interface between children and society and as such they
have a pivotal role in safeguarding young people from the documented problems
of a mental health system which is unduly focused on diagnosing the supposed
‘mental illnesses’ which are proliferating. It is not easy for schools, but their pastoral
care teams in particular need to be aware of the pseudoscientific diagnostic and
classificatory systems which are in common use in Britain and the dangers that poses
to children in their care.
This is a view shared by the British Psychological Society in its recent submission
to the American Psychiatric Association’s (APA) international consultation. The APA
publishes the influential DSM (Diagnostic and Statistical) manuals, and the BPS paper
was entitled ‘The Future of Psychiatric Diagnosis’ (2012). The National Institute
of Health and Clinical Excellence (NICE) current guidance is that psychological
interventions should preferably be used first and that psychotropic drugs should only be
used initially in severe cases of Attention Deficit and Hyperactive Disorders (ADHD). This sadly
is far from the case in the actual paediatric practice on the ground across the country where
psychotropic drugs are still too readily prescribed. But the increase is being noted and more and
more schools are now questioning the wisdom of classifying increasing percentages of their
intakes with questionable disorders requiring psychotropic medication.

Pastoral care staff are asking questions of the prescribing doctors to clarify why drugs are
required when the children concerned have often not shown specific patterns of behaviour which
the unsatisfactory checklists require in a school setting. Often medics accept parental responses
to certain checklists and do not contact schools to verify that the behavioral patterns exist beyond the family setting as well, as good practice requires. One survey showed that doctors had checked children’s behaviour with their schools in less than half the cases in which drugs were prescribed. The findings are backed by anecdotal reports from chartered psychologists belonging to the Health Professions Council.

“Pastoral care staff are asking questions
of the prescribing doctors to clarify why
drugs are required when the children
concerned have often not shown
specific patterns of behaviour which the
unsatisfactory checklists require in a
school setting.”
This mounting pressure has prompted the Department of Health to collect for the
first time comprehensive data about the prescription of psychotropic medications to
children by psychiatrists and some paediatricians. The problem is exacerbated by the
recently published and influential diagnostic and statistical manual DSM-5 classificatory
system (May 2013) which identifies more childhood conditions than ever before.
As a result of these developments, an estimated three quarters of a million individual
prescriptions will be issued to children for psycho-stimulant medication such as Ritalin
alone, this year. This represents a near four hundred fold increase over the last twenty years. In
1991, only 2,000 prescriptions were issued. Clearly, children have not become 400 times more
problematic in that time – indeed some social commentators would argue that children in the 21st
century are more emotionally literate and have a wider range of coping strategies than
previous generations. So one has to conclude this response to children’s complex needs
is a function of society and business drivers of profitability and advertising. We urgently
need to reflect on this before it does physical and psychological harm to broad swathes of future
generations of young people.

The psychiatrist’s bible
There is great concern that this newly republished and enlarged manual, DSM-5, known
as ‘the psychiatrist’s bible,’ has pathologised an ever larger number of previously normal
range patterns of behaviour. For example, what some would call normal shyness has been
relabelled as Social Anxiety Disorder (SAD), common mood swings have become Juvenile
Bipolar Disorder (JBPD), typical temper tantrums have been reclassified as Intermittent
Explosive Disorder (IED) and a natural grief reaction to losing a close family member
has become Temporary Grief Syndrome (TGS). The latter scandalously removes the
‘bereavement exclusion’ which previously blocked anti-depressants being used for two
months after the loss of a loved one. This risky step has been criticised by many medical
bodies including the Lancet journal. Doctors are now allowed to medicate children and
adults alike from a fortnight after their traumatic loss with antidepressants which in the
early stages of treatment have been shown by research to regularly increase the risk of
suicidal thoughts.

This has lead to successful class actions in the courts in the US citing the harm done
to young people. In the US, each of the plethora of conditions has a four figure code
without which the prescribing doctor and psychiatrist do not get paid by the Insurance
Company scrutinising the claim form. We are not an insurance-based health system in
the UK and therefore do not need these codes here and the stigmatising labels that are a

I view the trend towards mass medication of children with mind altering and
potentially toxic drugs and ‘drug cocktails’ as a form of psycho-economic imperialism.
By that I mean that young peoples’ developing minds are being colonised, using
biochemicals, for huge commercial profit and in effect, increased social control. This has
resulted from carefully constructed ‘business plans’ in boardrooms which some years
ago saw the population of children in the western world as a great market expansion
opportunity. The pharmaceutical companies have reaped the huge financial rewards of
this rich and very bitter harvest ever since. The scale of this toxic harvest is indicated by a
number of class actions taken out by parents in the US which have resulted in out-of-court
settlements of several billion dollars, one for not releasing the research evidence that
would have indicated the potential level of serious physical harm that had indeed resulted.
As Ben Goldacre author of Bad Pharma (2012) states, these multi-national pharmaceutical
companies are prepared to ‘cherry pick’ from research data and discount studies that
are unfavourable to their longer term financial interests. This is not a conspiracy theory
but a current profit-driven international business project which risks short-term physical
harm such as major sleep disturbance or neuro-muscular irregularities such as tardive
dyskenesia (uncontrollable and sometimes irreversible muscular spasms) in children with
the potential for long-term psychological dependency. As Baroness Susan Greenfield,
the ex-director of the Royal Society has stated, the use of psychotropic drugs will result
in young people who will end up returning to the repeated pattern of using  psychopharmaceutical interventions whenever they face a problem in life, thereby continuing this very profitable vicious cycle of pharmaceutical dependency.

