The New Zealand government has just published research showing the numbers of children aged 2-14 years being diagnosed with mental disorders has doubled in the last five years with the key driver being an increase in anxiety disorders.
In 2011/12, 3.2% of New Zealand children aged 2–14 years (25,000 children) had been diagnosed with depression, anxiety disorder or behavioural problems (ADHD/ADD). This rate increased from 1.8% (13,613 children) in 2006/07. The key driver of the increase was increased diagnosis of anxiety disorders in children.
The psychiatric literature is of course replete with theories about the role of brain dysfunction and genetics in the development of anxiety disorders in children and adolescents. What if though, our kids were anxious because they have a lot to worry about? No one seems to have considered that our kids might be anxious because they lead very stressful lives.
The clinical criteria for anxiety disorder are
A. Excessive anxiety and worry (apprehensive expectation), occurring more-days-than-not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more-days-than-not for the past 6 months).
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- muscle tension
- sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
A recent report on child poverty in New Zealand commented
We like to believe that New Zealand is a great place for children. For the majority of our children this is true. But it is not true for children living in poverty. As many as 25 percent of children – about 270,000 – currently live in poverty. Child poverty involves material deprivation and hardship. It means, for instance, a much higher chance of having insufficient nutritious food, going to school hungry, wearing worn-out shoes or going barefoot, having inadequate clothing, living in a cold, damp house and sleeping in a shared bed. It often means missing out on activities that most New Zealanders take for granted, like playing sport and having a birthday party. The impacts also include lower educational achievement, worse health outcomes and social exclusion. These differential outcomes, as well as the neurological responses to growing up in poverty, mean that childhood poverty can leave life-time scars, with reduced employment prospects, lower earnings, poorer health, and higher rates of criminal offending in adulthood.
In making recommendations they noted that”
We consulted with children on the solutions they thought were most important and they identified an action we had missed: it relates to them having the opportunity to play with friends, even if they are poor.
The report noted that child poverty rates in New Zealand were around double those of the mid-1980s.
Could being hungry and cold, having to share a bed and not being able to play with friends or have a birthday party be responsible for children being tired, restless, irritable and not sleeping well rather than these symptoms being the result of a brain disorder or bad genes?
What about children not living in poverty? A recent masters thesis found that New Zealand children, no matter where they live in New Zealand and how they are categorised socio-economically, have similar life stressors. The study found that
many of these stressors have the potential to lead to children feeling disempowered through a lack of control; anxious and experiencing hopelessness.
While children of single or unemployed parents lack basic necessities and opportunities, children of parents who both work lack parental time and attention. The research found children anxious about their immediate environment or the world around them, and worried about their future. They worry about what they see on the news and are concerned that war and global warming mean there is no future for themselves or their children.
New Zealand’s child abuse statistics are among the worst in the developed world. The author of a recent report on child protection in New Zealand comments
There is more than a problem here; instead, New Zealand now faces a child abuse epidemic with no region, community or ethnicity being exempt. New Zealand has the fifth worst child abuse record out of 31 OECD Countries.
In a 2009 report, the OECD tells us
New Zealand government spending on children is considerably less than the OECD average. The biggest shortfall is for spending on young children, where New Zealand spends less than half the OECD average.
In terms of child health, New Zealand has the highest rates of suicide in the OECD for youth aged 15‐19. <
Overall child mortality is also higher than the OECD average.3
Unicef New Zealand tells us that
31% of New Zealand children live in overcrowded conditions.
- Our rates of preventable, infectious diseases with serious long term health consequences for children is 14 times the OECD average.
The research on New Zealand children’s experiences of stress showed clearly that in addition to those factors which affect children directly and cause them worry sadness and feelings of hopelessness, many stressors experienced by children are connected to parents and teachers.
In a companion report to the one on child mental health, the Ministry of Health report on adult mental health shows 572,000 New Zealanders over the age of 15 had been diagnosed with anxiety or depression – more than were diagnosed with high blood pressure, high cholestrol, heart disease, diabetes, asthma or any of the other health problems surveyed.
So in New Zealand we have a large group of children and adults who are highly stressed. We have overwhelming evidence that this is linked to adverse circumstances and no evidence that this is caused by a brain disorder. Our response is not to alter those circumstances but to label and drug those affected by them.
Once you get into the mental health system in New Zealand you are 20 times more likely to die from suicide than those not in the system and 27% more likely to be tasered by police than a suspected criminal.
Child or adult, you are unlikely to have a drug-free involvement in the system. Ministry of Health child and youth health chief adviser Pat Tuohy is on record as saying the ministry has no concerns about the number of children being prescribed medication for ADHD. 4
The Government’s official position on the treatment of ADHD is that
There is now considerable evidence that a carefully executed regimen of pharmacotherapy is superior to alternative treatments including behavioural treatment alone. As a general rule, monotherapy with a stimulant drug (methylphenidate or dexamphetamine) is the first line of treatment. The stimulants, methylphenidate (RubifenTM and RitalinTM ) or dexamphetamine (DexedrineTM), are regarded as pharmacologic agents of first choice in ADHD. Behaviour therapy is much more difficult, labour intensive and expensive than pharmacotherapy. There is little evidence to support the value of adding behavioural approaches to medication.
