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Emphasis on neuropsychiatric frameworks of conceptualizing troubled youth is increasing. This focus leads to more biologically-based interventions. As such, the use of psychotropic medications is skyrocketing, while the utilization of psychosocial strategies is diminishing. Yet overall outcomes seem to be faltering. Admissions to outpatient, partial-hospitalization, and residential care have all increased dramatically between 1986 and 2004. In this article, the author stresses the need to re-establish the importance of relationships in care, and incorporate ecological interventions and skill development into treatment strategies. These are aptly represented by the Re-Education principles and evident in all Re-ED practice settings. Even when integrating the exciting science that is available, any additional strategies should be developed on the platform of the strength-based models of Re-ED and the Circle of Courage (Brendtro, Brokenleg, & Van Bockern, 2001).

Children who have experienced relational trauma present a host of problems and are often diagnosed with psychiatric disorders and then medicated. But there is evidence that commonly used drugs interfere with oxytocin or vasopressin, the human trust and bonding hormones. Thus, psychotropic drugs may impair interpersonal relationships and impede forming a therapeutic alliance. One prominent characteristic of trauma is that the safety within interpersonal connectedness is disrupted. These breaches of trust, respect, safety, and collaboration with adults further impair children's ability to recover from traumatic experiences. They become dysregulated, impulsive, moody, aggressive, untrusting, and withdrawn. These troubled youth become wary of adults. They receive wide-ranging diagnoses. A youth who becomes too impaired (or symptomatic) is often swept up into the realms of psychiatric and psychological treatment. Moreover, it is often believed that the combination of these disciplines can result in optimal outcomes for these children. This article provides a brief overview of the different classes of medications that troubled youth are typically prescribed. The use of medications in youth is not well researched and becomes particularly complex when considering developmental aspects of children, their histories, the use of multiple, concurrent medicines (polypharmacy), and the supportive networks in their lives. Nonetheless, research does provide some insight as to how these medications may affect the ability of a child to connect when in treatment.

There are major differences in perspective between the traditional medical model of treatment for troubled children and more recent strength-based approaches. This is particularly evident when widespread use of psychoactive drugs becomes a substitute for interpersonal therapeutic interventions. Drugs and relationships both impact the brain, but in markedly different ways. Medications may impact the brain in ways that facilitate short-term management of behavior. Long-term positive changes come as corrective interpersonal relationships serve to rewire the resilient human brain. More research is needed in order to understand how psychiatric medications and therapeutic interventions can be balanced for the benefit of troubled children.

Certain symptoms in disturbed or problematic children are believed to be the result of experiential difficulties. Other symptoms are attributed to biological factors, only to be remedied by medications. It is argued here that all psychological symptoms--even those as severe as delusions and hallucinations--have meaning and are directly related to unmet needs within these children and youth. In this article, the author describes how addressing the Circle of Courage needs of belonging, mastery, independence, and generosity may foster positive growth, even when symptoms can relate to brain-based disorders.

There are major differences in perspective between the traditional medical model of treatment for troubled children and more recent strength-based approaches. This is particularly evident when widespread use of psychoactive drugs becomes a substitute for interpersonal therapeutic interventions. Drugs and relationships both impact the brain, but in markedly different ways. Medications may impact the brain in ways that facilitate short-term management of behavior. Long-term positive changes come as corrective interpersonal relationships serve to rewire the resilient human brain. More research is needed in order to understand how psychiatric medications and therapeutic interventions can be balanced for the benefit of troubled children. [ABSTRACT FROM AUTHOR]

Certain symptoms in disturbed or problematic children are believed to be the result of experiential difficulties. Other symptoms are attributed to biological factors, only to be remedied by medications. It is argued here that all psychological symptoms--even those as severe as delusions and hallucinations--have meaning and are directly related to unmet needs within these children and youth. The author describes how addressing the Circle of Courage needs of belonging, mastery, independence, and generosity may foster positive growth, even when symptoms can be relate to brain-based disorders. [ABSTRACT FROM AUTHOR]