This from The TimesOnline (UK):
Talking the drugs away
by Page Shepherd
A pioneering children's clinic is weaning children with mental health problems off medication
Danny Vio was an ordinary, healthy seven-year-old until, one day, his primary school teacher caught him trying to stick a pencil down his throat. He said that voices in his head were telling him to do it. Across Britain, children like Danny are put on long-term drugs for such problems. However, a pioneering use of talking therapy is being introduced that may help to wean our nation off its habit of seriously medicating troubled youngsters. As Danny’s condition worsened he started to gouge his eyes until they became infected. “He kept saying, ‘Something is telling me to do it’,” says his mother, Munna Vio. “These voices were telling him to pull his eyes out.” The voices were a severe symptom of obsessive compulsive disorder (OCD). According to studies by Dr Isobel Heyman, a child and adolescent psychiatrist at the Maudsley Hospital, London, this disorder affects on average about ten children in every UK secondary school.
The Mental Health Foundation says that one British child in five has psychological problems. And a survey by the Office For National Statistics reports that one in ten has a clinically diagnosable mental disorder. Only this week, a GP diagnosed depression in four-year-old Mollie Murphy, from Sunderland. Andrew Dillon, the chief executive of the National Institute for Health and Clinical Excellence (NICE), says: “OCD may be the fourth most common mental disorder in Britain.” But it is still called the secret problem. In its milder form it is known to affect perfectionists, such as David Beckham, who says that he gets stressed if the contents of his fridge are not lined up neatly. But in its more serious form, the often violent, sexual or religious thoughts that feature in the condition are often too embarrassing for children to discuss.
The typical British response has been to reach for the pill bottle. Over the past ten years the prescription of antidepressants and other mind-altering drugs to children has soared faster in the UK than anywhere in the world. More than 700,000 children in the UK are on medication for mental health problems. And eight out of ten GPs say that tight resources mean they are having to prescribe pills rather than offer an evidence-based talking treatment, according to a report, We Need To Talk, published last month by the Mental Health Foundation.
Danny was fortunate enough to receive three months of an intensive and effective talking therapy at the only specialist children’s OCD clinic in the country, established by Dr Heyman at the Maudsley Hospital. She says her results show that 80 per cent of children treated there get better without the use of drugs.
In Danny’s head, the repetitive thoughts of OCD mutated into an imaginary monster that plagued him. He became so used to the demon in his head that he gave him a name, Ediota, and he could draw pictures of him. Getting Danny to bed became a nightly trauma; he insisted that his curtains were drawn in a certain way and his duvet was pulled to an exact position. He would not eat red food or small pieces of food, fearing that they were dangerous.
Dr Heyman is pioneering the use of cognitive behavioural therapy (CBT) to treat the disorder in children. The behavioural-therapy system is being widely adopted by the NHS as a treatment of choice for adults, as it appears to provide a comparatively high level of positive outcomes. “Some children may benefit from medication if used carefully and appropriately, but in general they should be offered CBT because it is a proven effective treatment in its own right,” says Dr Heyman.
Thanks to her role on an advisory steering group at NICE, government guidelines say that the therapy should now be offered routinely as the first-line treatment for children with OCD.
“Through CBT we can give children and families a toolkit of ways to fight anxiety, which can be better than the short-term benefits of medication,” she says.
When Danny came to the clinic, his life-threatening symptoms of refusing to eat, drink or even breathe had to be controlled with the antidepressant drug Sertraline, while he learnt the techniques of CBT. It is no easy panacea. It can be tough for children and parents as it encourages the opposite to what seems natural. Rather than a child running away from frightening things, and parents protecting them from such triggers, families are coaxed to expose the children to the things that scare them. It is through experiencing the anxiety that children can learn that, although their worry feels uncomfortable at its height, it will subside.
Parents are discouraged from consoling children too much during therapy, since they must learn to deal with their own anxiety. As Danny’s mother says: “It’s horrible to watch your son go through anxiety and not be able to help him, to make the pain go away.”
One such task was coping with Danny’s near-pathological fear of knives. The family discovered that this had developed after he saw a report about a child murdered with a knife at school. By the time Danny came to the clinic, this had snowballed to the point where he could not be in the same room as a knife, as he was convinced that he would pick it up and stab himself, or members of his family, to death.
But after 12 weeks of gentle, tailored one-to-one therapy, Danny became less fearful of knives. He now even enjoys helping his family to prepare dinner and says he wants to be a chef when he grows up. The voices in his head have largely been silenced and he is due to come off medication in January.
As a result of the new NICE guidelines, which Dr Heyman drafted, it is hoped (resources permitting) that other children will soon be able to benefit from CBT. “Every family has child mental health services in their area where effective talking treatments for all child and mental health problems should be available. Increasingly, the Government is monitoring that they are being provided,” says Dr Heyman.
Page Shepherd is a TV producer who spent 18 months recording Danny’s experiences. His treatment will be featured in a new series of Channel 4 documentaries, Help Me Help My Child, which starts on Monday December 4 at 8pm. For information about OCD, contact OCD Action 020-7226 4000; www.ocdaction.org.uk
Facing the fear
CBT is a talking treatment that emphasises the role of thinking in how we feel and what we do. It involves identifying how negative thoughts affect us and explores ways of challenging those thoughts.
At the Maudesley children receive between 8 and 12 weekly one-to-one sessions with a therapist. Together they design a list of challenges that the child carries out in the therapy room and at home to help tackle their OCD.
A child who washes his hands 20 times a day might shorten the number of hand washes and expose himself to the anxiety that brings, or resist the urge to wash his hands, even for a short time, until eventually the anxiety subsides.
The child and therapist work through the experiments, taking on bigger challenges.