International use of psychotropic drugs
Patterns of prescribed psychotropic drug usage vary dramatically between cultures and
countries. In Italy, where prescribing psycho-stimulants for children has been restricted
since 2006, the drugs are used by only 0.13 per cent of children. In the US, eight per cent of
the total school population are on psycho-stimulants alone and as many as 20 per cent on
one or more drug including anti-psychotics and anti-depressants. The range in the UK of
1.5 to two percent is thankfully closer to our European neighbours than our transatlantic
cousins but is rising. France also has lower rate of 0.5 per cent because psychotherapy or
increased engagement in sport is preferred as a viable alternative to using psychotropic
drugs. Some Scandinavian countries are also well below a one per cent level of the school
population prescription rate. For example, Sweden is at 0.15 per cent because of its
commitment to intensive psychological interventions.(1)

My belief is that we in Britain belong to a more progressive and less aggressively
intrusive medical tradition to Canada and the US, with a stronger leaning towards
socially constructed explanations of behaviour ‘disorders’. In the UK
and Europe, we also value individual differences even if some of those
behaviours are challenging to us. This theory is supported, in my view,
by the fact that American psychiatrists are still using Electro Convulsive
Therapy regularly with adolescents who are unresponsive to antidepressants
while the use of this contentious approach has significantly
reduced or even been restricted in some countries here in Europe and

Many psychologists working with children have started using the ‘ethical
legitimacy’ afforded to them by the ‘Duties of Registrants,’(2009) of the Health
Professions Council, to better safeguard children on their caseload. This
usually involves making a phone call to the prescribing medic and sharing
concerns about the pattern of behaviours in various settings and how this
may not comply with published guidelines or to clarify information about
the side effects of the drug or their interactions with other drugs in the drug

It is interesting that in most cases, medical colleagues thank the psychologist
concerned for sharing the information and usually make some appropriate adjustment to
the prescribing schedule. This has been particularly true in relation to cases where children
under the age of six were prescribed psycho-stimulants or antipsychotics – a practice that
runs against the advice of the NICE.

“Many psychologists
working with children have
started using the ‘ethical
legitimacy’ afforded to
them by the Duties of
Safeguarding a generation by appropriate challenge.
Professional bodies of educational and clinical psychologists are united in their concerns about the diagnostic schedules, like DSM-5, which they feel lack the necessary scientific validity
and are not fit for the purpose of 21st century holistic assessment.
Many case studies illustrating the dangers to children involved could be shared but a typical example is a thirteen year old boy who was already on maximum dosage levels of a psychostimulant and high levels of an antipsychotic drug. His mother asked for
him to be put on an anti-depressant to deal with his low mood. In this and a few other reported cases, such changes were made without seeing the child concerned, which is against General
Medical Council (GMC) regulations.

Others involve psycho-stimulants being regularly given to children with high levels of anxiety which again is againstNICE guidelines on ADHD.

We psychologists are not saying that drugs should never be prescribed and on occasions, we have seen the benefits of selective use. We do though urge the government to ensure that the well-researched NICE guidelines should be followed, particularly by prescribing doctors, and that psychostimulants should never be used with under fives and should also not be given to a child whose primary presenting problem is anxiety.

Surely when our precious NHS is under threat from swinging cuts, the time is right
to review practices which are expensive and fundamentally flawed. More and more
psychologists in Britain have principled concerns about labelling a still developing child
in such a pejorative way and the harm done to them by the internal attributions of
abnormality that may well result. Rather than a within child biomedical explanation of the
difficulties experienced, they prefer a more holistic and socially contextualised hypothesis
that includes a range of the complex web of interacting factors that usually explain
challenging behaviour.

A variation of the old maxim holds true – for every child’s complex presenting
behavioural pattern there is a simple and easy explanation or solution which is invariably
not good enough. Let us move as a society from a ‘quick fix’ mindset to one with a more
interactionist perspective that leaves the child better placed to use their personal power
and confidence to make better choices in a life over which they have more control.

Dave Traxson is a Chartered Educational Psychologist. (traxsondave@gmail.com)

For more information on the campaign outlined in this article, visit : copeyp.
blogspot.com (Challenging Overprescription by Professionals in Education for
Young People).
1.      Comparison of Psychotropic Medication in Youth (2008) by K.Jahnsen et al on BioMed Central Website
2.       and “Opening the White Boxes,” (2009)by L.Aafgard et al.Wiley.London.

1 comment:

  1. I agree completely and thank you Dave for this eloquent and informative article.

    There are so many effective, non-medical, non-invasive approaches these days to children presenting with disturbing or challenging behaviour, and good practice should always be to take the family and school contexts into account, together with any other relevant systems involved in and exerting influence on their lives. The drawback with such approaches is that it demands time, expertise and compassionate insight on the part of the professionals - reaching for a prescription pad is an unsatisfactory "quick fix" that protects the practitioner from the child's emotional distress! - but the short term investment is in my view worth it for the future health of children and therefore of our future society.