9 February 2004

Children in Care

For a number of years we have been highlighting the lack of effective of services for young people in care. In particular we have highlighted the number of unqualified staff caring for them - and the lack of supports that staff receive in caring for the most vulnerable and needy children in our state. Many of the children are traumatised by their life experiences and consequently are difficult to manage and look after. There is also well-documented evidence that they have a higher incidence of mental health disorders.

As Child and Adolescent Psychiatrists we diagnose disorders according to internationally recognised criteria in ICD10 and DSMIV. We prescribe treatment programmes according to well-recognised evidence based guidelines for these disorders. We know of no disorder where drug treatment is the only treatment prescribed.

Prior to being prescribed any treatment the child is assessed within the context of their relationships, usually their family, their school and their peers. Only then a decision is made based on best practice and evidence, what specific treatments to prescribe. These include individual therapy, family therapy, cognitive, behavioural therapy, social skills training, parent management, group therapy to name a few, in addition to drug treatments.

Child and Adolescent Mental Health Teams may also include clinical psychologists, social workers, psychiatric nurses, childcare workers, and speech and language therapists, occupational therapists who may carry out treatments as part of the overall programme. When treatments are prescribed they are strictly monitored by the appropriate professional individual case.

We would strongly refute some recent allegations in the media that the State is currently creating drug dependant children. This is untrue. There is no evidence that Ritalin, Concerta or Risperadal create dependence.

It is important that parents, whose children who have been appropriately prescribed these medications, are reassured. In such a sensitive area of care we would advise less scare mongering – and a representation of the medical facts.

There has been controversy over the SSRIs, e.g. Prozac, but when properly used and supervised there is no evidence that they create dependency. There is substantial evidence in international literature on the safety and effectiveness of all of these medications when prescribed for children with carefully diagnosed psychiatric disorders.