Since it's founding in 1997, the CYC-Net discussion group has been asked thousands of questions. These questions often generate many replies from people in all spheres of the Child and Youth Care profession and contain personal experiences, viewpoints, as well as recommended resources.
Below are some of the threads of discussions on varying Child and Youth Care related topics.
Questions and Responses have been reproduced verbatim.
Listen to thisHi everyone,
I was recently at a forum where a practitioner commented about the use of
drug treatment for children with ADHD, basically saying that children with
ADHD can be helped without drug treatment and commenting on the
over-prescription of Ritalin.
I was wondering what the current thoughts are of practitioners on this
topic?
Drug treatment with children is often described as the “medical approach” in
working with children, and therefore is a bad approach – or so the common
theory goes. This extends to all kinds of drug treatment, for example
stimulants for children with ADHD, antidepressants for children with
depressive disorders, and so on. The past 10 years in South Africa has
seen a dramatic shift in practice with children away from a medical approach
towards a developmental approach. This has been a very important and
necessary change, and has contributed greatly to changes in legislation and
policy that now recognises the importance of child participation and
protection, and a general strengths-based approach.
I am now wondering however, if a possible side-effect of this shift in
paradigm has not also been that we have become overly aversive to all things
“medical”, almost as if we think that any medical intervention cannot also
be developmental? Are we not perhaps over-sensitive to the
contribution that medical science can (and should) make towards helping
children deal with real and debilitating disorders?
I believe that I can take any “developmental model” approach and apply in it
a way that will not be respectful of the child, not promote participation,
not really focus on existing strengths; and I can also take any “medical
model” and apply it in a manner that does promote strengths, etc. My
point here is that it may not always be the approach itself, but the way we
work within the approach, that makes it a “medical” or “developmental”
approach.
Perhaps the time has come to include the medical profession in our circle of
child care practice and engage on these issues to reach better understanding
and find more common ground. I am certainly not saying that we should
start to put all the children in our care on drugs – please understand that
I am not promoting medical treatment per se. But perhaps we can be a
little more open-minded about instances where it is really warranted.
What are your thoughts on the matter?
Werner van der Westhuizen
...
Hello all,
I am a second year student in the Child and Youth Care Counselling program.
I am doing my practicumat an elementary school in a program for children
with severe disruptivebehaviours. All of these kids have severe ADHDalong
with other disorders. I find it quite a coincidencethat I received this
thread concerningthis topic, especially after my practicumexperience
today.
One of the boys came to school today without having had
his medication for his ADHD. I was able to see first-hand the effects that
medication has for kids with this disorder. This little guy was so
un-focused and distracted from the second he arrived until the second that
he left for the weekend. I have never seen him so unsettled before since I
started my hours there in September. He wasnot able to sit in his desk for
a period of five minutes before he would be up distracting the other
students.
All of the children in this program need both medical and developmental
interventions. When a child is as unfocused as that little boy was, there
was little that the behaviour support worker could do to help him during the
day.
Even though I highly believe that a child should be put on medication for
his or her disorders, the amount of the medication needs to be minimal. The
students at my practicumrequire a high enough dose of their medication to
allow them to be able to focus their attention and energy on completing
school tasks, butthey are not given a high enough dose to make them
in-active. Medication should be given to allow a child to be able to
properly function in whatever setting he or she is in. It is then up to the
people working with that child to provide support and instruction when that
child does get a little unsettled.
Melissa Radke
...
Hi colleagues in CYCW
Very well said Werner! The developmental approach in CYCW is here to stay
and so is the medical approach. Child and Youth Care Work embraces a
multi-disciplinary approach where practitioners from diverse professions and
disciplines contribute equally to the growth and development of children. It
is in this context where the most appropriate and effective approach
(medical or developmental) is considered depending on the child's need. To
flatly think that medical approach is not developmental is "not
developmental". The issue for me here and I guess for many other Child and Youth Care professionals as well, is to have a clear balance on the application of the
two approaches.
To think that developmental approach is "developmental" and medical approach
is "medical" might not, in many ways be true. It is "HOW" the approach is
applied that makes the difference. One needs to understand the holistic
approach to start embracing medical approach in order to realise the
significant contribution it has on the welfare of many of our children and
youth in need. How many children are on RITALIN is not the question. I think
the question is around what the need is for those children. As Child and Youth Care practitioners we can actually do more harm if we are one sided in our
thinking around this issue. Again, I think Child and Youth Care professionals need to be
comfortable enough about other alternative approaches and be aware of the
limitations that do exist amongst the multi-disciplinary team members.
