(Illustration of Pain, an evil to fight / Th Delorme - Discovery Gallimard)
In its edition of Wednesday, 7 february 2007, Liberation published an article about an event whose scope has been greatly underestimated.
recalled that in 2005 the prestigious National Institute of Medical Research published a study entitled "Conduct Disorder in children and adolescents." As part of its prevention plan against crime, largely inspired by this text, including the government promoted a very early detection of "problem behavior" in children are supposed to announce a route to delinquency. In this context the expertise of INSERM supra, which advocates the screening of "conduct disorder" in children from an early age, was particularly targeted.
This study provoked an outcry among all professionals involved with the Early Years (educators, child psychiatrist, pediatricians, psychologists, parents associations, teachers, etc..). Professionals involved then launched a national petition titled "No zero line for children 3 years" (http://www.pasde0deconduite.ras.eu.org/appel) who received no less than 191 900 signatures to date . In
Here is an excerpt:
" Professionals are invited to identify risk factors for prenatal and perinatal, genetic, environmental and temperament and personality. For example, are raised with regard to young children" traits such that the emotional coldness, a tendency to manipulation, cynicism "and the concept of" heritability (genetic) of conduct disorder. "The report insists on screening at 36 months following signs:" disobedience, hétéroagressivité, low control emotional, impulsive, index of morality low ", etc.. Will he go find the nursery thieves cubes or babilleurs mythomaniacs?
Given these symptoms, the children tested were subjected to a battery of tests developed on the basis of theories of neuropsychology behaviorist that identify any deviation from a standard established by the standards of the scientific literature Anglo-Saxon. With such a deterministic approach and following a relentless linearity principle, the slightest gesture, the first silly child may be interpreted as an expression of personality pathology that should be neutralized as quickly as possible by a series of measures involving rehabilitation and psychotherapy. From six years, the administration of drugs, stimulants and mood stabilizers should help overcome the most recalcitrant. The implementation of these recommendations not causing Does not formatting behavior of children, only induce Does not a form of addiction child, not to mention congestion care facilities responsible for treating all sociopaths? The expertise of INSERM, medicalizing the extreme phenomena of the educational, psychological and social development, maintains confusion between social unrest and psychological suffering, or hereditary disease . "
Their analysis of the hidden motivations of this text, apart from his motives are safe, are equally interesting:
" What offer experts
Three classes of drugs are nonspecific: antipsychotics, psychostimulants and mood stabilizers
. Their action is alleged essentially "anti-aggression".
Experts suggest:
- Develop new clinical trials with drug combinations.
- Promote research of new molecules including the identification of molecules
can reduce impulsive behavior through actions on neurotransmitters
. This "search for new molecules of interest in
prevention and correction of conduct disorder" (p 381).
's remarks Pasde0deConduite
There are few data psychopharmacology in children and adolescents: most data on efficacy and tolerance have been obtained in adults. Experts point out also that these tests were the most frequently performed in adults and "other evidence that conduct disorder "(p 285).
In the U.S., nearly 8 million children aged 3-20 years are now taking psychotropic drugs:
antidepressants, sedatives, or stimulants (including Ritalin). In this country, some teachers encourage parents to go see a psychologist, a physician to Decalmer with medication children as hyperactive. The laboratories are the primary beneficiaries of the development programs of psychological screening in this country. Many American associations are mobilizing to protest against the rise of the medicalization of schoolchildren, high school students. Alerts on the upsurge of suicide led the Food and Drug Administration (the equivalent of our AFSSAPS) to include warnings on drug packaging.
In France, in 2004 and most recently in 2006, Afssaps recalled that the prescription of an antidepressant should intervene only as second-line as part of a major depression. Thus, if the prescription of an antidepressant is needed in a child or adolescent, close monitoring of the patient must be completed and accompanied by research of suicidal behavior, especially early in treatment. He had even been talk in 2004 to prohibit the prescription of antidepressants in children under 18 years of age.
In France, the prescription of psychotropic drugs in children has long remained a taboo. Neither child psychiatrists apart from some services, 1 or pediatricians or general practitioners prescribe easily psychotropic drugs. However, statistics show that the number of boxes of Ritalin sold is growing rapidly. In 2004, 7,000 children were on Ritalin, which is six times more than in 1997.
