Risperdal for a 2-year-old?
Turning the Tide, One Interaction
at a Time

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I see him out of the corner of my eye.  This time he is carrying cups full of water, ones that he has been filling in the bathroom while he was supposed to be getting ready for bed.  Water is leaking over the side and it is only a matter of time before one of them completely overturns.  It is just one more episode in a day filled with seemingly endless capers, meltdowns, and poor choices in only the way a budding preschooler can display.  At times, it seems that just as quickly as he makes his way out of the timeout corner, his mischievous mind is in search of a new exploration, as the trail left behind warns.  Although there is occasional admiration for his ingenuity, it often feels that his day is measured by the string of redirections and admonitions that accompany his never-ending activity.

Every parent who has ever raised a young child knows that many days, it seems there is little to praise.  Toys left strewn, water running, disgusting messes, unused lights left on, spontaneous, defiant outbursts, toothpaste swallowed, and bedtime shenanigans are just a few on the infinite list of things that seem to make the day go long.  Even the best of parenting intentions and interventions at times fall flat.  Gains appear minimal at best and non-existent at worst, although some days aren’t that bad.  Part of the challenge stems from not knowing what is next and part of it comes in the energy that it requires to engage it all.  But somewhere in that day, often at unexpected times, quietness and compliance emerges unexpectedly.  However brief it may be, even beyond the actions that teeter on hilarious and hellacious, he responds in a positive, compliant way.  He offers to share.  He goes up to his room when asked to get his blanket.  He picks up the books on the floor.  And then just as quickly, it is gone, and he resumes his defiant charge.  It is at these moments that positivity is there for the reinforcing if only we are as in tune as when the problems began.

As a parent of a young child, these times can be stressful.  Increasingly, parents who feel overwhelmed are seeking out psychiatric support in many different ways.  One of these ways is medication.  Detailed in a Pediatrics article entitled, “National Trends in Psychotropic Medication Use in Young Children: 1994–2009” (Chirdkiatgumchai, 2013), medication usage for children (treated in an outpatient setting) ages 2-5 continued to climb from 1994, and peaked from 2002-2005, before gradually declining to about 1994-1997 rates until 2009. 

But amidst this reported leveling in medication usage among young children, a disturbing side trend has emerged.  Antipsychotic medication use in preschoolers has soared over the past decade, to the upwards tale of a two- to five- fold increase despite lack of FDA approval in almost all of these medications for this age group (Harrison, 2012) and little to no information about long-term side effects.  In addition, researchers have noted that most antipsychotic medications were being used off-label, and increasingly for the treatment of behavioral issues that many argue are both developmentally inherent and often a product of significant environmental dysfunction.  Despite little knowledge regarding long-term implications, no debate exists about the potential myriad short-term concerns that led the FDA in 2003 to require that all second generation antipsychotic agents include warning labels highlighting a significant risk of “diabetes mellitus, hyperglycemia, and severe hyperglycemia associated with ketoacidosis, hyperosmolar coma, or death.”

Authors of the Journal of Pediatric Health Care article noted a number of plausible reasons for possible increased usage.  They include societal acceptance, more awareness and availability, increased prescribing in vulnerable populations, and limited time for practitioners to exercise other options, in addition to other plausible explanations.  Although not clearly illuminated in the article, there is little doubt about the role that widespread advertising, physician influence (especially upon at-risk populations), and limited options play in this trend.  This must continue to be exposed.

But as a parent, what struck me the most was the following heading:  Demand for Quick and Affordable Treatments.  Imbedded within this paragraph was the following sentence: “Parent training and cognitive-behavioral therapy can be costly for families without adequate insurance and may seem too time-consuming for families in desperate need of a ‘quick fix’ . . . for treatments that often require 12 or more sessions to attain full benefit.” All of us understand that financial issues may be at play, although I wonder just how much the average household spends on mobile devices and electronic entertainment in a year.  But in regards to the “quick fix”, it seems that the biggest problem may not be the child after all, but our perception of what those first five years are about. They are anything but conducive to a “quick fix”, especially given that even the best of preschoolers are only compliant 70% of the time.  In many ways, it unfortunately fits with our American culture, which not surprisingly consumes psychotropic medication at 1.5 to 3 times greater (see same article) than our Western European counterparts.  As my colleague aptly noted, too, “Twelve weeks in the life of your child seems like a relatively quick fix” even though we both understood there is no such thing.

