Study, May/18:Systematic Review of Pharmacologic Treatments for School Refusal

The full title of this American study is "A Systematic Review of Pharmacologic Treatments for School Refusal Behavior".

 

Excerpt:

 

"RESULTS:  The search identified 6 articles, including 7 trials (6 RCTs and 1 open label) and 306 youths. Pharmacologic treatments investigated for school refusal included antidepressants (imipramine, clomipramine, and fluoxetine) and benzodiazepines (alprazolam). All pharmacotherapies studied had pretreatment to posttreatment improvements on school refusal, depression, and anxiety symptoms. However, included trials were severely underpowered and did not demonstrate significant improvement compared to placebo."

 

https://www.ncbi.nlm.nih.gov/pubmed/29741917 

 

It's extremely unsettling to think that antidepressants and benzodiazepines might be prescribed to children for "school refusal". I would want to know much more about what non-pharmacological treatments were offered and tried.  I can't access the full study, and the abstract provides little detail.

I wonder if this is an expansion of some of the evil ADHD policies that some schools encourage..

Sorry, I dont have details...

But yes, your right... -no apparent attempts to "first do no harm" these days, it seems...

Im not sure informed consent would be so valid in this situation either..!!

 

 

 

It makes me so sad to think of controlling children's behaviour with drugs like this. Their brains are still developing. Such use of medication could have life-long consequences. Is this really the best that can be offered to such a vulnerable segment of the population?

I would have to switch my son to a different school if that were the case. At any rate, I believe that his father and I would have stood firm on this. So very sad to read about this. These children are so young, still forming their brains. I wonder if someday (hopefully) it will be thought a barbarian practice. I think I'd try a meditation class for my child and of course make a very conscious effort to have good food and exercise. ANYTHING other than drugs.

Yes, Terry. Yes. It just seems wrong. I don't know the circumstances, but it doesn't make sense to me. They need to get to the root of the issue, and I can't believe the only solution to it is a chemical one.

That's it, Lapis, the root of the issue. In working at a school, I often saw a boy from an ADHD class eating sweets, waiting for his mother to pick him up. Maybe some intervention with parents on proper nutrition? There HAS to be something other than pills! I think the problem stems from a seemingly "easy" fix (drugs) vs. trying to get to the root of the problem.

MY kid is having school refusal.  At our last school, it was all about diagnosis, and referrals and guesses at problems.  This years school- new school- was telling me how diagnosis's still can be helpful.  We are moving again and I recently heard, a rumor, that about 80% of kids in the school in my CURRENT AREA are on meds!!!!    Just like what?  So I am moving to a more suburban area with less people, but I don't know if it is cities, less nature, or just drug pushers but damn, this is widespread problem.  My kid is 9, and the problem started when he was 4.  I was actually open to medicating him at the beginning but that was like only just before I joined benzo buddies and realized how crazy that would have been.

Oh, Green Cup, I'm so sorry to hear about that! I'm really not familiar with this issue, and I'm not sure if it's happening much here in Canada. Can you share a bit about what's happening and what the issues are -- especially with regards to medication? Why would so many children be put on medication?

Yup!! Just give 'em a pill - that'll fix 'em!! HELL!! Apologies in advance if I come across a tad cynical. I'm not denying all diagnosis, please don't get me wrong. But so many? And even then, could there not be more of an integrated approach, discussing the issue across many scientific and other disciplines?  I am one of the "guilty" who trusted (but not before I did a lot of research, attended many lectures, read everything I could on the issue, and that was long before Google!) I was convinced (at the time) the medical experts were right and I defended the drug to people who openly voiced their disapproval. These people were not in my shoes and they judged from an "ethical" perspective rather than evidence based perspective. I was shocked at the battering I copped. If a kid goes from being blissfully tuned out and at the bottom of their entire year; then "post-drugged" to go to the top 10% of their year, that to me was evidence that the drug worked!.  I cannot tell you the ramifications which resulted years later.  Had I my time over again, my decision would be very different!

 

Back in the 1980's - medical problem? ADD (there after known as ADHD). Two types; "Inattentive" type (shy, passive) and the "Hyperactive" (swinging from the rafters kind) Fix? Ritalin or Dexamphetamine. Oh, the "Developmental Pediatricians" (always said to be "the best in their field") would tell parents, "Don't worry, it's not "Speed", that's like comparing whiskey to cordial". And "to back up our findings, there have been so MANY studies (30 years in fact) to prove the harmlessness of these drugs".  Hmmm....I know first hand this was all BS 

 

Then Asperger - fix? Antipsychotics to assist "challenging" behavior. Next trending "diagnosis" Autism Spectrum Disorder! More anitipsychotics! I worked with a little boy who was at the high end of Autism, he wandered around the classroom in a daze, was 12 but more like 2 in behavior. Such a gorgeous child who responded so well simply teaching him songs He (like all children) need authentic connection and know they are listened to, completely heard and understood.

