The pursuit of the magic pill: the overuse of psychotropic medications in children with intellectual and developmental disabilities in the USA

McLaren, Jennifer; Lichtenstein, Jonathan D.

doi:10.1017/s2045796018000604

Cited by 11 publications

(3 citation statements)

References 22 publications

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“…Irrational polypharmacy, on the other hand, is when several of the same agents (e.g., second-generation antipsychotics, benzodiazepines, antidepressants) are prescribed because the patient is not responding to the first agent and the clinical focus is on treating each individual symptom rather than looking at the patient holistically (34, 35). The long-term effects of polypharmacy are unknown and there are little data to support its safety and efficacy, particularly in children and adolescents (34,(36)(37)(38)(39). Also, for many patients it is difficult to taper or discontinue psychotropic medications and appropriate deprescribing protocols are only in the beginning stages of development.…”

Section: The Crisis Continues: the Rise Of Irrational Polypharmacy An...mentioning

confidence: 99%

Why psychiatry needs an honest dose of gentle medicine

et al. 2023

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The pharmaceutical industry’s influence on psychiatric research and practice has been profound and has resulted in exaggerated claims of the effectiveness of psychotropic medications and an under-reporting of harms. After the regulatory approval of fluoxetine, the pharmaceutical industry began promoting (and continues to promote) a chemical imbalance theory of emotional distress. In the last decade, there has been an increased awareness about the limits of this theory and the risks of psychotropic medications. Nonetheless, the medicalization of distress, the sedimented belief in “magic bullets,” and the push to “scale up” mental health treatment have contributed to the meteoric rise in the prescription of psychiatric drugs and of polypharmacy. A major premise of this paper is that the conceptual framework of medical nihilism can help researchers and clinicians understand and address the harms incurred by inflated claims of the efficacy of psychotropic medications. We propose that psychiatry, and the mental health field more generally, adopt a model of ‘gentle medicine’ with regard to both the diagnosis of and treatment for mental health conditions and focus greater attention on the upstream causes of distress.

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Section: The Crisis Continues: the Rise Of Irrational Polypharmacy An...mentioning

confidence: 99%

Why psychiatry needs an honest dose of gentle medicine

et al. 2023

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“…These behaviours in both typically developing and neurodiverse children compound societal and educational limitations [58][59][60][61]. They reduce life satisfaction via degradation of social and familial relationships [62], increase economic costs [63], require higher use of physical restraints [64] and restrictive environmental placements [65,66], limit access to support services [67], impair caregiver functioning [68,69], reduce educational opportunities due to teacher burnout [70] and encourage use of restrictive practices including psychotropic medication use [71,72].…”

Section: Introductionmentioning

confidence: 99%

The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review

Baird

Candy

Flouri

et al. 2023

IJERPH

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The physical environment is of critical importance to child development. Understanding how exposure to physical environmental domains such as greenspace, urbanicity, air pollution or noise affects aggressive behaviours in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review, we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of aggressive behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0–18 years. We used the GRADE system to appraise the evidence. Searches were performed in eight databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and interior home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of aggressive behaviour. Most of the studies were rated as having low or unclear risk of bias. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of aggressive behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of aggressive behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and aggression problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the underlying aetiological mechanisms for environmental influences on aggression, the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people.

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“…Externalising behaviours and disruptive behaviour in both typically developing and neurodiverse children compounds societal and educational limitations [50][51][52][53]. They reduce life satisfaction via degradation of social and familial relationships [54], increases economic costs [55], requires higher use of physical restraints [56] and restrictive environmental placements [57,58], limits access to support services [59], impairs caregiver functioning [60,61], reduces educational opportunities due to teacher burnout [62] and encourages use of restrictive practices including psychotropic medication use [63,64].…”

Section: Introductionmentioning

confidence: 99%

The Association Between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review

Baird¹,

Candy²,

Flouri³

et al. 2022

Preprint

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The physical environment is of critical importance to child development. Understanding how exposure to domains of the physical environment such as greenspace, urbanicity, air pollution or noise affects externalising problems in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of externalising behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0-18 years. We used the GRADE system to appraise the evidence. Searches were performed in 8 databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of externalising problems. Most of the studies were rated as having high or probably high risk of bias. Greenspace rurality and interior design had most evidence, although the certainty of the association was low. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of externalising behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of externalising behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and externalising problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the mechanisms of action for both environmental influences on the externalising problems the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people.

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The pursuit of the magic pill: the overuse of psychotropic medications in children with intellectual and developmental disabilities in the USA

Cited by 11 publications

References 22 publications

Why psychiatry needs an honest dose of gentle medicine

Why psychiatry needs an honest dose of gentle medicine

The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review

The Association Between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review

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