In 1996, Dr. Rex Forehand published a book entitled, Parenting the Strong Willed Child, designed for caregivers of children ages two through six, which is now in its 3rd Edition.  Based on early applied behavioral analysis (ABA) and authoritative parenting research, it emphasized the importance of timeout, ignoring, and punishment as critical to teaching emotional regulation and impulse control at a young age.  But unlike much advice on discipline, it began with a focus on providing a basis for positive interaction.  The first skill, attending, focuses on using a set time (e.g., ten minutes a day) to encourage parents in the techniques of imitation and describing.  For example, if a child is building a tower of blocks, parents may say “That is a really tall tower” or “My tower leans like yours.”  On the contrary, parents are told not to ask questions or give directives, which typically entail much of what goes on all day.  The purpose is simple, but critical—teach children that they can get your attention through positive means just as they can through negative ways. Forehand goes on to teach the next step: Giving rewards.  The focus here is on distinguishing between different types of rewards (social and nonsocial) and techniques to increase the likelihood the reward will work.  Namely, working to make the reward as immediate, concrete, and specific as possible.  Young children like to hear they did good.  But without telling them exactly how they did well (picked up your clothes off the floor) right after they did well, there is little chance this praise will lead to future good behaviors.

But for parents who do need more intensive assistance to deal with significant emotional and behavioral issues, effective treatments do exist, and research indicates that they work well if an investment is made.  One of these is Parent Child Interaction Therapy (PCIT), which was originally developed by Dr. Sheila Eyberg. Further information is available at http://pcit.ucdavis.edu/about-us/.  PCIT is designed for children ages 2-7 and involves parents working directly with the clinician in session (using instantaneous feedback devices, such as a “bug in the ear”) for the explicit purpose of reducing negative behaviors and improving prosocial responding.  Similar to Forehand’s approach, PCIT focuses on relationship building skills characterized by the acronym PRIDE:  Praise, Reflection, Imitation, Description, and Enthusiasm. Treatment generally lasts 12-20 weeks (one hour per week) with booster sessions to follow during the next year.

For children with autism spectrum disorders (ASD) or severe developmental delays, ABA techniques have been shown to significantly improve long-term social, behavioral, emotional, and vocational functioning.  The following link provides brief one page introductions for its use in addressing negative behaviors and teaching conceptual skills:  http://www.stmarys.org/related-links.  Further information about all empirically supported treatments for young children can be found at the following link:  www.effectivechildtherapy.com.  Although the criticism is valid that practitioners can be difficult to find, there are a significant number of resources available to parents through many outlets for those who become committed to finding non-medication methods to address early challenging behaviors.  But we must invest in this pursuit with the same zealousness and commitment as we do in other ventures we consider worthwhile.

Coursing through all of this is the message that positive reinforcement is critical. But many times we find ourselves feeling that our children should just do what they are told, because well, they should.  And sometimes this is the case.  Too much praise and reward, used too lavishly and liberally, can create an expectation that they must always get something in return.  As Forehand notes, any reward that is nonsocial (e.g., treat) should always be paired with a social reward, so that the treat can be pulled and the behavior will still continue.  Likewise for the praise itself because sometimes everyone, even young kids, just have to do our part so one person doesn’t have to do it all.

But if we pan outward, there is a lifespan issue at play that most will not consider when their child is three.  Assuming all goes well, this little boy will become a man someday and there is a good chance he will take on a role as a father and a significant other.  The quality of his relationships with his significant other and his children will largely be associated with one thing:  his degree of positivity.  If he tends to have an argumentative demeanor early in life, there is a reasonable chance he may maintain a strong-willed disposition later on.  That being the case, it suggests even more of a reason that we as parents of these kids must find ways to teach positivity from a young age.  Sometimes it may feel like teaching a brick to be soft. But research on relationships suggests it is absolutely necessary.

