Beliefnet
Winter's end is a mixed blessing here in the Hudson Valley. No more shoveling, no more heavy coats, but no more snow days off from school, either. Snow days are a Sabbath that takes us by surprise. A hush blankets the neighborhood, broken only when the plow passes up the road, crunching the snow against the curb, and the dogs bark. There's no homework to worry about; the teachers haven't had a chance to assign any. In the afternoon, the kids bundle up and traipse off to the sledding hill in the park or build a snowman in the front yard. But mostly we welcome the day as it takes its own shape, fix pancakes for breakfast, sit together over the comics at the kitchen table, watch the snow fall.

It's a way of being that families seldom share today, and that's not just because we're all so busy. In light of the round-the-clock stimulation and organized activities many parents seem to think today's children need, time spent just being with kids seems pointless. As a culture, we have ceased to trust in the holiness of sharing simple presence and relationship. Once upon a time we set aside nonproductive time and called it "Sabbath," and we honored the command to remember and keep it holy. These days we like to make things happen.

Children with learning and behavioral problems are the hardest hit by this trend away from relationship, because these days when their parents bring them for professional help they are more likely to be offered a prescription bottle than a visit to a flesh-and-blood therapist. The grim statistics published some time ago in the Journal of the American Medical Association (JAMA) tell the story. And the federal government responded with an appropriate level of alarm by announcing a multipronged effort to reverse this trend. But changes in the medical and pharmaceutical approaches to children, though urgently needed, won't be enough unless the adults in children's lives reclaim the nurturing and healing power of simple Sabbath presence.

Here are the numbers staring up from the page on my desk: In just five years, from 1993 and 1997, prescriptions of selective seratonin reuptake inhibitors (antidepressants such as Prozac and Zoloft) for kids 5 and under increased 10 times in the U.S. Prescriptions of the blood-pressure medication clonidine, used in the treatment of attention-deficit/hyperactivity disorder, were up nearly 30 times. Three thousand Prozac prescriptions were written in 1994 for infants under a year old. We Americans are not alone; a study in Strasbourg, France, showed that 12 percent of children starting school were receiving psychotropic medications.

Most of the drugs prescribed are not recommended and have not been shown to help very young children, JAMA noted, and the commonly prescribed drug methylphenidate (Ritalin) "carries a warning against its use in children younger than 6 years." Pointing out that "there is virtually no clinical research on the consequences of pharmacologic treatment of behavioral disturbances of very young children and that there are valid concerns that such treatment could have deleterious effects on the developing brain," JAMA warned that "the reasons for these troubling changes in practice need to be identified."

Older children and teens are faring no better. More than 11,000 antidepressant prescriptions are written for children and adolescents every weekday, according to an article in the Family Therapy Networker. That's an increase of over 50 percent since 1994. And the research suggests that all these prescriptions are being dispensed not by mental-health professionals but by pediatricians and family doctors on the front lines who do not consider themselves adequately trained in the management of childhood depression.

These alarming statistics prompted the Surgeon General and the National Institute of Mental Health to hold meetings in September and October 2000 to discuss children's mental health issues and the administering of psychopharmaceuticals to young children. The government is currently working on a national action plan based on recommendations from these two meetings.

Meanwhile, the question remains: Why are millions of children a year being sent to pharmacies instead of to psychotherapists? The obvious answers are managed care, which reimburses for medications instead of the harder-to-quantify results of talk therapy, and Medicaid, which limits children's access to mental-health practitioners. But if people get the government they deserve, maybe our society is getting the health-care system that reflects our real family values, as opposed to the ones we like to think we have. We parents spend enormous amounts of time and money doing things to our kids rather than being with them; why shouldn't doctors do the same?

It would be foolish, of course, to suggest that no children benefit from organized activities or psychotropic drugs. But children are hungry for trusting relationships with adults who offer simple presence. Supportive, long-term relationships with caring adults or mentors are well documented to contribute enormously to childhood resilience. The pioneering and creative British pediatrician and psychoanalyst D.W. Winnicott wrote often about the "psychological holding" that takes place in what he called a "facilitating environment"-- at home or, when a child is having difficulties, in a therapist's playroom. It's the kind of connection parents nurture when we listen and respond sensitively and even playfully to a wide range of emotional expression. It's what therapists are trained to offer to children who need help.

Join the Discussion
comments powered by Disqus