Medicating our youth
The July/August article, "Are preschoolers being overmedicated?" starts with "Behavioral therapy is recommended as the first line of treatment for very young children. So why is medication use rising among this group?"
As a practitioner of behavioral therapy for many decades, I would suggest a hypothesis related to this question. Behavior therapy is indeed effective in young (and older) children, but often can be ineffective unless or until a child is appropriately medicated. And yes, there are serious side effects involved in the use of any medication, but there are also serious side effects of severe behavior problems. Families and clinicians balance.
Fred Kemp, PhD
Rochester, Wash.
The July/August article "Are preschoolers being overmedicated?" is another important acknowledgement of our field's apparent perfunctory embrace of medication as a common, acceptable and/or effective mode of treating youth. Unfortunately, our assumptions of medication effectiveness for youth are largely unfounded when critically examined or applied to a naturalistic setting. We must continue to promote and further develop effective alternatives.
Since the Monitor article, two important studies have emerged. A study in the Journal of Child and Adolescent Psychopharmacology found that from 2001 to 2010, rates of antipsychotic use in children younger than 6 years old more than tripled. In addition, use in teens is also rising: 1.18 percent of all adolescents were prescribed these powerful medications in 2010 compared to 1.10 percent in 2006 (Olfson, King and Schoenbaum, 2015).
These trends are occurring at the same time that the NIMH Director Thomas Insel has highlighted that the use of antipsychotics may indeed worsen long-term outcomes (when looking at functional recovery in people with schizophrenia, for whom they are designed). Research related to their use in young people is sorely inadequate both in scope and robust outcomes. Moreover, it is well-established that Haldol has neurotoxic effects (Nasrallah, 2013), yet its use is rising. While atypical antipsychotics are still more popular, dramatic concerns persist about metabolic, systemic and epigenetic side effects.
We must seek more acceptable strategies to assist challenging youth and their families. Psychologists' role in the ongoing use of antipsychotics with young people must be reconsidered.
Robert Foltz, PsyD
The Chicago School of Professional Psychology
Over the past six years, a training program through the department of psychiatry at the University of Iowa Carver College of Medicine has successfully trained numerous mental health providers in rural areas of Iowa and Nebraska to deliver one of the interventions mentioned in your article "Are preschoolers being overmedicated?", Parent-Child Interaction Therapyopens in new window. I found that once an effective alternative to medication was available in their area, primary-care providers were eager to refer their young patients for psychological intervention.
In the words of one of my favorite Iowa movies "If you build it, he will come."
Beth Troutman, PhD
Iowa City, Iowa
Guiding principles
The June article "Guiding principles" about the benefits of Improving Access to Psychological Therapies (IAPT) omits a potential problem of IAPT. This is best described by the list of the U.K.'s National Health System for recruiting "high intensity cognitive behavioural therapy workers." The homepage specifies "CBT therapists, clinical psychologists, counsellors, nurses, occupational therapists,;experienced graduate mental health workers or psychotherapists undertake this work. They are accredited/accreditable by the British Association of Behavioural and Cognitive Psychotherapies."
I hope the data will show that psychologists are strong competitors.
Lothar Wittmann
Otterndorf, Lower Saxony, Germany
Sexual orientation therapies
Regarding the June article "APA applauds President Obama's call to end use of therapies intended to change sexual orientation," on the call to end therapies where clients freely seek to modify unwanted same-sex attractions and behaviors: All such concerns could have been adequately dealt with through existing professional guidelines and state regulations. Indeed, the lack of ethics complaints against such therapists at the state level suggests that their professional conduct is not the problem, but rather their willingness to entertain the possibility of change for some clients.
We concur with Judge O'Scanlain's dissenting 9th Circuit Court of Appeal's opinion on the California ban for minors: "Empowered by this ruling of our court, government will have a new and powerful tool to silence expression based on a political or moral judgment about the content and purpose of the communications. The First Amendment precisely forbids government from punishing speech on such grounds."
Legislation in Washington state further disclosed ban-supporters' motives. A bill with bipartisan support to prohibit harmful aversive techniques with minors (e.g., electrical shocks, chemically induced nausea, ice baths) died after ban advocates protested that it still allowed for therapist speech in the potential facilitation of change.
APA's leadership celebrates when those with Gender Dysphoria change their biological sex, but our same leaders promote legal bans when those reporting attraction dysphoria desire to simply speak with a psychologist in a manner that could be construed as promoting change. Is it any wonder that APA is losing credibility with those not of a left-of-center persuasion?
Christopher H. Rosik, PhD
Fresno, California
Laura A. Haynes, PhD
Tustin, California
Elizabeth Kim, PhD
Garden Grove, California
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