John Gottman and his wife, Julie, have been studying relationships for almost four decades.  Much of their research has included observing and coding couples’ interactions in the laboratory to see which factors are most likely to lead to the success or demise of a marriage.  Over time, they found that they could predict divorce with a remarkable certainty simply based on the degree of positive moments versus negative moments they observed in a fifteen minute interaction.  As quoted in the book Why Marriages Succeed or Fail, Gottman stated “Amazingly, we have found that it all comes down to a simple mathematical formula: no matter what style your marriage follows, you must have at least five times as many positive as negative moments together if your marriage is to be stable.”  Those relationships on the demise generally average 1:1. 

All of us also fall short of the ratio of positive to negative moments on certain days. But as I watch the shenanigans unfold, I have to remind myself that this little boy stands where I did years ago.  It is easy to show love when love is shown.  But it gets hard to be positive when those close to you leave a trail of destruction and debauchery.  But as with every challenge, it presents opportunities – one of which is providing clarity for what is great, good, okay, bad, awful, and in between.  With clarity comes growth, and the chance to seek out clear ways to unite and avoid clear ways to divide.  And for us, it presents a chance to increase our capacity to love – not just the boy leaving a mess, but the spouse doing the same.  In seeing others’ weaknesses and strengths more clearly, we become privy to our own.  Then the process of growth can begin—accepting consequences for what we did wrong and asking others to do the same.  Hope only exists when we can see the positive in life. Before we ask this of another, we must do the same.  As Albert Einstein once said, “In the middle of every difficulty lies opportunity.”  Maybe these struggles are chances to turn the tide in a more positive way.

References:

Chirdkiatgumchai, V., Xiao, H., Fredstrom, B., Adams, R.; National Trends in Psychotropic Medication Use in Young Children: 1994–2009. Pediatrics. Online September 30, 2013. doi: 10.1542/peds.2013-1546

Harrison, J, Cluxton-Keller F, Gross D.; Antipsychotic Medication Prescribing Trends in Children and Adolescents. Journal of Pediatr Health Care. March 2012, 26(2):139-45. doi: 10.1016/j.pedhc.2011.10.009)

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

30 COMMENTS

  1. These are certainly not “medications” and as someone who still suffers and struggles to function with permanent neurological damage from these drugs (and nearly 20 years later), I find the use of that term to be highly offensive.

    To call it “medication” implies that the children are physically ill and that these neuroleptic drugs are making their “illness” better. It distracts from the fact that these brain damaging chemical straight jacket drugs are being USED ON CHILDREN FOR BEHAVIORAL CONTROL!

    Could you imagine if spankings caused tardive dyskeisia? Dystonia? Diabetes? Would spanking be allowed if it did? Surely not.

    People on that side of the fence need to stop using that term. The victims don’t deserve to be re-abused by the mainstream acceptance of how they rationalize their child abuse.

    • I agree. And as someone who suffered from a terrifying psychosis, within two weeks of being put on Risperdal (absolutely no history of such prior to the drug). But was dealing with doctors that falsely claimed the absolute worst adverse effect of the neuroleptics / antipsychotics was increased “Thirst.” There needs to be more honesty and / or knowledge of how truly unsafe these drugs are within the medical field. This is what my doctors, who supposedly knew “everything about the meds,” should have actually known, and been honest with my family, about the antipsychotics in 2001:

      http://www.ahrp.org/risks/biblio0100.php

      It is absolutely criminal for people to be forcing little children onto these drugs. They are torture, at least for a percentage of the population. And I’m thinking it’s a pretty large percentage, since the UN has come in claiming “forced psychiatric treatment is torture.” All the children on these drugs are being force treated – TORTURED! Antipsychotics should NEVER be given to children!