Vincent Hlabangana
...
Werner,
I really enjoyed reading your comment about prescribing drugs to the
children and youth we work with. I often do think medical practitioners give
out drugs when it is not needed for things like ADHD. So many young
children suffer from ADHD but there are a lot of ways their behaviours can
be helped or kept under control without Ritalin. I think further
testing should be done on children to make sure they are being prescribed
the right things if it is needed. I would not rule out or take away
these drugs for children because some of them really do need something in
order to be in school with other kids and teachers. I would be curious
to know what the outcomes were in South Africa after their shift in
practice. We may be able to learn something from studying other
countries who have started making the transition. I agree with you that we
as practitioners need to be a lot more open-minded and be able to accept and
implement change where necessary. Sometimes it takes experimenting before we
find a solution that works for each child.
Brandy Thorogood
...
If you have a child who has ADHD will you kill the child or what because to
me we should combine these two approaches medical and developmental approach
because each and every child has a unique strength that we should develop,
that child who is diagnosed with ADHD can teach you something, therefore
letting him/her be developed equally with other children we will be doing a
big favour for ourselves.
Virginia Vivilu
...
I know I'm singing a tune I've sung many times before
but I would like to share with you my letter published in the Globe and
Mail following their article suggesting that more kids required
medication for behavioral problems. Referring to my fifty or so years
in the field I wrote:
I never met a child I considered to be mentally ill. Deprived,
confused, angry, misunderstood and isolated they may have been, but they
were not "sick". The roots of their troubles were not medical but
relational. It's so easy to tag a child with the latest psychiatric
'disorder' and create new markets for the drug companies, but connecting
with a troubled child calls for awareness, commitment and, above all, adult
responsibility. A diagnosis of mental illness lets everybody off the
hook except, of course, the child who then becomes a 'patient'. If you
really believe that psychiatrists and the pharmaceutical industry have the
answer, ask to see the evidence produced by studies that have not been
sponsored by the drug companies.
In the final analysis, these treatment methods turn out
to be far more damaging than the problems they claim to remediate. Is
it really the children who are groping around in the darkness? (Fewster,
November 29, 2008)
For me this is still the only acceptable Child and Youth Care perspective.
Gerry Fewster
...
i enjoyed reading your comments on how helpful and
essential drug is for children with ADHD. However, I think in order for us
to help these children's developmental progress and their academic
achievement; we must provide them with more support than Ritalin. I think
providing emotional support and understanding them is important too. for
these, we can help families and society to be aware of labeling and its
consequences. We must fully aware them how harmful it can be on children and
their perspective of themselves and their behaviors when we label them. We
must do some experiment to find out how we can help these children without
prescribing them drugs. As a Child and Youth Care Counsellor, we should try
to facilitate school environment with programs which can meet the need of
children with ADHA, so in these school there has to be teachers who are
trained and know how to deal with these children. We must involve them in
doing tasks which require more physical movement as an example, teachers can
teach them science through actual gardening or building projects or
carpentry instead of just using text books.
Masoomeh Ashouri
...
I guess there will always be some differences of opinion
on controversial topics such as these – I don't see this as a problem at
all, as long as we are prepare to engage in these discussions with an
attitude of being willing to learn from other opinions and positions
presented. If one has such a strong opinion that you are no longer
open to being convinced of another point of view, there is no point in
joining the discussion anymore, because then it is not a two-way discussion.
For me the most important aspect of this difficult topic is that I sometimes
encounter professionals – both from the medical and child care positions – that are so set on their own approach that they are not even prepared to
consider the possibility that a child may actually have a real psychiatric
disorder, or they lean completely over to the other side and say that
psychiatric disorders don't really exist and every difficulty children
experience can be dealt with without medication. To me, any approach
that is so extreme is dangerous, because sooner or later a child will be
short-changed by our own unwillingness to consider all the possibililities
in assessment and intervention planning. What do we mean, after all
when we say that we work in a multi-disciplinary team?
Werner van der Westhuizen
...
Hello everyone,
I am a student in the Child and Youth Care Counsellor program at Mount Royal
University, and I agree with Gerry's response, in that medication is being
far over-used in the treatment of today's children and youth.
