Poorer Children More Likely To Get Antipsychotics

krou writes "A new study by a team from Rutgers and Columbia has discovered that poorer children are more likely to be given powerful antipsychotic drugs. According to the NY Times (login required), 'children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts.' It raises the question: 'Do too many children from poor families receive powerful psychiatric drugs not because they actually need them — but because it is deemed the most efficient and cost-effective way to control problems that may be handled much differently for middle-class children?' Two possible explanations are offered: 'insurance reimbursements, as Medicaid often pays much less for counseling and therapy than private insurers do,' and because of 'the challenges that families in poverty may have in consistently attending counseling or therapy sessions, even when such help is available.' The study is due to be published next year in the journal Health Affairs." The full article is available behind a paywall from the first link. The lead author of the study said he "did not have clear evidence to form an opinion on whether or not children on Medicaid were being overtreated."

Comments

Confounding Variables

[TheMeuge]

I deeply despise these kinds of articles for the joke they make of statistical correlation.

I think they could all come with a giant "Correlation!=Causation" red box warning.

On one hand, maybe the poor kids are getting over-medicated by a government/drug company/new world order rich person conspiracy.
On the other, maybe it just so happens that more of the poor tend to have psychological problems, which would explain their (and their children's) difficulties in progressing up within the society.
Or the environment endured by the children of the poor would tend to be more damaging than the safe and comfortable environment that the children of the wealthy enjoy.

Without much more data, and without very careful prospective analysis, these "correlation" articles are little more than curiously interesting FUD.

However, since they tend to be part of the outrage machine, I think we ought to hold the writers personally responsible for the reactions that ensue.

Re:Confounding Variables

[Runaway1956]

Hmmm. I've observed for decades that parenting skills seem to be people's lowest priority in life. I'm guilty, my parents were guilty, and many, many of my co-workers and associates are guilty. No one wants to take the TIME to work with their kids. And, parenting is a full time job - you can't spend 1/3 or more of your time on a job, a couple hours commuting each day, attend a couple meetings/ball games, spend an hour or two at the bar, and still find time to spend with your kids. Especially since the kids have their own routines that just never seem to mesh with yours. You find an hour or three to spend with the kid, and he has somewhere to go, something to do, a girl to see, or whatever.

Upper class or lower class, I see the same thing. Everyone has to go, go, go - they are busy with SOMETHING all day, every day - even if it's trying to score the next fix for their habit.

Is it any wonder that kids have problems? Couple that with our own unwillingness to spend time working problems out, and yes, drugs are over prescribed for the kids.

We've forgotten what it's like to be kids, don't know how to teach kids, and we're just annoyed that the kids are around to bother us - so we offer them some drugs that will change their conduct, and make them quieter, therefore more tolerable.

To really fix the problem, we need to slow society down a few notches. I've mentioned in another thread that grandparents serve a vital function in a healthy society. Today's grandparents are self centered, retiring to Florida or California at the earliest opportunity, rather than being part of the family. A retired person has little more than time - time that can be spent with the kids, helping them to understand the world, and teaching them to deal with adversity. Or, helping them with more mundane things, like algebra, or archery, or learning to drive.

Our culture is crazy - why shouldn't the kids be just as crazy?

IMHO, there are few conditions that can't be dealt with through patience, discipline, and love. Drugs aren't going to "fix" any problem a kid has. At best, he'll be turned into a zombie for as long as the drugs last, then he comes back to reality, with all the same problems.

But, don't try to sell those ideas to the big pharmaceutical companies. You'll be branded a heretic.

Re:Confounding Variables

[retchdog]

It doesn't show ignorance in statistics as such. I think that most of them would agree, more or less, with the statement "if you control for all confounding variables then, except for a few managable technical problems, the analysis will be causally valid."

Now from my observations, what the "c!=c" people generally believe is that scientists who've spent months or years on a subject, have not even tried accounting for even the most obvious confounders. It's a symptom of hubris and closedmindedness, not ignorance or stupidity.

Of course, often there is a valid criticism, but it's the burden of the critic to RTFA and give an insightful critique in terms of the experimental methodology at hand, instead of a sound bite. In that sense, I agree, it is very unfortunate that "c!=c" sounds so erudite; it helps one overlook the fact, that one is not contributing any information or insight.

rich v's poor

[naeone]

if you are rich and mad you are classed as an excentric, and if your poor and mad well you just plain mad

Drug Lobbies?

[Bob9113]

Two possible explanations are offered: 'insurance reimbursements, as Medicaid often pays much less for counseling and therapy than private insurers do', and because of 'the challenges that families in poverty may have in consistently attending counseling or therapy sessions, even when such help is available'.

