Diagnosis-Driven Treatment
Profits Big Pharma,
Not Children

Within days of an article in The New York Times Magazine with a title posing the question Can Preschoolers Be Depressed? a special report appeared in the same newspaper (Child’s Ordeal Shows Risks of Psychosis Drugs for Young) about the use of off-label, heavy-duty antipsychotic medications for the same age group.  Not unlike big tobacco’s attempts to expand its market base by appealing to young consumers with cartoon characters like Joe Camel, the pharmaceutical industry sends representatives to the offices of pediatricians and child psychiatrists to leave behind promotional items like Legos emblazoned with the logo for Risperdal, one such drug.

Insufficient research to support prescribing these drugs for small children has not prevented the practice, which finds ready takers among low-income families without the resources to understand or access other options like parenting instruction and family and individual therapy.  At their wit’s ends, mothers of so-called difficult children follow the advice of their doctors to give their two-year-olds drugs with serious side effects like weight gain and diabetes.

In the piece questioning the existence of diagnosable depression in young children as early as infancy, naysayers insist it’s inadvisable to label symptoms like anhedonia (inability to feel pleasure), low energy, poor appetite, insomnia, poor self-esteem and pervasive negativity as an emotional disorder.  Variability of expression and the immaturity of the brain, the say, renders it premature to label small children in that way.

Those who support the diagnosis point to scans showing similar changes in the hippocampus and certain neural networks in the brains of depressed children and adults.  Other studies link depressive symptoms in children with family problems;  e.g., a mother’s depression can quickly impose itself on her baby by virtue of her own joylessness and lack of responsiveness.  In addition, children are ill equipped to handle emotionally and physically overwhelming experiences like abuse and neglect, death and/or separation from caregivers, and any of the many other calamities that can befall them.  When children act out their distress in developmentally appropriate ways, they too often become a problem to be fixed, rather than being seen as the canary in the coal mine heralding impending doom.

To recognize the reality of depression in young children, one need only listen to adults whose early lives were rife with difficulties.  Traumatic experiences like incest and other forms of abuse have devastating effects on the still-forming brain.  Living in circumstances where caregivers struggle with their own pain- and anxiety-filled existence weighs heavily on the spirits of children.  As quiet as it’s kept, four-year-olds have been known to deliberately swallow bleach and six-year-olds to throw themselves down a flight of stairs with their arms at their sides, all in hopes of escaping what for them has become a prison of pain.

Yet to establish a diagnosis of depression in children provides a rational for medicating them with the same antipsychotic drugs being used for acting out behaviors like aggression, self-injury, tantrums and severe mood swings.  Any of these symptoms,  signs of distress in a child, requires attention to the entire environment, including parents, siblings and others involved in the child’s life.  Helping the caregivers invariably helps the children.  Drugging children solves nothing and interferes with normal brain development, only one of many side effects.

Both cited articles mention successes with early interventions that take advantage of the plasticity of the young brain.  Certainly, ensuring a safe environment for the child takes precedence.  In yet one more report of severe neglect resulting in the death of a preschooler, the family was not unknown to child protective services.  Evidence suggests that the four-year-old girl with congenital health problems who weighed all of  15 pounds had been physically restrained with twine.  Perhaps she had become too much for an overwhelmed mother to handle, not unlike the children of some of the mothers who desperately seek help from their doctors and receive only psychotropic prescriptions for their children.

The way to assist frustrated parents lies not in the direction of prescribing narcotizing drugs to those among their children who broadcast otherwise silent family problems.  The best approach requires a commitment of time and resources to uncover and address the specific environmental challenges interfering with the child’s healthy development.

Mother & Baby Duet:
Instrumental in Social Development

A mother hums to her little boy as she changes him on the shelf in a restroom while he looks with wide-eyed curiosity at the stranger attracted by the sounds.  On the train, another mother sings playfully to her child in a stroller.

All that billing and cooing does much more than entertain and/or soothe an infant.  Recent research strongly suggests that it plays a vital role in preparing children to learn the language, practices and rituals of their cultures.