I am currently involved in a practicum which takes place at a group home
specifically working with and supporting 6 girls, ages 13-17. Most of these
girls have had abuse occur in early childhood through age 12 or so when they
were apprehended from their home. This abuse ranges from physical to sexual
to neglect. The girls present with many types of negative behaviors such as
becoming verbally abusive, sexually
promiscuous, self harming, etc. It is important to note that these girls are
extremely caring, intelligent, compassionate individuals, when they are in a
good space. It is when they are unable to properly cope with a situation
that these negative behaviors are exhibited.
Sadly, five of the six girls are on some type of
medication to stabilize their mood, improve their concentration, help them
sleep, control their depression, etc, etc. I think that by medicating these
girls so much, we are partially removing their ability to learn coping
skills that will be so crucial to their mental, emotional, and personal
growth, which are paramount to societal growth.
I want to be clear in saying that I am not against medicating these girls, I
know that the medication can/ does offer some reprieve from the effects of
their past, however, I am worried that perhaps some psychiatrists are
too quick to write a prescription, and that it is actually having a
detrimental effect on their development. It is important to explore
other options in remedying some of their behaviours, such as counselling,
CBT, art therapy, group therapy, etc.
Thank you,
Jill Hastings
...
Dear Fewster
You're so right about relations and funny diagnoses. Have a look at
www.attachment-disorder.net
and
www.fairstartglobal.com
.
med venlig hilsen/ Votre/ Yours sincerely
Niels Peter Rygaard,
Denmark
...
I completely agree with you Gerry. For me it all comes down to the concept
of goodness of fit, meeting the child where they are at rather than shoving
pills down their throats. Yes, sometimes medication is necessary but it
should be seen as the last thing you try rather than the first. If a child
with behavioural problems is acting out, there may be needs in their lives
that are not being met. It is up to us as the adults to get past our own
psychological noise and figure out what these needs are in order to meet
them to the best of our ability. Kids have a right to be listened to.
Medicating them unnecessarily is like shutting them up. By medicating
children who have behavioural problems, we are teaching them the lesson of
the easy button. It is difficult for these children to control their
behaviours. Rather than providing them with the tools, such as breathing,
and providing them with distraction free classrooms that more so meet their
needs, we are giving them a simple solution of taking a pill every morning.
My question is, how will this lesson serve them later in life?
Fran deBruyn
...
Werner,
Great question and discussion. I can't resist offering some thoughts.
When I have a complex issue in whichI tend to have biases of one sort or
another, I look for analogies where my biases aren't relevant. My bias
is against medicating children, but I do allow for exceptions.
An analogy.I have a colleague who is quite close to me personally.
During a period of a few months, several of her close relatives and personal
friends either died or experienced other significant personal tragedy.
During the summer break (she worked in a school), when she was home alone,
perseverating about these tragedies, she began experiencing anxiety that
affected her daily routine. Then, for a period of 72 hours, she did
not sleep and became increasingly irrational. She finally went to her
doctor, who prescribed medications for her anxiety. They helped
dramatically. She could sleep.Herrationality gradually returned.A
few weeks later, school resumed and she returned to work. After a few
months, she told her doctor that she no longer needed the medication and
asked to be weaned off. He counseled her against this, but she
insisted and he agreed.It is several years later. She has had no
further problems. The point – sometimes medication is necessary.
She would not have readily regained her rationality and her perspective
without it.
And another. I have a respected colleague who would waken at 2:00 am
after a big meal with serious indigestion and pain that kept her up for
hours. It seemed that rich or fatty foods were the cause.
Changing her diet helped. Then she found a medication that worked almost
immediately or would even prevent the problem when she took it before bed.
She went back to her regular diet. After months of no further
problems, she awoke one morning at 2:00 am and took the medication. It
did not help. After hours of agony, she went to the emergency room at
6:00 am. Seems she had a blocked bile duct causing her gall bladder to
become seriously infected andready to rupture. The medication was
treatingthe symptoms and masking the real problem. They removed her
gall bladder that morning. She had no further problems and never
needed the medication again. The point – when medication only treats
the symptom, you can expect serious problems later. It is my concern
that too many times when we medicate children, we are only treating symptoms
and failing to address underlying problems that are I think, often of a
developmental nature.
When medication makes it easier to address underlying problems, I think it
is beneficial, provided we are prepared to discontinue it when it is no
longer needed. When it keeps us from addressing underlying problems, I
think it is a disservice.