Second-line medication can be considered for children and young people whose diagnosis is clearly ADHD but who fail to respond to stimulants or who have unacceptable side effects. These medications include tricyclic antidepressants and, where all else has failed, atypical neuroleptics such as risperidone for a short term. The aetiology of ADHD is likely to involve a variety of genetic and neurological factors. Hereditary factors are thought to contribute most, accounting for 50 percent of the variance (Epstein et al 2000). An organic neurological problem involving the frontal lobes (especially executive function) and/or basal ganglia in the brain also has considerable support (Clark et al 2000). Social factors alone are not considered an etiological cause but may exacerbate preexisting symptoms and genetic or neurological vulnerability (Barkley 1998: Chapter 5).5
Medication as the most effective, cost efficient and evidence based intervention is similarly promoted for depression and anxiety. In a population of just over 4 million people, the following data shows how prevalent pharmacotherapy is in mental health treatment in New Zealand.
In a recent thesis entitled New Zealand Children’s Experiences of Stress and Coping, the children interviewed gave the following explanations for their stress and anxiety
You can see it in her eyes, she is tired and she doesn’t look as happy as she used to look.
It makes me sad because mum is so tired, she doesn’t concentrate. Sometimes I just want to grab her and take the stress away.
Sometimes I can’t do anything cause I get little panic attacks. It scares me cause my dad is bigger than my mum and when they are both in the room arguing I get all hot and I can’t breathe properly. I worry that my dad might hurt my mum.
When I watch the news, I don’t like what Im seeing half the time. I don’t like the bombings in Iraq and Iran.
Recently I‟ve been worrying about some of the wars that are happening on the other side of the world, why are we just killing people, why can’t we just kind of stop it. I kind of just think, I hope it doesn‟t get any worse.
I’m worried about the environment and the global warming, the ice and how it’s going. I write it down in my little notebook… all the stuff that I’m stressed about for global warming. Cause when I look at it, I’m thinking, people should actually stop the global warming before it’s too late for their children.
I’m stressed that a tsunami might hit us. I was worried that it would hit Auckland and then everyone would die. And maybe that meteorites might hit the earth. Like the greenhouse gas and the ice is melting and the water pressure will go up. And I was worried about the chicken flu, the bird flu. And the earthquake outside Tonga. I was really worried and I kept on telling my parents that we should move away for a while.
So it means we can’t go outside at night, because there’s all gang people come out, and people get beaten up for no reason. I’m scared to go outside.
I’ve got a TV up in my room and I always watch the news, to see what’s going on around the world. I worry that it might be some of my whanau6
I’d say that we are all scared and you guys just tell us not to worry about it, like we’ll be more anxious. And maybe sometimes they should worry a bit more about what the possibilities are. It’s like hard to be a child. Sometimes I worry that I may not pass university. My future.
I get stressed out when I hear something that I don’t really like because New Zealand is on one of the fault lines, it makes it even bigger. And I think that maybe the house is going to fall down and I would die, and I don’t want to die.
The future, if we have children, would there be a future for them.
Our kids are scared, stressed and worried. Many are being denied the basics of a happy childhood – time with relaxed and happy parents, opportunities to play with their friends, sufficient food, freedom from fear of harm and hope for the future.
We hold firm to the view however that New Zealand is a great place for kids to grow up and if they’re not thriving, it must be a deficiency in their biology not a deficiency in their environment.
Labelling our children as mentally disordered and giving them brain damanging drugs is cost effective – not only in terms of treatment cost but in terms of savings on the spending that would be necessary to address the social and economic factors impacting their wellbeing.
The Government’s anxiety and stress over balancing the budget is not seen as a mental disorder, nor mind altering drugs seen as necessary to managing this but the real and natural concerns of children are.
At CASPER we tell kids all the time
there’s nothing wrong with you, there’s a lot wrong with the world you live in.
It’s time we in New Zealand accepted that if large numbers of our children are anxious, sad and unable to function well, this is not such a great place to be or raise a child. And that identifying and addressing defects in our social environment rather than in our children is the only sane approach to building the future we desire.
1 NEW ZEALAND CHILDREN’S EXPERIENCES OF STRESS AND COPING Fiona Gail Pienaar A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Behavioural Science, The University of Auckland, 2010
2 Charlotte Renwick University of Auckland Policy Report October 2011 Protecting Our ChildrenEffectively Reducing Violence Against Children In New Zealand http://policyprojects.ac.nz/charlotterenwick/files/2011/10/Protecting-Our-Children-C.Renwick.pdf
3 NEW ZEALAND Country Highlights OECD (2009), Doing Better for Children http://www.oecd.org/els/familiesandchildren/43589854.pdf
4 NZ urged to shift stress on drugs as first option
BY REBECCA TODD Christchurch Press Last updated 05:00 13/01/2010
5 New Zealand Guidelines for the Assessment and Treatment of ADHD Published in July 2001 by the Ministry of Health PO Box 5013, Wellington, New Zealand
6 Whanau is Maori for extended family