 

Perhaps its time for a review? What's going on with our kids? Societal changes? Our education system? (not blaming the poor teachers by the way), just that there are so many pressures on kids to achieve and also on teachers to ensure favorable outcomes. I mean my granddaughter was given mandatory nightly homework in kindy!

 

Parents assume the education system knows what they are doing (and to be fair many educators are miracle workers, they instill confidence and teach how to learn and a love of learning. Such genuinely have the children's best interest at heart)..

 

What is a parent to do? What are schools to do? I feel it all needs to be a collaborative effort. This can only be achieved if all parties are considered equal and are well informed (including being well informed outside their area of specific expertise). The broader systems need to collaborate, medical and educational, and set aside their biases.

 

School refusal, challenging behavior? Lets look what's behind "challenging behavior", or at the cause/s, rather than drugging children to "behave" and attend? 

 

A friend (a pediatrician) put his own daughter on AD's at the age of 10. She was an extraordinarily high achiever, brilliant academically, musically, artistically. She was burned out by the age of 10 and her father thought he could fix her with ADs! She told me she hated the drug, it made her feel "neutral" and she was tired of being "the best". It's all way too complicated and sad.

 

Sorry for the rant, this is close to my heart  Harmonee

Wow! Harmonee, thanks so much for all of that -- and for your passion. There's so much in there, and I appreciate the depth of feeling and experience that's behind it.

 

Someone very close to me spent more than 30 years teaching very young children, and if you asked her, she'd say that medicating young children is not necessary. What they mostly needed, in her opinion, was a bit of extra time and attention. In some cases, getting outside and getting active were the answers to whatever was termed "hyperactivity". I don't think anyone considered medicating young children when she was teaching in the 70s and 80s.

 

I don't want to over-simplify things, and of course, I'm not part of any of those systems at all, but it really worries me that young children have to be medicated to make them conform. I know a young man who was medicated with Ritalin at a young age (6, I think), and who eventually sought out other, more dangerous forms of self-medication during his teenage years -- likely in order to try to feel "normal" once the Ritalin was stopped. I don't think he ever required medication at all. He's fine now, thank goodness, but he faced a major battle to get to a better place. I wouldn't wish that on any other young person.

Hi Lapis, yeah sorry, that all just spilled out, I have seen so many consequences resulting from kids unnecessarily medicated, much like the young man you described. In my situation (due to medical records archived) someone close to me lost her young child in a hideous custody battle. Her ex subpoenaed every medical record dating back to her young teen years and his legal team literally used them by picking and choosing certain records which twisted the facts against her. Literally one long-winded referral written by a ticked off "developmental pediatrician" to another specialist (who said at the time he though the pediatrician only had an axe to grind) was used as a major piece of "evidence". The lawyers were so clever at distorting the reality, which made her appear to have had a long history of poly-substance abuse and a mental disorder! She was only 16 at the time of the referral letter and 20 years later they deemed her an unfit mother which was so far from the reality. It was a case of legal abuse, as the ex is a wealthy lawyer; the mother had no assets and had to self-represent. Ultimately her own child was punished (having little contact with her mother against her will) for circumstances which occurred 20 years earlier. So as you can see, it touched on a very raw nerve.

Someone very close to me spent more than 30 years teaching very young children, and if you asked her, she'd say that medicating young children is not necessary. What they mostly needed, in her opinion, was a bit of extra time and attention. In some cases, getting outside and getting active were the answers to whatever was termed "hyperactivity".

My nephew was just like that too! He was so hyperactive but really just needed much more attention and activity. He was such a bright kid, full of energy and needed attention so badly. He chose extreme actions to receive any attention from his parents, and so he was deemed a bad kid. When he stayed with us we ran him into the ground with physical activities and exhausted him of all his excess energy. He was given clear boundaries and it was like Jekyll and Hyde. He was putty in your hands, and such a lovely boy when all that energy was used up and he didn't feel the need to do crazy things to get attention. Sadly he ended up on the streets. From the age of 20 (he's now 36) he wanders from place to place. He was so bright, he could have done anything with his life, but at home he was never encouraged, so much potentiality lost.

 

To me it is so concerning that people are encouraged to seek help, but years later it can be used against them. I had no idea medical records could be subpoenaed and a person consequently can be deemed mentally deficient even due to having had an episode of depression!! The system/s are crazy, not the individual. Lol, sorry another rant  Harmonee

No, please don't apologize, Harmonee! Your stories are so touching, and I'm sitting here feeling intensely angry and upset by actions that seem so unfair. I'm so sorry to hear about these things! What happens in the first few years of life is so important, and the better start children are given in those early years, the better off they will likely be.