In a special report on music appearing in Science News, babies were described as coming into the world prepared to engage musically, crying with the same melodic patterns found in their mothers’ conversations.  The singsong nature of motherese, the universal language of babyspeak, takes advantage of that innate ability; adults automatically speak in a higher-pitched and exaggerated manner when addressing infants and toddlers.

One researcher, psychobiologist Colwyn Trevarthen, believes that babies have an active part in this exchange with their mothers, recognizing  when an adult invites them to respond and at times initiating the musical interactions.  In addition to building a foundation for later learning, what Trevarthen has come to call communicative musicality also provides for emotional expression and sharing between parent and child, crossing cultures with only minor variations.

The critical nature of these formative experiences is best appreciated in their breach.  Studies conducted by psychologist Maya Gratier of women diagnosed with depression and/or borderline personality disorder (BPD) demonstrate how a mother’s own inability  to respond to the desperate attempts of her baby to engage musically has negative consequences for the child’s development.

Because of their personal histories of severe childhood abuse and neglect, women with BPD have difficulty sustaining ordinary relationships and controlling their impulses.  They feel empty emotionally, fear abandonment, tend to elicit angry responses from others, and end up in intense, tumultuous relationships.

Ill equipped because of their own early deprivation, these mothers produce sounds devoid of any musical sense when trying to speak motherese.  They utter repetitive, sometimes odd, noises that lack rhythmic flow.  Seemingly unaware of their children’s desire to participate, they create no entry point for it.  Babies of these mothers give up and withdraw or actively demonstrate their distress by becoming fussy and upset.  Although the depressive women in Gratier’s studies could generate more variety in their communications with their infants, they did so in a low, flat voice lacking rhythmic timing.

Flexibility and expressiveness are prerequisites for musical attunement with one’s baby.  These women (and others like them) can give no more than they have received.  Children raised without the benefit of rhythmic relationships miss out on the opportunity to successfully complete a critical stage of development and encounter difficulties in subsequent social situations, starting in preschool.

Research findings like these point to the importance of early intervention for mothers with histories of severe childhood abuse and neglect, perhaps in the form of music lessons for the mother and infant duet.  Not only could it benefit the child, it could also teach the woman a skill she had missed out on learning as a baby.

Personality Disorder Diagnosis
Instrumental in Denial of Benefits

Between 2005 and 2007, the Army discharged about 1,000 soldiers a year with a diagnosis of personality disorder, effectively barring them from receiving veteran health care and combat-related disability payments.  Unlike Post-traumatic Stress Disorder (PTSD), caused by encounters with life-threatening events, a personality disorder has its roots in early life, rendering it a pre-existing condition and therefore not the Army’s responsibility.

After a 2007 article appeared in The Nation noting those figures, the Army announced a new policy that required higher level review of all cases.  Soon after that, diagnoses  of personality disorder dropped to 75 percent of their previous level while those of  PTSD skyrocketed, reaching 14,000 by 2008.  Despite this coincidence, the Army steadfastly denies that it had inappropriately discharged all those service members.

In a recent New York Times report on the issue, a personality disorder was described as “a deeply ingrained maladaptive pattern of behavior” whose symptoms could be mistaken for those of the “anger, irritability, anxiety and depression” associated with PTSD.

There are ten categories of personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), only two of which contain any of those symptoms:  Antisocial Personality Disorder (“irritability and aggressiveness”) and Borderline Personality Disorder (“dysphoria, irritability or anxiety,” “inappropriate, intense anger or difficulty controlling anger”).  Both of these labels carry major stigma, the first because it describes a person without conscience and the second by virtue of its pejorative connotations in the mental health field.

Studies have found up to three quarters of people with Borderline Personality Disorder (BPD) have histories of childhood sexual and physical abuse.  Not surprising then that its symptoms mirror those of PTSD.  Assaults on children during the critical years of brain development affect their ability as adults to manage emotions and relate to others.

In selecting the personality disorder diagnosis, the Army managed its bottom line at the expense of the women and men who suffer mental anguish from their war experiences.  Apparently this practice has not abated; Army psychiatrists have discovered another diagnosis that blames the victim, Adjustment Disorder, characterized by “marked distress that is in excess of what would be expected given the nature of the [psychosocial] stressor.”  Congress is looking into that one.

