Frontline program on medicating kids for psychiatric issues

[Doctor Bagel]

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I just watched this last night and thought it was pretty interesting. It doesn't answer a lot of questions (it seems like no one can), but it seemed to give equal representation to ideas in favor of and against medicating children. It's special focus was on the diagnosis and treatment of bipolar disorder in kids. You can watch it online here --

http://www.pbs.org/wgbh/pages/frontline/medicatedchild/

 

[Chimed]

Yeah. I saw this last night. I thought they did a pretty good job of presenting a balanced view of the inherent problems and challanges in treating children with a psychiatric diagnosis.

 

[PeeWee137]

i saw it too. it was fascinating. but it makes me wonder if some parents "doctor shop" when they think something is wrong with their kid. its almost like an official diagnosis is comforting to them so it can be "fixed", and it lets them off the hook from being a bad parent. im still on the fence as to whether a 4 year old can be bipolar. but the show was as unbiased as it could have been. 👍

 

[whopper]

Frontline's a great program. I consider it one of the best journalism shows.

Unfortunately I missed last night's program.

 

[TheWowEffect]

but it makes me wonder if some parents "doctor shop" when they think something is wrong with their kid. its almost like an official diagnosis is comforting to them so it can be "fixed", and it lets them off the hook from being a bad parent.

Oh! those evil parents Don't get me started on this😡

But seriously, there is a very thin line here we are treading on. It makes a stronger case for more objective and refined diagnostic techniques in psychiatry. Hopefully, DSM-V can lead us in a better direction.

 

[Chimed]

Frontline's a great program. I consider it one of the best journalism shows.

Unfortunately I missed last night's program.

Hey whopper, were did you get that hip and funky "2 year member" icon and how come nobody else with greater then 2 years has it? 😀

 

[Doctor Bagel]

Hey whopper, were did you get that hip and funky "2 year member" icon and how come nobody else with greater then 2 years has it? 😀

Supposedly it's being processed in batches, so eventually everyone who qualifies will get it. 🙂

 

[Chimed]

Supposedly it's being processed in batches, so eventually everyone who qualifies will get it. 🙂

Wow, and now you have a 5 year cool and funky icon!

I feel so inadequate. Not only am I a lowly intern, but I have two years to go before I get one of those icons...🙁

 

[whopper]

Hey I didn't do anything specific to get that badge other than be on the forum!

Chimed, don't worry. You're in good company as an intern.

 

[MBK2003]

i saw it too. it was fascinating. but it makes me wonder if some parents "doctor shop" when they think something is wrong with their kid. its almost like an official diagnosis is comforting to them so it can be "fixed", and it lets them off the hook from being a bad parent. im still on the fence as to whether a 4 year old can be bipolar. but the show was as unbiased as it could have been. 👍

I think the journalist came from a biased point of view, but overall gave a relatively fair representation. I'm glad that they had John March on, as he came off well as the voice of reason. There was one psychiatrist who made me cringe and yell at the television however. It was the psychiatrist who discouraged the mom from therapy, instead preferring to go up on the child's Trileptal and suggested Xanax as a reasonable option for the child's 2 hours of anxiety prior to leaving for school. Later you saw this Mom putting the kids to bed in front of the television, holding and stroking them. I wanted someone to also mention that individual and family therapy would be reasonable options for this kid.

 

[billypilgrim37]

I think the followup segment should be a Biederman-Geller steel-cage match, once and for all.

As peds bipolar is my primary research interest, this was a fun segment, as I interviewed with quite a few of the docs on the program (including my future PI).

 

[Chimed]

I think the journalist came from a biased point of view, but overall gave a relatively fair representation. I'm glad that they had John March on, as he came off well as the voice of reason. There was one psychiatrist who made me cringe and yell at the television however. It was the psychiatrist who discouraged the mom from therapy, instead preferring to go up on the child's Trileptal and suggested Xanax as a reasonable option for the child's 2 hours of anxiety prior to leaving for school. Later you saw this Mom putting the kids to bed in front of the television, holding and stroking them. I wanted someone to also mention that individual and family therapy would be reasonable options for this kid.

I must have been making popcorn during this part.

I agree with you. Unless there is a situation where it would be too soon to open old wounds with something like psychodynamic therapy, adding counseling and therapy should be standard of care, no matter what the medication.

 

[billypilgrim37]

adding counseling and therapy should be standard of care, no matter what the medication.

Probably depends very much on the geography, and I'm not sure if they ever say where "Dr Bacon" practices. Just as there's a shortage of child psychiatrists in less populated areas, there's a fantastic shortage of qualified therapists in these areas as well. In places where I've lived, a referral to a counselor or therapist meant a referral to the Christian counselor who did more harm than good and who thought CBT meant Christ Beats Terrorists. Because there was nobody else within a 45 minute drive available.

And you might say the psychiatrist himself should offer those services, but given the demand for child psychiatrists in some of these areas, a 1-hour therapy session means that 2-3 other children do not get care at all.

Therapy may be of marginal benefit, and depending on the cost to the family, might be an entirely inappropriate recommendation to a family already struggling to keep from exploding.

Which isn't to say that I don't agree with you in theory 🙂

 

[MBK2003]

Therapy may be of marginal benefit, and depending on the cost to the family, might be an entirely inappropriate recommendation to a family already struggling to keep from exploding.

