A remarkable rise in children’s emotional and behavioural problems?

2011; W.W. Norton & Company, 2012

A striking upsurge in the diagnoses of ADHD, childhood depression and bipolar disorder, autism?

A significant increase in the number of children taking psychiatric medications?

It’s a mental health epidemic.

Or, not.

What happens when you view children’s symptoms as evidence of something wrong in the family instead of slapping a label on them?

What happens when you take a holistic and humanistic approach to treatment rather than make a diagnosis of a psychiatric disorder?

That’s what Marilyn Wedge posits, that we frame the child’s problem in the wider context of the family and work within that context to solve that problem rather than turn to drugs.

Referring to cases like four-year-old Rebecca Riley’s (who died from an overdose of the meds she was prescribed for bipolar disorder, in the absence of any therapy whatsoever), Pills Are Not for Preschoolers considers the risks of the the psychopharmacological approach.

Not only do drug companies not produce these drugs with children in mind, but in some cases the companies and researchers have concealed clinical studies which revealed their products were ineffective for children.

Even more disturbing, some, like Forest Laboratories, concealed a study that showed that two of its best-selling antidepressant drugs might put young users at risk, cause them to become suicidal.

And, yet, in 2005, children and teenagers under 19 years of age accounted for 15% of antipsychotic drug use (up from 7% in 1996).

[In the United States, this has an additional impact on society because Medicaid provides antipsychotic drugs at no charge to covered children, often prescribed by primary care physicians not psychiatrists; this cost $7.9 billion in 2006 and comprised Medicaid’s single biggest expense.]

Maybe it’s Big Pharma’s “robust consumer advertising”. Maybe it’s the lure of consulting fees that doctors earn from drug companies (one earned at least 1.6M between 2000 and 2007). Maybe it’s lack of motivation to make other changes on the parents’ or children’s parts.

Whatever the reason, parents often feel “more comfortable buying into a frame of reference that does not involve them in their child’s treatment or in the origins of their child’s problems”.

But, let’s say you don’t want to take the risk of lack of testing, inaccurate reporting, or side-effects, what are the alternatives in our overmedicalized society? What can family therapy contribute?

In examining the child’s situation, Marilyn Wedge uses a variety of techniques.

Reframing. Considering the child’s problem or symptom as “having a benevolent purpose in the family”, trying to help or protect a parent.

The author discusses a case in which a young boy was brought to her with longstanding behavioural problems. His violent outbursts did “successfully” attract his father’s anger away from his mother, so that he would be angry at him instead of at his mother in the evenings. (This clearly requires changes in the family system.)

Listening to Children. Considering that a child overhears and understands many adult conversations.

Marilyn Wedge shares a case in which a young boy was worried that his father had broken his arm and was on disability, which caused a number of economic problems. His attention was fragmented and his sleep disrupted, so that his teacher had suggested he had ADHD (but this, too, was resolved with changes in the family home).

Marilyn Wedge, PhD

Moving between Two Levels of Meaning. Considering the parallels between the child and the family.

The author speaks of a case in which a young girl was experiencing severe anxiety. Her mother was also experiencing tremendous anxiety and felt caught between her parents and her husband; the daughter was mirroring this anxiety and felt caught between her own parents, whose marriage contained a great deal of conflict though much of it remained undiscussed. (Specific changes and interventions are discussed in detail.)

Importance of the Invisible. Considering that children don’t always sharply distinguish between reality and nonreality.

Speaking of a study involving a young girl who seemed to exhibit symptoms of paranoia or schizophrenia, the author describes the girl’s imaginative belief that invisible people were watching her. The girl was feeling extremely lonely (as was her mother in her marriage) and was openly worried about her mother’s happiness, but the invisible people disappeared when these problems in reality were eased.

Marilyn Wedge’s strategy is first to communicate to the child that she understands what’s happening and that she will adopt the responsibility of “family helper”. She discusses a variety of interventions, or “helping”, in which very small changes in home behaviour have a wide-reaching effect.

Many of these cases involve young children, but teenagers appear as well, and there is some discussion, too, of transition periods in older children’s lives (e.g. children who move back into their family home after they are grown),

Sometimes specific dialogue is reproduced, time frames are recounted, and background information is provided in terms of other treatment offered (often unsuccessful). Beyond these cases, the author does discuss cases in which she dealt with outright resistance (and used paradoxical techniques to bring about change). She also discusses cases in which family therapy was not successful.

The tone is a satisfying blend of informal (e.g. use of “I”, dialogue, scenic sketches, anecdata) and formal (e.g. notes, statistics, therapy-speak, specific practitioners occasionally referenced). It is informative without crossing the line into academic prose, and somehow it manages to cover a vast swath of ideas and facts without overwhelming the reader.

And, as if what’s already discussed above is not enough? There’s more in Pills Are Not for Preschoolers. The subjective nature of diagnosing psychological problems. The risk of inaccurate diagnoses. Complications resulting from the prescription of specific drugs. The science of interpersonal neurobiology, which maintains that family relationships affect the neural circuits of a child’s brain. The development of systems therapy. The politics surrounding the writing of the DSM.

Pills Are Not for Preschoolers is a slim package, offering just over 200 pages with nearly as many endnotes, an index and an appendix, but it’s a solid text on a Drug-Free Approach for Troubled Kids.

Thanks to TLC and the publisher for inviting me to participate in this tour (and special thanks to the organizer who had more than a few challenges getting this copy to me).

Other thoughts on this book:

Monday, August 27th: There’s a Book
Tuesday, August 28th: Just Joanna
Wednesday, Augut 29th: Family Volley
Thursday, August 30th: Attention Deficit Whatever
Friday, August 31st: Two Bears Farm and the Three Cubs
Tuesday, September 4th: Family Dysfunction and Mental Health Blog
Wednesday, September 5th: Earnest Parenting
Friday, September 7th: Here’s to Not Catching Our Hair on Fire
Tuesday, September 18th: Surviving the Madhouse
Friday, September 21st: Misbehavin’ Librarian
Tuesday, September 25th: Family Dysfunction and Mental Health Blog – guest post

[Edited to add that, after posting my response to the work, I visited the other sites and learned from the comments there that the author will include information about the influence of nutrition and food allergies/sensitivities on children’s neural and psychological health in her next book. Our family has personal experience with this, so we firmly believe that more talk of food is an integral element in treating troubled kids.]