I remember my lab rat in the Skinner box. Looked very much like an
ADHD kid. We made our rats that way by depriving them of food for 24
hours. Seems that rats with unmet needs become increasingly active.
Mine looked as if it was driven by a motor. Our professor explained
that we did this not so that they would 'work for food,' but to make them
active, exhibiting all of the behaviors in their repertoire so that we could
reinforce behaviors that we wanted.Makes me wonder whether some of the
kids diagnosed with ADHD simply have unmet needs? It's really hard to
concentrate on anything and sit stillwhen you have to go to the bathroom
really bad.Or when you are really, really hungry. But not all needs
are so simple – needs for recognition, respect, achievement and
accomplishment, exercise, a little play, feeling safe...How about fresh air
and daylight? And so many more. I grew up in a time when
theysaid kids with such symptoms had 'ants in their pants.' Didn't
have many professionals to make diagnoses or prescribe meds. The kids
and the adults had to find other ways. My recollection is that schools
were better at meeting kids' needs in those days. Educating kids is an
adult need more so than a kid need.
And I wonder whether ADHD is really a disability. Being aware of
everything in one's surroundings without focusing on one particular thing.
Perhaps not a good thing in the classroom. How about when driving?
Or how about in the wilderness or on the battlefield? Or the
basketball court or football field (American or other)? The player who
is concentrating on the ball and making a shot on goal but unaware of
players around her is likely to have the ball stolen or the kick blocked.
There are times when the ability to focus and concentrate single mindedly
are good, times when being fully aware of everything is good.
So, is focusing and concentrating a natural ability? Or is it a skill
that children must develop? Or is it a bit of each? Is it easier
for some because they have natural talent in that area? Is it more
challenging for others because their natural talents lie in other areas?
It seems to me that part of the thing is knowing when to be aware of
everything and when to concentrate on something specific.
I have heard that there are children with ADHD who improve dramatically on
medication, although I have never known one. But when we medicate
them, should that be the end of it? Or should we look for other
problems and address those? Do we insist that they meet our needs while we
neglect theirs?
There seems to be a movement to find a biological origin for problems of all
kinds, and then the necessary medication.Adults can't be expected to teach
children who have a biological incapacity to learn. And children
certainly can't be expected to be responsible for their behavior when they
have a disability. So no one is responsible, except the psychiatrist,
who is only responsible for making the correct diagnosis and finding the
right medication and titrating the dosage.
Having said that, I know that there are times when long term medication is
extremely helpful and perhaps even essential, having worked with both
children and adults in mental health settings. I have met rare
children who I thought were mentally ill – hallucinations and delusions.
I suspect their medication was necessary, perhaps for the long term.
And I have known many adults who were seriously mentally ill and on
medication for life. I can't help but wonder whether there was a point
developmentally where other interventions might have been more beneficial
for them.
I think it is Karen Vanderven who says that behavior is a symptom, not the
problem. When we medicate symptoms, are we neglecting the problem?
John Stein
New Orleans
...
I myself am a second year Child and Youth Care student in a practicum where
many children are suspected of ADHD or have ADHD symptoms (being too young
to make a diagnosis). I believe in some cases it's not necessary to
distribute medication, especially while still developing. These
prescriptions that are being handed out are still considered quite new in
the world of medicine and the long-term effects have yet to be determined
(especially on a child who is still constantly developing). I suggest that
if any of the staff are considering to inquire putting a child on medication
that it is dealt with through a professional specializing in that area.
Along with coping methods for the overactive/
inattentive children, use their energy to work with it, instead of against
it. Try to make learning activities where the children can engage
interactively or give them (what my practicum calls) a "Body Break". With a
body break you give the child a chance to be active and get all their energy
out in a open space away from the class and other distractions. The body
break is a great time to bond with the child, with the benefit of tuckering
them out a bit so they are able to maintain focus. Also (depending on the
age of the children you are working with) you can distribute "Fidget Toys"
to the particular children who frequently act out in class. Something such
as a ball of play dough works well, which keeps their hands busy, reducing
the chances of disrupting class. I hope this helps!
Jenna
...
Hi John and Jenna,
Thanks for your input, I think it provides a nicely balanced perspective on
things.
I am myself strongly biased against using medication with children, but it
is important of us to be aware of our biases so that they don't interfere in
those instances where the needs of a particular child may not match our
specific bias or expectations. I too would be very hesitant about
prescribing medication for children, even with ADHD where research is now
strongly showing a biological basis for the disorder, and most psychosocial
approaches that do not combine with medication show little promise. I
still think a cautionary approach is best where medication is concerned.
