Complex issues for parents
Your article [“The Push to Label,” Nov. 5] put forth the many conflicting and confusing bits of information a parent has to sift through when making the difficult decisions about intervention for a child who is struggling. As a parent who has experienced this dilemma, and as an educational therapist who works with families dealing with these issues, I am grateful for such a well-researched and unbiased discussion.
Medicating a child is not a simple choice. It is always amazing to me how little tolerance others have for the struggles of children and especially for their parents, who are just trying to raise their “non-typical” kids. I checked out the comments to your piece on the latimes.com website; so many people are judgmental of parents who are even considering medication.
Debra B. Hori
Pasadena
--
I am a child- and adolescent- psychiatrist in Chicago. I believe you omitted the factor of economic interest on the part of the pharmaceutical industry.
Great expense in research, development and marketing of the new mood-stabilizing medications results in significant effects on physician education and prescribing behavior.
Nonpharmacologic treatments such as family and individual therapy, educational accommodations and training do not receive anywhere near the funding they deserve.
It is a struggle for working psychiatrists to remain skeptical of new drug treatments when they are constantly bombarded with advertisements, new research in peer-reviewed journals and pharmaceutical representatives on a mission to sell. Even parents are influenced by marketing; many seek a quick fix.
Some psychiatrists and mental-health professionals feel pressure to come up with a diagnosis quickly, often after the first meeting. They may need a diagnosis to get paid. The insurer may reward physicians who come up with a quick fix rather than generating expense getting to know the child and family.
Our profession needs to take the higher ground and lead families and the economically concerned to more careful diagnosis, more comprehensive care and more selective use of emerging, often effective, treatments.
David L. Goldberg, M.D.
Chicago
--
As a licensed marriage and family therapist, I would advise Katie’s mother and dad to seek a consult with an MFT prior to medication. When we take history, we ask such things as: When do the problem behaviors occur? Is there a pattern? Maybe tantrums occur after school because the child is tired. Try a nap before a pill. What is the household environment like? Is there a television set yammering away constantly? Try reducing the sensory overload in the home.
Marriage and family therapists help parents look at their family as a system and introduce structural and strategic changes to help all the family members.
Lynne Sherman
Santa Barbara
--
I found your article to be thoughtful and balanced. However, it missed a significant issue: Most psychotropic meds are prescribed not by psychiatrists but by primary care doctors. Under managed care, healthcare makes it difficult to see specialists and tries to funnel as much as possible to primary care.
What we hear is that when a parent comes in to complain about some behavior of their child, there is an expectation, if not a pressure, for primary care doctors to give patients a prescription so they feel that something is being done.
In addition, primary care doctors know that most people won’t follow up on a suggestion to see a mental-health therapist or psychiatrist and are more likely to comply with a prescription, which does not necessarily create the label of mental illness.
The solution that mental health groups are advocating for and which most health plans are embracing on paper (but only slowly making real) is to co-locate mental health therapists in primary care offices so that the options can be explored with someone with the time to consider alternatives to medication.
Rusty Selix
Sacramento
The writer is executive director of the Mental Health Assn. in California.