The announcement of the figures of prevalence of conduct disorder referring to 9% of children can not fail to discuss a strategy to promote a new disease (conduct disorder), with its psychotropic treatment in the key. We have experience in France, a major consumer of psychotropic where nearly 20% of prescriptions of antidepressants in adults are considered unjustified.
Also many doctors believe that prescribing psychotropic drugs in the small is pure folly, while the brain structure is not yet fully developed and that are not available from studies in children .
In the proposed treatment of " conduct disorder "in the sense identified in the expertise of INSERM, if the therapies under reeducation does not work, they are drug treatments that are offered with, in this case the requirements in the long term: in fact the effect psychotropic drugs is expected to calm the "disorder", but the molecules do not function as a "cure" ... conduct
Worse, beyond the aspects of "therapeutic" which have been reviewed, the experts suggest preventive treatment, that is supposed to prevent the onset of the disorder lines and thus provide an indication based on risk factors.
There is danger for our children.
(1) Services which are also experts from the INSERM report "
Often we think that these petitions lead nowhere, except that it has seen its share fully successful. Indeed, the June 16, 2006, the government gave up its reform include articles on the prevention of delinquency among very young children.
Some time later, INSERM admitted to spell certain aspects unaudited and not scientific methodology for was used in making this expertise. The spokesman Inserm announced that the working methods of INSERM in psychic will be reviewed. There will in particular take into account the diversity of epistemological approaches and practices, as experience of field workers and the contribution of humanities and social sciences concerned with the issues considered. "The multidisciplinary is a condition of an ethical and scientific " considered Jean-Claude Ameisen, chairman of the ethics committee of INSERM. Jean Marie Danion, professor of psychiatry Strasbourg, director of Inserm Unit 666 and spokesman for the Institute said: "Now when expertise will have strong societal implications, such as this, we will ask professionals in the field make us proposals on names of experts to consult. Then, after work but before its publication, we spoke to have access again to avoid giving the impression of a text holder of an intangible reality. It We must also reject any approach to security, being a constant vigilance vis-à-vis the risk of political capture .
But the highlight of this action was the eagerly awaited decision of the National Ethics Committee seized by the group that issued last February a highly unfavorable review on the INSERM report. More than the mere fact that these are the terms and arguments that are interesting, some critically. Here's how Liberation recounts this event:
It's refreshing. By publishing his views "on the detection of certain disorders in very young children," the National Ethics Committee will pay the prestigious National Institute of Health and Medical Research (Inserm). He slams expertise Collective of the Institute which tended to establish links between conduct disorder in children and future delinquency. (...)
Choice . These are also the authors of the petition who, last spring, before the National Ethics Committee. Although they took both the response of the wise in their favor. First, the very purpose of the work of Inserm is questioned: "It is worth noting the ambiguity of the definition of" conduct disorder "because it tends to obscure the boundaries between pathology and delinquency among approach medical and judicial. "
Similarly, the committee was surprised by the very particular choice of the experts, almost all belonging to the same school of thought. The committee can then give them a little history of catching up: "The temptation to reduce, classify and prioritize all aspects of the complexity of human behavior using a single template for reading, and use it to predict people's future is not a novelty.
Some people today can read all of the identity and the future of a child by studying the behavior of the sequence of its genes, or by imaging analysis of brain activities ... The history of science shows us the futility of trying to reduce this or that criterion in determining the future of a person. "
Crystal Ball . In fact the ethics committee follows a consistent line, worrying about the place that takes genetics into medicine, perceived as a real crystal ball. The sages point out the obvious: "The social risk factors or environmental appear at least as crucial to future behavior that genetic factors, neurobiological and psychological individual child. "Highlighting genetic predisposition risk, again, to bring children" away "and stigmatizing them by treating them" like children different and dangerous. "
Logically it shows an opposite trend in psychiatry that aims to prescribe psychotropic drugs to children too agitated. "The administration of psychotropic drugs or anxiolytics for young children is a facility to which our society must not yield." And for those who have not understood this point to order a wakeup call: "Medicine must first consider the child as a child in danger and suffering that must accompany, and not as a child possibly dangerous, that should protect society ... We reiterate our opposition to a medicine used to protect society more than people. "
" And the journalist concluded:
" Rarely, in any case the wise took a firm position . "
Yes! There is even a small revolution in the field of research, medicine and social psychiatry and especially of medical ethics in general.
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