Someone tweeted this out the other day — “Mental Illness in Kids: The Surprising Warning Signs”. The signs for pre-school and early elementary school-age kids included:
- Behavior problems in preschool or daycare
- Hyperactivity way beyond what the other kids are doing
- Trouble sleeping
- Persistent nightmares
- Excessive fear, worrying, or crying
- Extreme disobedience or aggression
- Lots of temper tantrums all the time
- Persistent difficulty separating from a parent (if it goes on for months).
There were two other lists — one for grade-schoolers and another for tweens and teens.
Not once in the article was childhood trauma mentioned as a reason for any of these behaviors. Many child trauma experts are now saying that what psychologists and psychiatrists call “disorders” are behaviors that are reasonable, normal responses to toxic stress caused by trauma during childhood. These traumas include severe and chronic trauma, such as emotional, sexual and physical abuse, neglect; family dysfunctions, such as domestic violence, parents who are alcoholic or addicted to other drugs, a family member incarcerated or diagnosed mentally ill, and losing a parent; and community dysfunction, such as violent neighborhoods or bullying. It can also include traumatic events, such as being a victim of war, natural disaster, a life-threatening disease or accident.
Labeling children’s fear, hyperactivity, excessive disobedience or nightmares as “disorders” has people reaching for mood- and mind-altering drugs as a first and, sometimes, only resort, especially with kids in foster care and group and residential homes.
“Sometimes the kids are just doing what human beings are wired to do under immense traumatic stress. We just don’t understand it, and call it mental illness,” says Charles Wilson, senior director of the Chadwick Center for Children & Families at Rady Children’s Hospital in San Diego, CA.
The real name of the summit was: Because
Minds Matter: Collaborating to Strengthen Management of Psychotropic Medications for Children and Youth in Foster Care. (All the presentations’ PowerPoints and handouts are here.) It came about because of a GAO report commissioned by U.S. Sen. Tom Carper (D-Del) that showed 21 to 39% of children in foster care, according to Medicaid claims from five states, were prescribed psychotropic drugs in 2008, compared with 5 to 10% of children who weren’t in foster care. Medicaid spent $59 million on the drugs. The report also found that thousands of foster children were overdosed; some were receiving doses higher than adults are prescribed. Hundreds of children were overloaded with five or more medications at once; according to testimony at a hearing held by Carper, children rarely should receive two. Infants were also given psychotropic drugs, which is against against any sane person’s idea of good practice.
According to a National Survey of Child and Adolescent Well-Being (No. 17 Psychotropic Medication Use by Children in Child Welfare), other studies found that among children enrolled in Medicaid in 2011, “children in foster care were prescribed psychotropic medications at rates from 3 to 11 times higher than nonfoster children.”
“We must ensure that medical standards are met and best practices are followed,” Carper said in a press release. “Unless our Medicaid policies properly reflect best medical practices, the result will damage not only the program’s financial bottom line but, more importantly, the health and welfare of our nation’s foster care children.”
Resources and tools:
- The Center for Medicaid and CHIP Services issued a bulletin that provides a complete set of tools and resources for states to make sure that children in foster care are being given psychotropic drugs appropriately.
- ACF published information, research, resources, and recordings of technical assistance webinars held in the past few months, plus two useful reports: Promoting the Safe, Appropriate, and Effective Use of Psychotropic Medication for Children in Foster Care, and Promoting Social and Emotional Well-Being for Children and Youth Receiving Child Welfare Services.
- CMS provides information on state programs that look at psychotropic drug use in their drug utilization reviews.
Now, you can’t do much about war or natural disasters, life-threatening disease or accidents. But labeling kids with a “disorder” can often be putting the blame for the behavior on the victim. That’s why a few child welfare service agencies are taking a different approach: working with the whole family. They’re doing this because, more often than not, parents of a distressed kid need as much help with their own trauma as their children. Many parents grew up with childhood trauma, and never had help understanding it or know how to change their behaviors so that they don’t pass on their trauma to their children.
San Diego’s Child Welfare Services agency is one of three in the U.S. that’s embarked on a goal of integrating trauma-informed practices into their entire agency.
More on that in another post.