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One would like to believe that advances in science have resulted in improved outcomes for troubled youth. Trends in treatment have changed dramatically in two decades. Technology to understand the brain and its functions are highly advanced. But the United States is now medicating youth more than any other country. There is growing concern about the burgeoning use of psychotropic drugs to manage childhood behavior problems. Examining the commonly used stimulant and antipsychotic medications across the last 20 years indicates that people need to re-evaluate their methods of care for their most troubled youth. This article critiques this practice and calls for a reorientation toward relationship-based interventions. (Contains 1 graph.)

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).

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.

From its inception, psychology has sought recognition as a science, but, unfortunately, this is not happening, especially in the clinical arena. It is all too often referred to as "junk science." Eloquent arguments are constantly made defending psychology as different because it is dealing with unknowns, such as the mind and the soul. However, the fact remains that psychology is not progressing well, with extremely poor treatment efficacy rates and with its tenacious clinging to psychological tests that are repeatedly shown to be unreliable and invalid. Thus, psychology is not policing itself. However, change and reformation may be forced on it because the federal courts and 33 state courts have based new laws for more rigorous standards for trial testimony, and it appears that the new laws are aimed at cleansing the courts of "junk science," namely, psychological testimony. This article reviews the changes that thus far few psychologists, lawyers, or even judges know about. However, slowly the new laws will permeate the courts and perhaps exert a strong influence for psychology to adapt. [ABSTRACT FROM AUTHOR]

A universally accepted operational definition for the term "disease" is not yet established in contemporary psychiatry. In clinical psychology and psychiatry, disease has been used indiscriminately. The term disease has been invoked (even when no systemic etiology or pathology has existed) to describe addictions, a cluster of bizarre symptoms, and to justify crude medically based treatments (e.g., electroshock, lobotomy, involuntary commitment, medication prescription). More recently, sophisticated machines such as CAT scans, PET scans, and MRIs have been used for questionable research conducted to try to identify supposed diseases, to justify the overuse of psychotropic drugs. Economic and industry interests have superseded scientific concerns. To establish scientific rigor in psychiatry and clinical psychology research, an operational definition of disease is proposed. [ABSTRACT FROM AUTHOR]

This article reports on children who have experienced relational trauma. It discusses that children after the trauma present a host of problems and are often diagnosed with psychiatric disorders and then medicated. It mentions that there is evidence that commonly used drugs interfere with vasopressin and oxytocin, the human trust and bonding hormone. It argues that psychotropic drugs may impede forming a therapeutic alliance and may impair interpersonal relationship. The safety within interpresonal connectedness is disrupted after trauma.

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]