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
I am a second year student in the Child and Youth Care Counselling program. I am doing my practicum at an elementary school in a program for children with severe disruptive behaviours. All of these kids have severe ADHD along with other disorders. I find it quite a coincidence that I received this thread concerning this topic, especially after my practicum experience 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 was not able to sit in his desk for
a period of five minutes before he would be up distracting the other
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 practicum require a high enough dose of their medication to allow them to be able to focus their attention and energy on completing school tasks, but they 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.
Hi colleagues in CYCW
Very well said Werner! The developmental approach in CYCW is here to stay and so is the medical approach. Child & 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.
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.
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.
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.
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.
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
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.
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,
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?
Great question and discussion. I can't resist offering some thoughts.
When I have a complex issue in which I 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. Her rationality 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 and ready to rupture. The medication was treating the 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 still when 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 they said 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?
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!
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.
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?
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 the convenient consensus that all approaches 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.
So true and so well expressed. The liberal consensus, desirable in many ways, is nevertheless in danger of tolerating the intolerable.
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.
As evidence, I trundle out this 2003 paper here from time to time.
(Available at http://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
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.
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.
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
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?
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?
Gerry, well said, Thank-you!
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.
They usually 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 that I'm anti-medication because I do think that 10% 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!
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.
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.
Very well said Gerry and Clayton !!!!
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.
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 & 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.
Thanks for your thoughtful comments about the uses and abuses of psychotropic medication.
My suggestion that Child & 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.
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.
Well said, 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.
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.