      As to parenting, I loved raising my children. My children are my pride and joy. They are so wonderful. And I believe one of the keys to successfully raising good children is such a parental positive attitude always. It is about teaching your children to respect themselves, but also to treat others as they would like to be treated. It is about enjoying the various stages of their progress towards being indepentant and responsible adults. But also being able to forgive the inevitable imperfections, while encouraging new learning, alone the journey.

      We need a societal shift back towards a respect for the importance of properly raising children. The medical community now considers being a stay at home mom, and active volunteer, “unemployed.” That’s ungodly disrespectful, and lacking insight, on the part of the medical community. Properly raising children is not “unemployed,” it’s a grotesquely under respected, but invaluable service that our society seems to have forgotten how to properly do.

      And the doctors solution is pushing antipsychotics onto 2 year olds. I’ve pretty much lost all respect for mainstream medicine at this point.

      • “Properly raising children is not ‘unemployed,’ it’s a grotesquely under respected, but invaluable service…”

        Not only do I undoubtedly agree with this, but it made me think of my experience with healing. I could interchange the words, “Healing is not ‘unemployed,’ it’s a grotesquely under respected, but invaluable service…”

        I know it’s a bit askew from the topic, here, but when I read your comment, this just popped into my head, so I thought I’d say it out loud. It’s totally true. My healing is my prized possession in life, and in order to accomplish it, I had to get away from the mainstream at all cost, which meant a long period of ‘unemployment.’ Mainstream is dense, unhealthy energy, imploding and exploding all over the place, all projections, no ownership. So how can healing ever occur?

        But it was only perceived unemployment by a culture that considers mainstream employment the be all end all, which I’ve never believed. It’s an option. There are many options for healthy and successful living. I’ve never worked harder in my life than when I was healing from med toxins on top of family issues on top of social issues. I was fully employed by my healing. I think the same thing can be said about parenting. That’s a lot of employment.

        It’s time to get this all straight. Mainstream anything is for the birds. It’s all tainted with deceit and mistrust, and I believe it’s destroying itself. I think that’s good news, as it will allow for a new and improved reality. I believe it’s happening now.

        • Alex,

          I agree, healing is a job, too. Especially since the patients have to research medicine themselves, because doctors won’t medically explain other doctors’ malpractice. Or the doctors are so deluded by their drug reps, that they have no clue what they’re doing. Thank God for the internet. Recovering from psychiatric attack – because psychiatrists wanted to cover up a “bad fix” on a broken bone and sodomy of a three year old for a pastor – is indeed what I’m still working on recovering from. How sick, the function of psychiatry is rendering senseless, and poisoning, innocent people for unethical people. “You can’t heal from something you can’t talk about.”

          • Yes, exactly. WE do all the work, they get paid zillions. And for what???? Just like you say, how can anyone heal from any kind of wound, whether physical or emotional, when their process is either stifled or misdirected, due to bad medicine. And it’s such public knowledge, now, too, that’s what is so frustrating.

            Sounds like you had a lot of salt rubbed into your wounds, which is what I experienced, too, from psychiatry, and mental health care, in general. Indeed, speaking my truth, straight from my heart, has been my best healer. My very best wishes to you on your recovery and healing.

  2. Excellent, again, James. I think it’s important for parents to give themselves a lot of permission and self-compassion. Parenting, like life in general, does not come with a manual. I can’t imagine a more challenging endeavor. All that authenticity, individuality, the unpredictability, the myriad stages of development, bonding and separating, community and world influences, etc. And if it’s more than one child in a family, add to that sibling rivalry. Oh vey! That is so much responsibility, it can be overwhelming. Yet, parenting has been practiced since the beginning of time all over the world. I don’t know if there is such thing as ‘getting it right.’ I think it’s always ‘learn as you go and do the best you can.’

    I’m curious what would you and others feel would be the indicators of sound parenting? Are there any? Or is it just way too subjective and personal an experience?

    I really appreciate this thought:

    “In seeing others’ weaknesses and strengths more clearly, we become privy to our own.”