I also could not help playing the devil's advocate in this instance.
Sometimes our own biases and fears are unfounded. Let me cite an example outside of this field, which I think still illustrates my point. I recently studied a module in pain management, and an interesting discussion point was around the use of medication to manage pain. Research in this field has shown that, contrary to popular belief, most pain patients are under-medicated and do not receive the optimal dosage of medication to have a therapeutic effect. Also interestingly, in cases where patients with intractable pain could manage the doses of medication themselves, they tended to use far less medication that medical personnel expected, refuting the popular belief that patients will overmedicate and become dependent on the pain medication. In this instance, the treatment of patients with chronic pain has for many years deprived them of the therapeutic benefit of pain medication simply because the medical profession strongly held the belief that patients will overmedicate and promote dependency on drugs.
My point is that similarly in our field, our own
strongly held beliefs may actually harm children by depriving them of
optimal therapeutic treatment in those instances where it may have been
therapeutic and appropriate (not in all instances). Could it be that a
commonly held belief among child care workers is that "we don't medicate" – and perhaps underlying this belief is the unspoken words "because if we
admit that some children need medication we admit our failure to care
therapeutically"? It would not be an accurate belief, but I think it
may be more common than we would care to admit.
For me, the "red flag" pops up whenever someone hold such a strong belief
about a particular way of treating children, or caring for them, that they
would not consider any other possibilities, and this for me is the greatest
risk or danger. We are all looking at pieces of a puzzle, and it is arrogant
to assume that the one piece I am holding will fit everywhere.
So in the end I agree with you completely – there are those instances when
we should consider the useful of medication for a specific child, but in
general we agree that it is not always the most useful and empowering way to
help children deal with challenges.
Werner
...
Hi John, a well considered and enlightening post. I like your analogy and will utilise it in my teaching drawing examples from my own experience.
Unmet needs most definitely is a major part of the
difficulties faced by these kids. We wouldn't be working with them
otherwise. More affluent children in well-resourced homes don't really come
to our attention. I wonder why?
Peace,
Jeremy Millar
...
I have followed the discussion on the use of drugs as a response to the behavior of children with great interest. Predictably, the initial outcries of concern gradually gave way to the voices of reason and blended into theconvenient consensus that allapproaches have their place. How nice!
Meanwhile, millions of kids, from infancy onwards, will
continue to be medicated into compliance and the one profession that could
speak out on their behalf remains strategically silent.
How sad!
Gerry Fewster
...
Hi Gerry,
So true and so well expressed. The liberal consensus, desirable in many
ways, is nevertheless in danger of tolerating the intolerable.
Yours
David Pithers
...
Then lead the outcry, Gerry – most people do not know how to start the
revolution, so compliance becomes the default response. How nice to
criticise; how much more helpful to lead.
Gary Broderick
...
I concur.
As evidence, I trundle out this 2003 paper here from time to time.
(Available at
https://www.cyc-net.org/pdf/Mitchell%202003a.pdf)
I worked as a frontline Child and Youth Care for 2 decades in
British Columbia – specialized fostercare, mental health, educational and
youth justice settings – before getting my CFA's ('come from away' papers as
they say in Newfoundland).
This theoretical reflection was written as I did my doc research in Scotland
where there is far less of a tendency to label any young person and/or drug
them than we seem to accept as normal here in the US/Canadian context. It
seems timely still since the DSM-V version will be out in 2013 I hear and
already those labelled previously with Asperger's are dis-included. Hmmmm. I
wonder who's going to be included for the first time?
Also recommend a PBS Frontline program available online from a few years ago
called 'Medicating Kids'.
Richard C. Mitchell
...
Hi Gerry,
Yyou are so correct. We self censor and moderate towards
the status quo failing to step back and question the real underlying causes.
All the worse when we work in this field and have all been children who were
oppressed by adults and their systems for eliciting conformity. We need to
keep asking the difficult questions and it is interesting that this topic
appears regularly on the discussion site.
Peace
Jeremy Millar
...
I have a Child and Youth Care degree from UVic and a 6 year old child that was diagnosed with
ADHD in kindergarten. I knew from infancy he had attention and impulsivity
issues. We started medication in March (of Grade 1) and now my son is able
to APPLY the skills that he has learned in the first 6 years of life.
