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

The short answer...

[MindPrison]

...yes.

But how do I back up such a horrifying claim? By analyzing the current state of affairs in our world today, and I can only draw conclusions from our countrys actions lately. A while ago, we had the news investigators claim that poor & unemployed people get showed back in the queue when it comes to medical attention, medicines and treatment. Incredibly enough - our government admitted that it was a problem, and further investigations showed that the doctors "general" reasons for doing so - wasn't motivated by the government - but by the fact that these people held a job, a position in the society - and thus were a better "investment" for the future.

Also - the doctors pointed out that "people with a position in society" were less likely to complain about mistreatments and other complaints, as the poor were more prone to lawsuits and false claims for monetary reasons, rather than real facts. This were all the rage on Danish TV a while ago.

Re:Parent pushback

[Lemmy Caution]

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.

Information outside of your expertise is dangerous

[Anonymous Coward]

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.

Perhaps

[gad_zuki!]

Mental illness runs in the family and affects economic status. So poor parents pass on their mentally ill genes to their kids thus their kids are more likely to be mentally ill and on some kind of treatment. My own personal experience registers this is as true. I see a lot of emotional problems, especially mood instability, with poorer people. I wouldnt be surprised if this was a chicken and egg problem explained without the "OMG BIG GOVERNMENT/CAPITALIST CONSPIRACY" angle slashdot tends to sell.

Re:Perhaps

[krou]

Just because mental illnesses may be more common amongst poorer people doesn't explain why they are more likely to be given drugs. Please also note the line that says "Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts". If they're less severe in nature, then why the drugs?

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

[Trepidity]

The article is actually normalized for one of your claimed possible confounds, the variance of psychological problems by socioeconomic position. The finding isn't just that the poor get more antipsychotics full stop, but that the poor with the same diagnosis as a wealthy person are more likely to be treated with antipsychotics for that condition.

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.

Re:Confounding Variables

[adolf]

Nay, on the grandparents being more involved

My own parents have taken two of their grandkids away from their folks, ostensibly because the real parents didn't have time, and came close to getting three more. One of them was my own. They did this, ostensibly, because the real parents were "bad" parents who didn't spend enough time with their kids, or who were too strict when they did.

I don't recognize them anymore. In fact, I've gone so far as to fire both of them.

I remember them as drunken/angry vigilant defenders of the castle. Mom had her rum, and the occasional office job -- Dad had a real, swing-shift job that ate his soul but made good money and the occasional beer. I remember being up late while Mom sang Barbara Straisand tunes and played the piano (which she was never very good at), and I remember growing up in fear of waking up Dad when he'd been working nights.

Mom would bring home weird guys from the bar while Dad was at work. And there was a special belt that Dad had, mostly for when we'd pissed off Mom somehow and that made her tell him to "do something." The belt eventually broke in the middle. (For Mom, kitchen utensils were the favorite implement.)

But they've been going to church for the past few years, so they know better for what's good for their grandkids than the kids' own parents do. Court action ensues. Lies are told. Honesty defeated, kids disappear from the home they've always known.

Nay, on the grandparents. When I was a kid, Grandpa would take me to feed the ducks and get ice cream. If he had a problem with how I was being treated, he'd talk to my folks about it until he was satisfied. Nowadays (and this is in more than one family that I know) the grandparents think they've got it all figured out, and are willing to abandon their own children in order to do what's "right" for their grandkids.

Nay, again. Parents need to step up and be parents, and grandparents need to be grandparents. Any other way and the kids end up even more screwed up than they were going to be otherwise, while the courts seem to think it's OK.

How this works...

[ZephyrQ]

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.

Re:Information outside of your expertise is danger

[Lord Kano]

I agree. Several years ago I saw a child who had some emotional problems come around relatively quickly with psychotropic drugs. Pumping an 11 year old full of these medications isn't the best solution but this kid was going to end up hurting someone or himself and his mother didn't have the money for the best therapists. It took about a year to get the combination of medicines and counseling right but it caused an amazing turn around in this little boy.

If they weren't so quick to medicate poor children, we'd be asking why so many poor kids are going without adequate treatment for mental illness.

LK

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

Herein lies the answer

[TheMeuge]

Without the "writers" reactions - we'd have a society that quietly accepts anything

But that's the problem. We DO have a society that quietly accepts everything... everything that appeals to their basest drives, or reinforces past prejudices, with little to no application of logic or reason.

In this case, as well as when considering Anthropogenic Global Warming, Evolution, or vaccinations, the most paranoid conclusions are the most satisfying, in that they reinforce a foregone conclusion, as well as relieve the bearer of further responsibility.

Glaciers melt = not my fault, it's the sun.
Child has autism = not my fault, it's the vaccines
Child has problems = not my fault, it's the drug conspiracy
Too stupid = fluoride in the water
School shooting = gun manufacturers and video games
Poor = Conspiracy of the rich

These are just a few of a myriad of memes that have been further reinforced by the advent of the Internet and the ensuing ability to find supporters of the most wildly wrong ideas.

And that's scary.