 

I must admit, I'm not even sure I understand whether "school refusal" means that the school won't let the kid be in class unless s/he's medicated, or if the child him/herself is refusing to go to school and so they medicate him/her. It's not a term I'm familiar with. Either way, it's not good.

School refusal is when the kid refuses to go to school.  This is what my kid does.  His started as a separation anxiety, and has kind of turned into more anxiety.  He basically just gets really really anxious when it is time to go to school and will start saying and doing ANYTHING to not have to go to school.  He will fight, cry and have panic attacks if someone physically tries to make him go. 

 

THIS is the main problem I have with drugging the kids for this.  If you are drugged into compliance, you NEVER figure out why you were anxious.  There IS a reason.  A LOT of times the reason is bullies.  I have talked to other parents and found this true, especially in kids who only refuse school sometimes.  My kid does it A LOT now.  He says he hates school because he would rather be home with me.  Thing is, I totally get this.  I felt the same way until 4th or 5th grade.  I actually did not like school at all until 7th grade when I actually wanted to see friends.  I honestly think it is really normal to not want to be in school.  It drives me nuts when teachers ask why he doesn't like school.  I'm just like, are you crazy?  Who the hell would rather be at school?  Ah maybe I am jaded.

 

Like Harmonee- I know an autistic kid who is on a ton of drugs.  He is 19 now, and on 5 drugs that I have been telling him to get off for years and he had to really fight to be able to taper.  He is currently tapering down on an antipsychotic.  Fun fact, he very very worried about the violent thoughts he was having about hurting someone when he was 15 and they gave him xanax, and he said that the xanax did work on his worries,  so he wasn't worried about his thoughts anymore and was violent.  He was then hospitalized and medicated for years.   

 

Lapis- I am in Canada.  We do have school refusal here and ton of kids here are medicated.  I was seriously shocked to find this out as well.  Since i moved here from the US, I am always comparing the two health systems.  I always secretly hope the Canadians learn from America's mistakes before they imitate many practices. 

I'm sitting here feeling intensely angry and upset by actions that seem so unfair. I'm so sorry to hear about these things!

Oh again sorry, I guess I am just so affected by this. My last intention was to pass negative energy on to you. I guess life has a way of sorting itself out and life isn't always fair. It just hurts when little kids are involved.

I must admit, I'm not even sure I understand whether "school refusal" means that the school won't let the kid be in class unless s/he's medicated, or if the child him/herself is refusing to go to school and so they medicate him/her. It's not a term I'm familiar with. Either way, it's not good.

I see Greencup has experienced this first hand, not good, what a nightmare for her and her child! I got the impression from that article they were expecting parents to medicate their kids if they didn't want to go to school? I almost flipped!

 

Thanks for being so kind Lapis  Harmonee

 

If you are drugged into compliance, you NEVER figure out why you were anxious.  There IS a reason. .....says he hates school because he would rather be home with me.

Yes I totally agree! Sounds like he doesn't get the feeling of attachment at school that he needs and gets from being at home with you! Like you I would have never gone to school had I had an option to stay at home with my mother!  I remember running home from school so often from the age of 4 until I could no longer get away with it.

It drives me nuts when teachers ask why he doesn't like school.  I'm just like, are you crazy?  Who the hell would rather be at school?  Ah maybe I am jaded.

You're not jaded at all. Shouldn't the teacher be asking herself (and your little boy) why he doesn't want to go to school rather than asking you? My husband grew up in Germany. They had one teacher who stayed with them from the beginning to when they left. Luckily she was such a loving person, she was a second mother to the kids. He loved school because he felt safe and knew the teacher was kind and understanding. All the kids would go to her if they had any issues and she would help them sort things out. School can be so overwhelming for some kids, I remember too what that was like.

 

Like Harmonee- I know an autistic kid who is on a ton of drugs.  He is 19 now, and on 5 drugs...

Yet another perfect example why we must not medicate children. Why is it society always seems to need to turn to the magic silver bullet approach? Have we forgotten to care long enough to inquire and stand back to get a clearer view of the larger picture? We need to nurture children, it really does take a village to raise a child and it's a shame we've lost that concept 

 

Have you seen Tina Payne Bryson's work? I've read many of hers and Dan Siegel's books, the latest being "The Yes Brain Child". Here's a short snippet which might help your situation?

 

 

Harmonee

 

 

Thanks, GreenCup and Harmonee, for explaining everything and for sharing your stories. I hate the idea of medicating young children, since their brains are still developing, and we just don't know the consequences.