"Medicated into compliance" is an ignorant comment.
Denise Bailey
...
Hi Denise,
Thank you for your input. I think it is important to consider the
facts and not just have an emotional reaction to this topic, although I can
imagine that it touches many people on a personal level.
I maintain that every child should be assessed individually by a
multi-disciplinary team (yes, that should include not only child care
workers) and that each child's needs should be considered in order to make
an informed decision about the appropriate interventions. If a team
approaches a child's situation with a ready made-up mind ("medication is
bad") then we are not truly considering that different children may need
different interventions, or sets of interventions, to help them be effective
in their lives.
What more can I say? My call is not for a pro-medication or an
anti-medication campaign, but for an open-minded approach that will consider
each child as a unique individual. If our own strong personal biases
get in the way, then we are not doing justice to the child in need.
Werner van der Westhuizen
...
Dear Denise,
I appreciate your comments as there is nothing like personal experience for
creating wisdom. I would however urge against taking what happened to your
son as a conclusive argument against dissenters from medication. To this
effect I have a question... You know how your son has responded to his
medication, but how do you know that it is only medication that he could
have responded to?
Also many of the comments about drugged into compliance are based on other
people's experiences, not theory, of precisely that, happening to children.
I am glad it worked out well for you but does this mean
that medication is the best or only answer. What do you think?
Olusola Adebiyi
...
I have been following the "drugging kids" debate with great interest. This
issue evokes a range of emotion in me and requires that I step up to the
plate. I would like to begin by responding to Gary's challenge by
saying that Gerry Fewster has been leading the outcry against drugging
children for decades. As a teacher and researcher he has written volumes on
this topic and continues to take a courageous stance in informing the public
about the other side of the debate; the one not funded by the pharmaceutical
companies. On this side we are beginning to understand how so many of
the so-called 'disorders' and 'syndromes' are actually unconscious survival
strategies learned in relationship as early as conception and through the
prenatal and perinatal periods of development. By creating safe and
responsive relationships with children, care providers can address these
developmental interruptions, drawing upon the child's own inner resources.
To cite one of Gerry's aphorisms, "all injuries happen in relationship and
all injuries are repaired in relationship".
Anyone who wants to explore a comprehensive relational alternative to
controlling kids with drugs and behavioral consequences should read Gerry's
new book, Don't Let Your Kids Be Normal: A Partnership for a Different
World (obtainable on Amazon). In this work he describes ways of
relating that accept and acknowledge every nuance of self-expression as
being real and necessary in discovering and honoring the authentic self.
Unlike psychotropic drugs, this does not offer an easy solution or quick
fix. There is no point in rejecting the medical model without having
something to offer in its place. We expect medical practitioners to
read their literature and so should we. Until we do, how can we can
speak together on behalf of kids instead of relying upon the voices of those
we assume to be leaders?
Verna Oberg
...
Gerry, well said, Thank-you!
Clayton Ellis
...
Denise,
I also like the idea of having a team approach when doing an assessment, but often if there is input from the medical society it would be very difficult to come up with an alternate approach. I have been working with youth for more than 20 years and I have yet had the opportunity to have anyone not follow a Doctor's suggestion of medication of some type.
Theyusually have the most education.One of the drawbacks of working with youth who have been medicated is that when the life of the young person improves it is often the great diagnosis make by the Doctor that gets the credit, so the cycle continues. Also, working with medicated youth takes some of the fun out of it. I don't want readers to think thatI'm anti-medication because Ido think that10% of our youth could benefit from this type of treatment. But that would mean that only 90% of all injuries "happen in Relationships" and that only 90% of all injuries are "repaired in Relationships."
I can live with that!
Clayton Ellis
...
Hi Olusola,
I believe you are right, that many different medications could have worked and/or doses. I think parents need to be open finding what works best for their child. Right now the push is on Biphentin, though Concerta and Ritilan are also out there, as well as others.
My son is followed by the Child Development Team, involving the OT, Speech/Lang, pediatrician, school support teacher, Support services coordinator at the school district level, parents, and child. (PT too, but my son doesn't use that service). We meet quarterly to review progress and goals. We live in a town of 20,000, so there are awesome services here with relatively low waitlists.