Interesting explanations, but they ignore the economics and politics of the issue. Medicaid is heavily influenced by politicians. Politicians are heavily influenced by lobbies. Lobbying money flows very heavily from drug companies.

Run it backwards: Lobbying money flows heavily from drug companies. Politicians are heavily influenced by drug companies. Medicaid is heavily influenced by drug companies.

There are almost certainly other significant factors at play, but to ignore the influence of drug pushers on our government is stunningly short-sighted.

Also consider the health care bill: They've removed the public option and kept the new law requiring people to buy health insurance. Who are they working for? I want everyone to have access to health care. This story, however, is a stark example of the risks of channeling public funds to corporations, and of channeling corporate profits to policy-makers. That is a self-reinforcing system that will destroy us.

Re:Brave New World

[TubeSteak]

Parents have to do their damn job and set boundaries until their kids are old enough to think for themselves.

I'd like to second this.
Generally speaking, children are not puppies that can be trained solely by relying on rewards for good behavior.
You don't necessarily have to use corporal punishment, but you absolutely have to provide meaningful consequences.

Re:Brave New World

[FlyMysticalDJ]

I disagree. I think you'll find that if you sit down with a child and talk to them, you'll find that they do understand a lot more than you give them credit for. And yes, they want what they want, they're scheming and will find whatever ways to break whatever rules and escape punishments. The point is don't let them escape. The only reason people find corporal punishment to be more effective is because they don't have the patience to sit down with a child, or make the sit and think it out without going off and not making sure the punishment is being executed in full. The only reason corporal punishment is so effective is because lazy parents can hit their kid, and that kid will feel the sting of it long after the parent has stopped talking to them about it.

Re:Herein lies the answer

[TapeCutter]

I think your missing the point because you are putting words into the GP's mouth that are simply not there. - "not my fault" may be true but the urge to blame comes up with "it's the vaccines" rather than random bad luck/genes/whatever. You demonstrated this nicely by projecting your own urge to blame onto the GP and came up with "he is blaming the parents".

My own urge to blame says the "rise in autisim" is more likely a statistical artifact atributable to better diagnosis of the people that doctors diagnosed as "retards" in the not to distant past.

that's insightful

[r00t]

There's no more "factory jobs" out there that will feed a family like even 15 years ago. All kids are pushed to perform in ways I'm not asked to, and I'm attending college both on campus and/or online and work full time. Frankly I think that's overkill but "education" seems to think that everybody should be trying to go to Harvard rather than state school.

We currently have little use for the people who are unfit for advanced education. We eliminated their jobs via protective measures that made them uncompetitive on the world market: environmental protection, worker safety, short work weeks, disability protection, minimum wage, etc. Other parts of the world have been happy to take the jobs, and they even ship us back much of the pollution via global winds and ocean currents!

Idle poor people tend to end up in jail. One can argue if that's worse than a dangerous job or not.

We're also ignoring biological reality. People naturally start families as they complete puberty, but we fail to prepare them for supporting families at that time. School drags on for years, offering neither vocational training nor more advanced studies. Tracking is schools is very inflexible, with a student who falls behind becoming permanently stuck in a slower (not merely later) track. For this reason, and because we are hesitant to face the anger and political power of parents with dumb/violent/lazy kids, we don't track kids early. Accepting biological reality would mean adjusting our educational system to ensure that most people would be fully capable of supporting a family around age 16, give or take a couple years. The dumber ones would have useful vocational skills, the brighter ones would have the equivalent of a non-joke 4-year college degree, and very few would be left needing either additional education or prison. We made everything all generic and watered-down though, resulting in near-worthless high school diplomas that merely mean you mostly showed up for class. Neither the bright nor the dim are well-served by this waste of time.

BTW, providing **social** rewards for academic success would go a long way toward motivating students. (money, the right to wander out for fresh air, more in-game time, parking rights, etc.)

For those that do go to college, we mislead and abuse them. We give loans for degrees that offer little hope of providing an income to pay off the loan, then we don't provide a reasonable way to escape the responsibility for repayment. Sure, you can get that interpretive dance degree! It's little wonder that so many people can point to an unemployed college graduate they personally know as an example of why education is worthless. Even the people who make wise choices get stuck spending too much time listening to non-technical professors pushing personal political agendas.

Ever wonder why so many people get communications degrees now? It's because they need to prove that they have the writing skills that used to be expected of those graduating from 5th grade or 6th grade. Ouch. Without some sort of college degree, nobody will believe that you have the basic literacy required for simple office work.