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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."
There are many explanations, none of them happy-making:
1. families with dysfunctional dynamics that lead to serious behavior problems among children are more likely to be poor
2. families with histories of psychotic behavior are more likely to be poor
3. the same behavior is interpreted differently when it occurs among middle class and/or white children than when it occurs among poorer or non-white children
4. non-pharma interventions are more expensive.
Which of these explanations one jumps on first is a good litmus test of one's political ideology.
Before y'all get on your high horses, note that antipsychotics aren't exclusively used for psychosis. Abilify, one of the most popular, is used for mood swings, psychosis, bipolar in general, and as an adjunct to antidepressants. Abilify is an amazingly effective method of relieving intense psychological suffering quickly. The middle class alternative is a year or two on therapy and a couple other antidepressants, which is probably a nicer way of doing things for the patient, but is much slower and less cost effective. Once a patient is on a drug like Abilify, it is much easier to deal with their psychological trauma quickly. It might not be the best solution, but it is a very good one. And, truth be told, poor people aren't going to get the same care as middle-class people.
Doctor, Timmy is getting in trouble in school.
How does he get in trouble?
The teacher says he is too active and might have ADHD.
Have you seen a counselor about this?
No, we can't afford one!
Well, let's try a round of Adderall...
This might seem oversimplistic, but I teach a high school 'behavior intervention' classroom and deal with parents all the time who have the same concerns/issues. More often than anyone will admit, many of the issues related to behavior have to do with cost/consequences...and parents who will not/can not engage the reality of their children's behavior (It's not their fault! They are just picking on Timmy!).
Often, the teachers are just as guilty making these recommendations as the doctors--it is illegal for a teacher to recommend/suggest that a child has to be medicated to attend school, but it happens. And many 'poor' parents do not have the background/education to question the recommendation. So, they go to the doctor and tell them that Timmy has to have medicine to attend school.
The fun part in all this is watching the merry-go-round of meds that a child will/will not take to modify their behavior. For some kids, it is necessary to function. For most, it is not.
By the time they get to high school, many are dependent on the meds to function.
The subtext of this story is that medication is bad, that treatment of a disease state with chemicals is sub-optimal. What if the real story here is that middle-class children have a higher probability of being under-medicated and under-treated? They are already under-vaccinated because of bizarre anti-preservative delusions that tend to be associated with higher economic status parents. I've actually met middle-class parents who tried to treat their diabetic children homeopathically. That's a stupidity reserved for those with sufficient income, inappropriate self-esteem and just enough self-regard and personal "knowledge" to be dangerous.
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