Children and Psychotropic Medication: What Role Should Advocacy Counseling Play?
Ingersoll, R. Elliott, Bauer, Ann, Burns, Laura, Journal of Counseling and Development : JCD
During the last 5 years, there has been a growing emphasis on advocacy in the counseling profession summarized as advocacy counseling by Kiselica and Robinson (2001). During the last 10 years, there has also been an enormous increase in the use of psychotropic medications, but there is still a paucity of research on the effects of these agents on children (Riddle, Labellarte, & Walkup, 1998; Weller, 1999; Werry, 1999; Wozniak, Biederman, Spencer, & Wilens, 1997). The medical model in Western society, with its focus on alleviating symptoms using psychotropic medications, continues to dominate as the paradigm for understanding mental and emotional disorders (Gabbard, 2001) despite increasing evidence of its limitations (Fisher & Greenberg, 1997). In addition, pharmaceutical companies continue to hold a great deal of economic power in a society that overvalues the medical model (Healy, 1997).The convergence of increasing psychotropic medication prescriptions for children, the dominance of the medical model, and the economic power wielded by pharmaceutical companies are all issues that could be appropriately addressed by advocacy counseling.
Advocacy counseling includes social action and social justice approaches to counseling and works to "increase a client's sense of personal power and to foster sociopolitical changes that reflect greater responsiveness to the client's personal needs" (Kiselica & Robinson, 2001, p. 387). In terms of children being prescribed psychotropic medication, advocacy counseling can help counselors to critically examine the shortcomings of the medical model and how counseling interventions can address the same symptoms that the medical model claims to treat. In addition, children and their families face difficult treatment choices when psychotropic medication is recommended and may have limited information with which to make those choices. Advocacy counseling can help these clients and their families increase their sense of personal power as well as address sociopolitical dynamics that may increase the treatment choices available to them. In this article, we outline a brief history of pediatric psychopharmacology, the current prescribing trends and power issues, and then recommend related areas for advocacy counseling practice. Although this article focuses on the medicating of children for mental and emotional disorders, it should be noted that the effectiveness of psychotropic medications for adults is also being questioned in the field (Fisher & Greenberg, 1997).
A BRIEF HISTORY
Werry (1999) noted that the use of drugs to control children's behavior is an old practice. From the use of brandy to soothe infants to other sedating drugs like barbiturates and opiates, children have been administered psychotropic agents as long as such agents have existed; however, research on such practices dates only to the early 20th century. Werry has asserted that research in psychopharmacology for children began with the publication of Bradley's (1937) article on how amphetamines seemed to calm overactive children. In the same period, studies were conducted on the effects of antihistamines on children (Connors, 1972). Outside of these two areas, studies examining how antipsycliotic medications affected children with mental retardation were the only primary contributions to child psychopharmacology until very recently (Werry, 1999).
Bradley's work (see Gabbard, 2001) reemerged in the 1960s after psychiatry began moving away from a psychodynamic model toward the biological model dominant today. The decade of the 1960s saw increasing use of double-blind, placebo-controlled trials that have become the norm in evaluating medications. Using these methods, medication effects on learning and academic performance began to be evaluated, but the research focused primarily on stimulant medications that were being used to treat minimal brain dysfunction (MBD). MBD, a label now discarded, was a diagnostic precursor to today's attention-deficit/hyperactivity disorder (ADHD). …