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Sunday 16 August 2015

REFLECTIVE CHECKLIST IDEA -"An Educational Psychologist in the UK, Dave Traxson, has come up with a terrific suggestion to help contain the epidemic of careless medication in kids. He has developed a Checklist of questions doctors should think about before prescribing psychoactive drugs to children." - Professor Allen Frances - Courtesy of Psychiatric Times Website + SELECTED PLAUDITS

A Checklist to Stop Misuse of Psychiatric Medication in Kids
July 30, 2015 | Couch in Crisis – PsychiatricTimes Website

A perfect storm of interacting detrimental factors has resulted in the recent massive overuse of psychotropic medication in children.
Drug companies started to focus their marketing campaigns on kids when the adult market was saturated. Children make perfect customers—get them used to psychoactive pills when they are young and they may continue to use them for life.
Doctors have swallowed the misleading sales pitch that typical problems in children are really underdiagnosed and undertreated “mental disorders”—very easy to diagnose and very easy to treat with a pill. Just the opposite is true. Children change so much in response to environment and development that their diagnosis and treatment always require the greatest care, patience, and time. I can’t picture ever starting a child on medications after a brief evaluation, but this is often done.
Parents far too readily follow doctors’ advice about medication for their children. I recommend always becoming a fully informed consumer and getting second and third opinions before allowing your child to take any psychiatric medicine. This is an important decision that requires careful deliberation and full parental input.
Overwhelmed teachers often recommend that parents take their kids to doctors for medicine when the problem may be more in the classroom than in the kid.
Dave Traxson, a child and educational psychologist in the United Kingdom, has come up with a terrific suggestion to help contain the epidemic of careless medication in kids. He has developed a Checklist of questions doctors should think about before prescribing psychoactive drugs to children. Dave writes:

There has been an unchecked, exponential growth in the use of psychostimulants, antidepressants, and antipsychotic drugs in kids—often harming more than helping them.
I have devised a Reflective Checklist to help clinicians think through the necessary steps that should be part of every careful prescription of medication for children.
• Does the child have a classic presentation that closely conforms to an approved indication for this particular medication?
• Is there well documented research on efficacy and safety with children of the same age, gender, and social grouping?
• Are the child’s problems pervasive, occurring in a wide range of social settings and observed by many different individuals?
• Are the child’s problems severe, enduring, and impairing?
• Do the child’s parents and involved professionals see the problems as significant enough to require medication?
• Are there stresses in the child’s relationships, social context, and recent history which might explain this pattern of behaviors?
• Has a psychological or social intervention been tried prior to prescribing medication?
• Have there been any significant adverse side effects from medication?
• Have you carefully weighed short- and long-term risks and balanced them against possible benefits?
• Have you received informed consent from the parent and (where appropriate) the child?
And, perhaps the most telling question
• If a child in your immediate family or circle of friends had the same presenting problems as the child you are considering psychotropic drugs for , would you be prescribing medicine now?
Thanks, Dave. We simply don’t know what will be the long-term impact of bathing a child’s immature brain with powerful chemicals. We are now conducting an uncontrolled experiment without informed consent with unknown consequences for millions of our kids.
There are childhood problems that certainly do require medication, but this should only be a last resort after careful consideration of less invasive interventions. Medication should never be, as it now too often is, a first and careless reflex. Dr Traxson’s Checklist is an excellent guide to more responsible practice.
And parents must be mindful of the need to protect their kids from excessive medication use. There is not a pill for every child-rearing problem. Never accept a prescription if it has been written after a quick evaluation without a full exploration of alternatives.

- See more at: http://www.psychiatrictimes.com/blogs/couch-crisis/checklist-stop-misuse-psychiatric-medication-kids?cid=dlvr.it#sthash.FBqx17H5.dpuf


1 - "Dear Dr. Traxson, I saw your proposed checklist re child psych medications in Psychiatric Times.
It seems clear, thoughtful and feasible. I wonder if you have done any work regarding its psychometric properties, such as reliability, validity, sensitivity, specificity?
Thank you.”
 Lloyd Sederer, MD
Medical Director, NYS Office of Mental Health
Adjunct Professor, Columbia/Mailman School of Public Health
Medical Editor for Mental Health, The Huffington Post
Contributing Writer, US News and World Report

2- “Thanks Dave - up to your usual high standards for Safeguarding Children & Young People.”
Chris Goldburn, Social Care Consultant.  Specialising in Safeguarding and Children's Services Improvement & Delivery.

3 - “Thanks for the check list. I wonder how many children would really need medications after working through this checklist?  I am a child and adolescent psychiatrist (Denmark), and as the years go by I find fewer and fewer children really need medications, and more and more do so much better without the meds that didn´t really help in the first place. But it is not popular talk around the block.”

Lisbeth Kortegaard - Consultant Child and Adolescent Psychiatrist at Child and Adolescent Psychiatry in Hoejbjerg, Central Region, Denmark
I am

4 - "I am a clinical psychologist who specializes in comprehensive evaluations of children and adolescents. I find that I am, with alarming frequency having to "un-diagnose" children who have been labeled with DSM disorders for which they do not remotely meet criteria and then are medicated based upon hasty, uniformed and frankly incompetent diagnostics. A good example is the number of children who actually meet criteria for ADHD whose emotional regulation problems are misdiagnosed as a bipolar disorder and then drugged accordingly. This is a huge disservice to our children and their families and I would add to David Traxon's list a comprehensive evaluation that looks at the child's functioning across multiple domains.

5 - A psychiatrist from Uttar Pradesh sent me a message of support saying that she had distributed it to her small team of mental health professionals and she was confident that when they use the checklist reflectively it would save their limited resources for more important priorities. Hard to top that on several counts.

- See more at: http://www.psychiatrictimes.com/blogs/couch-crisis/checklist-stop-misuse-psychiatric-medication-kids?cid=dlvr.it#sthash.FBqx17H5.A2RSI2AZ.dpuf