Re:Herein lies the answer

[Anonymous Coward]

"Poor = Conspiracy of the rich"

Except this one has abundant evidence. Government's are paid off by business to sit on their hands and not do anything their people request (disability, raise the minimum wage, etc).

Then there was the Bailout. Socialism for the rich, market discipline for everyone else. I could cite numerous other instances, oh like workers being killed by coca cola? Not to mention workers WERE being killed here in north america all the way up into the 1930's, your middle-class life came from a concerted effort of the working class against the rich. Ever wonder why we call it the 8 hour day?

http://en.wikipedia.org/wiki/8_hour_day

What's even scarier is most peoples total lack of knowledge about business history.

Re:Herein lies the answer

[buswolley]

I agree. You know the main reason there is over-medication of the poor is probably the rate that poor clinics see people. 5-10 minutes with a doctor results in the easiest solution.

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.

Healtscare system..

[arikol]

Isn't this just an indicator of how broken the US health care system is.

I have a hard time imagining this to be a problem in this way in the countries which have good public health systems. I've never had to think about the cost of healthcare, that's what I pay taxes for. My neighbour doesn't have to worry about the cost of healthcare, that's what I pay taxes for.

We pay damn high taxes. The benefits are pretty big, though and completely worth it.

I decided to go to University after having worked for over ten years.
Fees for school?
Free (for a good university, well, any university).
That's what I've been paying taxes for.
The youngsters studying with me. I paid for their tuition too (or took part in that).

And it pleases me.

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:Parent pushback

[Trepidity]

The study found an effect even among poor v. wealthy children with the same diagnosis, though, which none of 1/2/3 could explain. 1/2/3 could plausibly lead to more psychotic diagnoses among poor children, but not to more prescription of drugs within the same diagnosis.

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.

Middle Classes Under-Medicated?

[meehawl]

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.

In the UK this would be very Skewed

[Anonymous Coward]

Is there any allowance for children with mental problems eg.ADHD in the US?

In the UK it is not unknown for jobless families to seek to get their children diagnosed with ADHD in order to get a Disability Living Allowance. A bonus benifit designed to help pay for the extra care a disabled child would need.

Of course there is nothing wrong with little Timmy and the parents know this too so they don't give them the pills.

They do still pick up the prescriptions (to keep the diagnosis going) and drugs but end up dumping them. Occasionally get a bagfull of around a years supply of the stuff left in to the Pharmacy to be disposed of anonymously or worse dumped in the street.

Sounds cynical of me I know but people aren't beyond pushing their kids to do this when they themselves are very keen to be classed as sick because allowances are higher than those for the well jobless.

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:Dumbass

[icannotthinkofaname]

No duh GGP was based more on Karl Marx than the Acts of the Apostles. But I need to know: Did you actually go and check Acts 2:44-45 before you told GP to check his sources?

New American Bible, Saint Joseph Edition, from around 2003 or so, Acts 2:44-45 -

All who believed were together and had all things in common, they would sell their property and possessions and divide them among all according to each one's need.

Marx was a philosopher, as we all know, so why shouldn't he have read up on his early Christianity? Acts 2:44-45 came before Marx, and Marx should have known his Christian stuff as a philosopher, and all this I would call evidence, though not proof, that Marx could have has his line inspired by the Acts verses.

emupaul

[the_orginal_emupaul]

I went through a mental psychosis episode after mixing music for a windows 7 party i was preparing to hosting & smoking some super strong weed. I peeked and It looked as though I broke enlightenment my room glowed a bright yellow I - then blacked out a few times and had realistic hallucinations even thought a Jay'z and Kayne was having a party out side my door, I told my dad I found jesus and I had him by the balls (was holding two silver zen balls) then eventually woke up on my bed to find my mom sitting on my coach with a bible in her hand. Anyway my mom and dad where very concerned I guess and for some reason or another they took me to the local hospital (Swedish American) then after-wards a cop drove me to the mental institution called H Douglas Singer Mental Health Center (Rockford IL) I was there 9 days but it felt like less I held against my will (its basically a huge prison) Anyway on the day of my release I was prescribed Risperidone 2mil 1in morning 3mil at night for sleep since I have trouble sleeping anyway that drug is not cheap! if your uninsured at walgreens 30pills cost $190. I stopped using cause it was making me feel worse and I was recently prescribed Seroquel 200mg in the morning and 200mg at night it slows my thoughts down so I don't think as fast (racing thoughts that usually focus and 1 2 or 3 words over and over again) anyway I also noticed a minor side effect...I noticed after taking it for a the first week I stopped dreaming it seems I never get to REM. Anyway I really don't know why im sharing this but I read slashdot everyday and never comment and since this was was kind of relevant to some events in my life i thought I would share. There is a lot more to the story I fail to mention only because it would seem to over the top for anyone to believe - "conspiracyish"

Re:Acts of the Apostles

[JAlexoi]

You should read up on early Christian history. Christians lived basically in communes. And they were essentially communists.
Whereas, the so much beloved capitalism, is essentially anti Christian.

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.