The school works very closely with us (plus I work there as a Child and Youth Care worker facilitating leadership groups full time so I am right in their face so to speak) so I know that my son is out daily for OT breaks, social skills groups, and speech blocks. He was funded for a one to one aid at summer camp for a week to help make his camp experience successful, and went to half day OT camp for a week to work on sports skills and encouraging others/ teamwork/etc. I chose to continue the med throughout the summer so that my son can use his skills and work on maintaining friendships.
I know this is a difficult debate, and I liked Werner's comment about how each child must be considered as a unique individual. I feel lucky that I have such a supportive team approach in my community.
Thank you,
Denise Bailey
...
At the risk of perpetuating an unproductive dialogue, I want to challenge the belief that those who question the use of psychotropic medication with children are being reactionary and emotional, rather than rational and scientific. The rationality of my own position is, that while I can identify many relational reasons why a child might feel, think and act in a certain way, I have absolutely no evidence to suggest that the problems might be bio-chemically based. And neither have the ‘scientists.’ After decades of zealous and highly funded research, the assumed relationship between biology and ‘mental’ illness remains glaringly equivocal. Over the past thirty years we have been bombarded with un-replicated studies sponsored by Drug Companies to promote their products, but that’s about it.
Based on this evidence, it would be totally irrational and unscientific for me to support meddling with the chemistry of a child’s brain when I can only guess what the long term developmental effects are likely to be. And yes (tsk tsk), I do have an emotional response when I consider the ever-increasing numbers of children and infants who are being chemically manipulated.
Gerry Fewster
...
Very well said Gerry and Clayton !!!!
Relationship.......
Relationship.......
Relationship.......
Lorna McPherson
...
Hi folks,
I have a slightly different take on the meds topic. Looking at the
fundamental beliefs, basic principles, etc. of Child and Youth Care and medicine, CYWs are,
basically by definition, "against" medication, doctors are "for" it.
Or, more accurately, Child and Youth Care is based on the belief that a responsive
milieu/environment (the kinds of things Jenna mentioned doing) is the answer
to social/behavioural problems; the medical profession is based on the
belief that a bio-chemical approach is the answer. Individual CYWs and
doctors may believe any combination of things along that spectrum, but as
professions, that's the basis.
Now, from the point of view of the child/parent/teacher, what really matters
is what's available – what approaches to ADHD are accessible as information
(what they can read or hear about), and what are actually available as
"treatment." And both knowledge about the Child and Youth Care approach and the Child and Youth Care services
themselves, are determined by the "power" of the profession – the ability of
the profession to have its message heard and its services available.
Doing this through our jobs as CYWs (students or grads, front-line or
managers, or writers in Gerry's case) is part of the answer. That's
significant, but only a small part. Without an organizational voice,
it doesn't go very far.
And the organizational voice for CYWs is our professional associations.
For instance, here in Ontario the association is speaking up to stop the
replacement of CYWs with nurses and nurse practitioners in the adolescent
unit of a psych hospital (see www.oacyc.org).
In doing so, they are both letting the public know about the Child and Youth Care approach,
and working to maintain it as a real alternative to medication for youth and
their parents.
Without active membership in your professional associations (or working to
get one if you don't have one), it doesn't matter how opposed you are to
meds, or how strongly you feel about the Child and Youth Care approach. It's pretty
well all just talk, as in Gerry's province (British Columbia). There
they have probably the most developed levels of Child and Youth Care education (diploma to
PhD), so plenty of people talking about the Child and Youth Care approach in university and
college classes, but just the bare bones of a professional association.
No body to get the talk into the public media (for parents). No body to get
government resources put into the Child and Youth Care approach. No body to speak up
when school boards, hospitals, or residences might want to reduce Child and Youth Care services (frequently resulting in an increase in meds). No body to
provide parents with the option of a Child and Youth Care approach, for instance by providing
professional liability insurance to CYWs who might want to go into private
practice, or by advocating with employee assistance insurance providers to
include CYCs in their roster of available professionals.
So besides through what you do in your jobs or practicums, I think the next
best thing to do about this issue is to become a member of your professional Child and Youth Care association. I assume Gerry is a member and strong promoter of his
provincial association (as am I in Ontario). For the rest, if you
aren't a member, contact your local state/provincial association or national
association (one or the other should be on the web) and give them an equal
amount of time you spend on CYC-NET. It will help to give parents and
kids a real option to drugging.
Dennis McDermott
Harrowsmith, Ontario
...