    I believe you speak such truth, here, universally. Our children, especially, are our mirrors. It’s hard when parents don’t realize this, and in turn, create a duality with their kids. I see this happen more often than not. I think radical self-responsibility is essential for a child-parent relationship. By radical self-responsibility, what I mean is for parents to own their stuff, and not take issues out on the kid. Sometimes, the kid needs direction or boundaries; other times, the parent is the one being unreasonable and not hearing the kid’s heart and spirit. That can come back to haunt the family. It’s hard for everyone concerned when that happens.

    Indeed, positive reflections are vital for anyone’s well-being. I remember when Jodie Foster won one of her Oscars, she said in her acceptance speech, “I want to thank my mother for making me feel as though all the finger paintings I brought home from kindergarten were Picassos. I never forgot that.

  3. James,

    When my friend John Breeding and I were testifying in the Texas legislature about the drugging of children, the chairman of one of the committees read a list of the number of children in state foster care or Medicaid that were on psychiatric drugs.

    Starting with teenage years, then the number on drugs… until it got down to two year-olds, and the number on drugs.

    I felt ill. Literally, sick to my stomach.

    And the room where the committee hearing was held was full of pro-pharma and NAMI members, who were intent on seeing expansion of “treatment” for children.

    Sometimes, I just can’t hear any more. It just makes me want cry.

    Duane

    • As I reflect back on my childhood I can never remember running into any so-called “mentally ill” kids, never ever. “Mentally ill” children only began cropping up when the toxic drugs appeared on the scene, and now we have two year olds on antipsychotics and Disability!

      Knowing what we know about the toxic and damaging effects of these drugs, how can any responsible adult stand up and say that they want “treatment” for children? This is just mind boggeling, to say the least. Where is good common sense in all of this? Why would any parent want their child drugged to the gills?

      I agree; it makes me cry, especially since no one is listening to us about any of this.

      • Stephen,

        The upside is that there are a few legislators out there who care. They need to be educated. One committee chair in the Texas legislature truly did not know the difference between a psychiatrist and a psychologist. He welcomed us into his office, before the hearing. John and I talked with him and educated him about what was taking place. He was concerned. The bill never made it out of committee.

        The downside is that there are a *lot* of state legislatures (fifty at last count), and *lots* of legislators who need to be educated. This is why I hope we begin to focus on getting *pro-active, federal* legislation in place. The work at the state level is exhausting, and there needs to be *federal* protection, especially for children in foster care, Medicaid programs, and the juvenile justice system.

        Duane

  4. James,

    This is a very good article and I am grateful you are focusing on the horror of subjecting two year olds to toxic neuroleptic and other lethal psych drugs while advocating for nondrug alternatives. This child drugging is pure EVIL in my opinion for greed, profit, power, laziness, social control, etc.

    However, you claim there is little information about the long term effects of these toxic drugs when in reality, there is tons of information that these poison drugs are deadly and brain/body damaging for adults and all the more so for children per Robert Whitaker and many other experts:

    http://www.behaviorismandmentalhealth.com/2014/02/17/drugging-our-children-a-book-review/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+BehaviorismAndMentalHealth+%28Behaviorism+and+Mental+Health%29

    Though the following article pretends these poison drugs are “weight neutral” for adults, this is a huge LIE, but it admits these poisons cause obesity in children and the related diabetes, heart problems, and other huge risks:
    http://www.forbes.com/2009/10/27/antipsychotics-lilly-astrazeneca-business-healthcare-children.html

    Antipsychotics pose “Ominous long-term health implications” for children_JAMA
    http://www.ahrp.org/cms/content/view/645/9/

    Anyway, all you have to do is google toxic effects of antipsychotics for children and you will be overwhelmed with the evidence of how deadly these poison drugs are for adults and even much more so for children, which is just common sense since children are more vulnerable than adults. There have been many lawsuits for boys growing breasts from these poisons and many cases of tardive dyskinesia and early death and there is the infamous case of Rebecca Riley, which are only the tip of the iceberg.

    And of course, Dr. Thomas Insel, Head of NIMH, has now admitted that all the DSM stigmas are invalid lacking any evidence or science and it is all too clear these toxic drugs are being used for social/behavioral control from cradle to grave. This Big Pharma predation on our children shows that our country/world has become more and more psychopathic and narcissistic while losing its moral compass in my opinion.

