Think outside the pill box

9th November 2007 at 00:00
A long embrace is one effective way to heal a child's mental distress, says Oliver James.Both the main political parties swear they'll do more for the 10 per cent of children diagnosed with a mental illness. But even if they did throw more money at the problem by spending it on existing conventional solutions, it would be largely wasted. A radical rethink is required about the diagnosis and treatment of children and support for their parents.

At the moment, the process of identifying which children need help is haphazard, with only one quarter ever treated. Educational psychologists do most of the referring from schools, yet they are specialists in cognitive disabilities, not emotional problems. So every school should have a person trained in diagnosis of psychological distress. This could be a teacher, educational psychologist or school counsellor - not necessarily working full-time.

After diagnosis, there are two main kinds of treatment: pills for ADHD and depression, and cognitive behavioural therapy. Yet neither of these is appropriate in the vast majority of cases.

Although many child psychiatrists are now turning against the use of drugs in all but extreme cases, psychiatry is still grounded in a disastrously misconceived model: mentally ill humans are mechanisms with a physical malfunction. Pathological patterns of brainwaves or electrochemistry are primarily caused by genetic abnormalities and are best treated by chemicals.

Many child psychiatrists abandon this model within a few years of beginning their clinical practice, but it still underpins the way difficult children are regarded - including the fact that they are deemed to have an illness, rather than as being emotionally distressed by family maltreatment and a deranging society - the true causes in the majority of cases.

Since they have few drugs they can give children (for depression, child psychiatrists may prescribe only Prozac; GPs are not meant even to prescribe that), doctors often pass the child on to a psychologist practising CBT. This is little better than drugs. It explicitly avoids examining the causes of the problem. Instead, it seeks to brainwash them into "good" or "healthy" behaviour, using thought processes that exclude emotions.

Damaged children need help that addresses the causes of their problems. Ideally, especially where the child is still small, parents should be enabled to provide the help themselves. The alternative is therapy for the child that helps them to understand the causes and overcome the damage done by maltreatment.

Parenting education classes are the commonest intervention for improving the quality of care and guidance. Where these are not too programmatic and take trouble to explore the parents' own childhood maltreatment, they can be helpful. Usually, the more they resemble a supernanny, naughty chair approach, the worse, although there are some parents in need of training because their own childhoods were disorganised.

For more extreme cases, a proven method is prolonged parent-child embrace, where parents engage in physical embracing and intense eye-to-eye contact. This has worked for children with ADHD and conduct disorders, as well as anxiety and depression. I have found a modified form of it can have impressive results.

Where the child receives individual therapy, exploration of the underlying emotions and their causes is crucial. This can be done in many different ways, depending on age and the type of distress, through art, music and sandpits. In addition, many children from severely disturbed homes need elements of techniques employed in post-traumatic therapy.

One of the best therapy packages for disturbed children is provided by Kids Company in 33 inner-city schools across London. Through therapy, social work, art work and group activities, they give children back their childhood.

Of course, it would be far better to prevent the problems in the first place. This would involve cutting the divorce rate (a major cause of child mental illness), reducing parents' working hours so they have more time for their children and - above all - much higher status for the role of mother.

Alas, none of these is likely in the short term. But if a government were to abolish child psychiatry and CBT altogether, I doubt it would increase children's mental distress. If the money were used for the kinds of measures described above, it could have a considerable impact.

Oliver James is a child clinical psychologist and the author of Affluenza - How to be successful and stay sane

REFERENCES

Limits of child psychiatry and pills: Timimi, S, 2005, Naughty Boys, Palgrave.

Prolonged Parent-Child Embrace: Welch, MG et al, 2006, Complementary Therapies in Clinical Practice, 12, 3-12.

Kids Company: Batmanghelidjh, C. Shattered Lives, Jessica Kingsley.

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