Greetings all, and especially Gerry
I've been holding onto this post for a while waiting to try to formulate my
response; and I think I've got it. It's undoubtedly a bit defensive, but I
can't help but wonder if this post isn't also a form of defense ;
projection.
You've identified us as the one profession that could speak on their
behalf, and I'm not sure if that's accurate, and if it is, how did that come
to be? First off in most of the country that I live in, and you too Gerry,
we haven't yet attained the status of "profession". i.e we don't have a
regulating college, people with all kinds/levels of training are employed in
situations that are identified as Child and Youth Care.
Secondly we work with all kind of other professionals like Social workers,
teachers, psychologists, nurses, psychiatrists. How is it that we're the
"ones" who could do something about this? What exempts these folks from
protecting children and youths and families from the trend to medicate?
Furthermore, of all those involved it is my belief that we are the ones most
likely to suggest and implement efforts that are relational, not medicinal.
And in doing so we model another approach, and offer something to children
youths and families that is more.
So how about losing the indignation, and judging tone; with respect.
Michael Wattie, CYC, cert.
...
Greetings Michael
Thanks for your thoughtful comments about the uses and abuses of
psychotropic medication.
My suggestion that Child and Youth Care is the
one profession that can speak out in the best interest of kids is not really
a stance of 'judgment' or 'indignation' but a reflection of what I believe
should be the primary focus Child and Youth Care practice.
In a nutshell, I believe that effective Child and Youth Care practice works from the "inside
out." The focus is upon the subjective experience of the child rather
than external judgments and labels applied by parents and professionals.
By the same token, the essential resources for change and growth are to be
found within each individual child, rather than in specific forms of
treatment or therapy. Practitioners who work in this way are
more curious about the inner world of the child than the theories that
purport to explain behavior
and the techniques designed fix the problem. For these reasons, their
essential skills are personal and relational rather than objective and
technical.
By contrast, psychiatrists are primarily concerned with the brain,
psychologists with deviations from their standardized norms and social
workers with environmental circumstances. None of these folks are in a
position to respond to the subjective experience of the child. Caught
up in their own theories and traditions, they are not likely to challenge
their own methods of external intervention and questioning each other's
would be very "unprofessional".
I hope these comments help to clarify my position Michael – although I can
be judgmental and indignant at times. On the other hand, this also serves to
explain why I hope Child and Youth Care never becomes a "profession" like the others – but
that's another story.
Cheers,
Gerry
...
Dear Gerry,
Your third paragraph is a complete masterpiece. Everybody in the field – and other fields – should read it. I might say, based on the
"inside-out" approach that any interventions, therapies etc. take into
account (very strongly) the inner life of the child. Certainly
relational skills are fundamental and 'the essence' of the field as you and
others have described previously. However, that does not mean
that other skill sets cannot be useful – e.g. activity programming, many
others that can further enhance the relational approach. It doesn't
have to be 'either-or'.
On the matter of what is a 'profession' and 'professional' I still
think Child and Youth Care needs to become 'a profession' that focuses on
the special nature of the work done. That does not mean that it has to be
the same as other 'human service professions'. Rather, using a blend of
structural characteristics of 'professions' and its own unique perspective
(e.g. the one you described so well) it can create a new notion of what it
means to be a profession, gaining the benefits of such and avoiding the
pitfalls . (I wrote about this back in the mid-90s, in my article on the
life span in the (then) (Canadian) Journal of Child and Youth Care.
I look forward to further discussion.
Karen VanderVen
...
Well said, Gerry.
Regards,
Ruth
Cape Town
...
Dear Gerry,
I am sorry but I think you are misinformed about social workers. To
say that we are concerned primarily with environmental circumstances is
simply not correct. It is about as incorrect as saying that child care
workers are glorified nannies. Perhaps this is the point where we will
have to agree to disagree.
Werner
...
Dear Werner,
I am a Child and Youth Care Worker who worked in Residential care for about 5 years, and then got a job as a Child Protection worker with Health and Social Services. (Small northern town, due to my related degree and experience.). I did that for three years and now am a Leadership Facilitator in a 1-8 school, working with selected high risk kids.
Each job was very different, but I was able to bring the
core of my training to all positions. Relationships.
Social workers are incredible people. I can't say enough about the amazing
people I worked with. I couldn't do that job again, and took a $20,000 job
cut to get out of it. It is the craziest emotional job I have ever had and
will ever have.
You and your team are doing an amazing job out there. Thank you for doing
it.
Denise