    I must say I find it very upsetting when people write articles saying the effects of these poison drugs on children are unknown or information is lacking when they have been all too well known for many years with the number of destroyed lives increasing daily. Also, see information about “Dr.” Joseph Biederman who single handedly created the child ADHD and bipolar fad frauds while working under the table for Johnson & Johnson to make millions with his cohorts and promising positive studies in advance exposed by Senator Grassley along with the Big Pharma front groups like NAMI, CHADD, etc.

    When the following information hits such main stream media, you know things are really bad though it still cites the junk science and bogus numbers of the so called “mentally ill” by NIMH that comes from misleading survey calls asking questions from the discredited DSM per the excellent enlightening book, http://www.amazon.com/Mad-Science-Psychiatric-Coercion-Diagnosis/dp/1412849764:

    http://usatoday30.usatoday.com/news/health/2006-05-01-atypical-drugs_x.htm

    As all can see, there is tons of information for the all too well known lethal effects of neuroleptics for both adults and children that Dr. Fred Baughman, Child Neurologist, calls the worst medical crimes ever perpetrated against humanity in his many articles and books like ADHD Fraud exposing ADHD, bipolar and other bogus DSM stigmas applied to children and adults as 100% fraud.

    Again, I applaud your focus on this ominous problem, but I think it is important that you also include the horrific effects of these poison drugs or animal tranquillizers that are in no way “medications” in any sense of the word.

  5. Hi Duane and Stephen,

    I appreciate all of your passion and good common sense as fellow old timers who can see through this fraud since such vicious predation against children for greed, power and profit never happened in our day.

    The fiends in the school system were trying to get my son stigmatized as ADHD and drugged to the gills by “referring” me to a mental death trap agency for my son’s problems that were a result of a less than ideal environment at home and work thanks to interrelated adult bullying. Though I wasn’t familiar with this whole fraudulent biopsychiatry/Big Pharma cartel at the time, as a mother, I sure knew that stigmatizing and drugging my child was not going to be in his best interests, so I fought it like the plague it is and he was not stigmatized as ADHD and drugged!! It makes me sick to know now that schools have a less than noble incentive to collude with this fraud to create more easily controlled drugged zombies to hide their poor teaching/discipline and get more federal/state money for each child they can stigmatize as “mentally ill.” Thus, there are no safe places for children any more not to mention parents refusing to scapegoat and destroy their children who can be threatened with the loss of their children by self serving social service people also colluding with this monstrosity. Then, there are the parents who refuse to see their own role in their children’s problems who eagerly seek out these life destroying stigmas and drugs.

    As a result, I made it my business to learn all I could about “Toxic Psychiatry” and I will always be forever grateful for the immense courage and honesty of Dr. Peter Breggin exposing this fraud at the outset of this horrific paradigm created when psychiatry sold out to Big Pharma. Dr. Peter Breggin’s book, Reclaiming Our Children, does a great job of exposing the fact that this current despicable biopsychiatry paradigm scapegoats the least powerful children or victims for less than ideal schools and parenting to put it kindly. Dr. Fred Baughman, Child Neurologist and author of ADHD Fraud, is another hero exposing that the child ADHD and bipolar fads are 100% fraud and the worst medical crimes ever perpetrated against humanity. Of course, we can thank the notorious “Dr.” Joseph Biederman for single handedly creating the child ADHD and bipolar fad fraud epidemics so he and his cohorts in crime could make hidden millions under the table from Johnson & Johnson by promising positive study results for use of neuroleptics for children and toddlers no less before the studies were done exposed by Senator Grassley. But, what can one expect when Biederman compared himself to God at his deposition that journalists exposed with the disdain such malignant narcissism so rightly deserved.

    I guess the “The Narcissistic Culture” and “The Narcissistic Epidemic” are alive and well that would allow parents/teachers to rationalize stigmatizing and drugging their kids to scapegoat them for family, school and other problems. Unreal!

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