One has to wonder at the shabby treatment service members continue to receive at the hands of the institutions designated to serve them.  Saving money by denying benefits to those who need and deserve them constitutes unconscionable behavior, not unexpected from narcissistic or antisocial personality types but from the United States military?

Exercise Cools Rage Reactions

In a recent Sunday Times Magazine article, the phys ed writer Gretchen Reynolds described a recent study that found that for young men with “high trait anger,” which she translated as having “a very short fuse” and being “habitually touchy,” exercise took the edge off their intense emotions.

Extrapolating from studies that demonstrated a link between low levels of serotonin and aggression in animals, and mood disorders in humans, the researchers hypothesized that because the neurotransmitter serotonin increases with exercise, it probably plays a role in the modulation of anger.

Individuals with traumatic histories often react defensively with rage when triggered, usually by situations that their brains associate with previous hurts.  In addition, the development of a healthy serotonin regulatory system in the brain can be negatively impacted by early trauma, leaving the adult without the full benefit of a neurotransmitter that has been shown to calm nerves.

It comes as good news then that exercise has the potential to help trauma survivors deal effectively with their reactivity.  The freedom experienced once runaway emotions come under control opens up possibilities for exploring the stories embedded in them, one more reason to push away from that computer or get off the couch and take a brisk walk.

Frown Muscle Needed for
Recognizing Negative Emotions

Better think twice before getting that shot of Botox between the brows.

Putting on an emotional face activates areas of the brain responsible for the subjective experience of that feeling.  Without that link, scientists have discovered, recognizing related emotions in others becomes more difficult and creates a disadvantage in social situations.

In research described in Science News, women who had received Botox injections took longer to read sentences describing angry or sad situations than they did for descriptions of happy situations.  Because the shots paralyze frown muscles, researchers hypothesize that they gradually erode the connection between those muscles and the neural networks involved in coordinating negative emotions.

Not sure about the validity of these findings?  Break into an authentic grin and notice how that brightens your mood.  Turn down the corners of your mouth and see what happens.  Then reflect on what life would be like without the ability to experience anger.

Another Model Parent
Murders Her Children and Herself

When firefighters showed up to tackle the blaze at the apartment building in Staten Island, they discovered five victims: a two-year-old boy barely alive who would die later in the hospital; two girls, ten and seven, and a 14-year-old boy, all with their throats slashed; and their 30-year-old mother, also dead.  The teenager, CJ, had a straight razor under his arm.  Investigators quickly determined the fire was deliberately set.  (New York Times)

Because of his recent history of fire setting and an assault on his school principal, CJ was immediately deemed the murderer.  Much rumination followed about what might drive a youngster to commit familicide and those who knew the family were quick to share their observations about what a close-knit group they were, how Leisa Jones, their single mother, struggled to provide financially for her children, how in their home she insisted on proper manners and behavior.  (New York Times)

Only after the tragedy did some start to wonder about the pressures on young CJ to be the man of the house.  Those aware of the family’s circumstances shared observations of how he always took care of his younger siblings and did the things his mother needed him to do.

Where were they before when his behavior signaled the existence of serious problems, at least within himself but probably also inside the family?  A child who assaults a principal and sets fires clearly suffers from distress of some kind.  Did anyone try to find out what was troubling him?

And what sense did it make that he could set a blaze without slitting his mother’s throat, too?  Surely the screams of the children would wake her.  The youngest child was undoubtedly spared because he could do nothing to stop the perpetrator unlike the older children who could.  How often does someone, especially a teenager, commit suicide by slashing his/her own throat?  And how could the blade end up under his arm?

Far easier to blame the troubled child who acts out his/her distress than to contemplate the still unimaginable possibility that parents kill their children even though there are ample statistics testifying to that fact.  “In 2007, one or both parents were responsible for 69.9 percent of child abuse or neglect fatalities” and “more than one-quarter (27.1 percent) of these fatalities were perpetrated by the mother acting alone.”  (Administration for Children and Families)  Still everyone remains shocked when these murders happen in their neighborhoods.

It’s time that adults take notice of disturbing behaviors in the children they encounter and make the effort to find out what’s wrong, to intervene before tragedy strikes again and leaves them scratching their heads and trying to figure out how it could possibly have happened.