Which isn't to say that I don't agree with you in theory 🙂

I agree that there is shortage of qualified child therapists, however, I think that as psychiatrists we play some role in finding and utilizing appropriate resources for therapy. For example, some school social workers and school psychologists have time available for therapy/counseling slots for high-needs kids. They often have some CBT training and have the distinct advantage of being able to observe classroom behavior. I would argue that any child carrying a diagnosis of pediatric bipolar disorder is by definition a "high needs child" and would deserve some additional utilization of resources to get an appropriate multimodal treatment. I'm a big proponent of family therapy which when done well has great potential to stabilize these struggling families.

 

[Doc Samson]

This is why I get upset when we start separating "psychopharmacologists" from "psychiatrists." A well-trained child psychiatrist should be able to "do" both meds and therapy. Of course, whether competing time demands allow them to do so is another question entirely.

FWIW, Dr. Mrs. Doc Samson (a child psychiatrist) nearly broke our TV when Dr. Bacon recommended against psychotherapy - and she trained under Biederman (as much of a psychopharm guru as he is, a lot of his patients are in therapy too).

 

[BabyPsychDoc]

just want to say thank you to Dr Bagel for posting the link - I watched the show on the internet last night. I was shocked at the lack of regulation in the field, with pretty much everyone doing whatever they wanted - the ***** pushing Xanax on a 4 yo with school anxiety, the social worker "interpreting" the brain scan results, the parents blindly following all these ..."businessmen in the field of medicine", I guess, is the appropriate term, since I honestly can't call SW a specialist, and I do not want to call Dr Bacon a specialist, either.

I agree that following "the oncology model", with every kid's mandatory enrollment in a trial, may be an answer. However, there are some differences between child psych and oncology. You cannot get chemotherapy without being under care of an oncology specialist. You can be put on some psychotropic meds (Ritalin, of course, SSRIs also come to mind) by any GP or paediatrician. Unless there is a law stipulating that only kids that have been assessed by a child psych can be started on any psych meds, the "oncology model" proposal will remain wishful thinking. And I think it would be very difficult to pass such a law with current shortage of child psychiatrist. Not to mention the discontent such a proposal would cause among GPs and peds. 🙁

 

[Demosthenes]

There was one psychiatrist who made me cringe and yell at the television however. It was the psychiatrist who discouraged the mom from therapy, instead preferring to go up on the child's Trileptal and suggested Xanax as a reasonable option for the child's 2 hours of anxiety prior to leaving for school. Later you saw this Mom putting the kids to bed in front of the television, holding and stroking them. I wanted someone to also mention that individual and family therapy would be reasonable options for this kid.

That made me cringe, too -- in fact, for many of those kids, I'd have said "behavior mod" long before medication. And by that, I mean parenting classes, classes for the parents about how to set limits, say no, etc. And then, some behavior mod for the kids, too, of course...

The other one that made me cringe was the five year old dx'd as "manic" for her "grandiosity" when she was sounding remarkably like a five year old girl who'd watched too many violent TV shows and never had anyone say "no" and mean it.

Maybe I'm just old and crochetty, though.

(And my bias is showing. I've seen some kids who really and truly show the criteria for ADHD. And I've seen about a gazillion others being medicated for it, when it really looks like simple lack of discipline, combined with a failure to recognize normal childhood behavior, to me. By "normal childhood behavior," of course, I mean that kids are supposed to have shorter attention spans, they're supposed to have energy to spare, they're supposed to want to be active, and experience monkey brain -- it's normal for a kid to want to run around the park, and get distracted by butterflies, and ask a million questions. That's what makes them so exhausting -- it's hard for any adult to keep up with that. But pathologizing it doesn't necessarily help. I'll climb off my soapbox now, though, before I fall...)

 

[billypilgrim37]

The other one that made me cringe was the five year old dx'd as "manic" for her "grandiosity" when she was sounding remarkably like a five year old girl who'd watched too many violent TV shows and never had anyone say "no" and mean it.

In defense of at least this case, I saw quite a bit more of Axelson's tape of the Jessica girl at a conference (and the tape included multiple visits over a few years), and with a more detailed history, it would be difficult to argue with the diagnosis. And if I remember correctly, her parents were pretty much doing a plethora of behavioral modification, limiting television, etc. And her periods of grandiosity (and separate episodes of melancholic depression) were discrete and markedly different from her normal self, and her behavioral changes were well-documented at school and by other 3rd parties.

 

[Demosthenes]

In defense of at least this case, I saw quite a bit more of Axelson's tape of the Jessica girl at a conference (and the tape included multiple visits over a few years), and with a more detailed history, it would be difficult to argue with the diagnosis. And if I remember correctly, her parents were pretty much doing a plethora of behavioral modification, limiting television, etc. And her periods of grandiosity (and separate episodes of melancholic depression) were discrete and markedly different from her normal self, and her behavioral changes were well-documented at school and by other 3rd parties.

Ah, thank you. That is different -- I've got my own little bee in the bonnet about behavior mod for parents, based on what I see on a far too regular basis. Bad me, I do tend to assume the parents are not trying behavioral interventions -- or not trying them consistently -- so it's good to hear that this set of parents were.

And it's very good to be reminded that I do make that assumption far too often...