Over-Medicating America's Kids

Over-Medicating America's Kids
Posted by FoM on February 02, 2000 at 07:43:02 PT
By Lawrence Diller
Source: Washington Post
Simon's mother, Rachel, did not mince words. Over the telephone in our first conversation she asked me point blank:"Would you medicate a 2-year-old?"For the past 20 years I've evaluated and treated children with behavioral and school problems. I'd like to think that when I've used medication in a child I've considered many other strategies before reaching for the Rx pad.
Yet over the past five years, I've seen the age at which parents and doctors will consider psychiatric medications for children become considerably younger. Some parents and preschools are hoping that I will consider using Ritalin in children as young as 4. But Simon was only 29 months old.I did meet Rachel one time without Simon. Insurance problems kept us from meeting again. I don't know if I could have helped this family, but I'm almost certain I wouldn't have prescribed any medication to Simon. I was flabbergasted when I later learned from his mother that Simon saw a highly respected child psychiatrist and was now taking Lithium, Zoloft and Risperdal--three psychiatric drugs at once. I didn't know who felt crazier, Simon or I.Quietly yet steadily, the trend to use multiple psychiatric drugs on children has grown, raising alarm among mental health professionals, pediatricians and school nurses who dispense many of these meds at school. About 4 million children younger than 18 take one of the stimulants Ritalin, Dexedrine or Adderall. Probably more than a million, mostly teenagers, have used Prozac or one of its sister drugs, Zoloft and Paxil. The rate for children younger than 9 taking antidepressants has soared twelvefold in half a decade. A survey of Michigan Medicaid children found 223 toddlers, 3 or younger, were prescribed psychiatric drugs. Forty-four children were taking two or more drugs simultaneously. Nationwide, no one has any idea how many children take more than one psychiatric drug at the same time.More than 150,000 prescriptions for the antihypertensive drug Clonidine were issued in 1996 to children to treat attention deficit-hyperactivity disorder. Anticonvulsant medicines such as Depakote or Neurontin are routinely employed to manage a new form of manic-depression, now called bipolar disorder, supposedly identifiable in children as young as 3. But the newest antipsychotic drug, Risperdal, is catching up to the anticonvulsants in popularity among doctors for the bipolar disease.Of the more than two-dozen psychiatric drugs used in children, only the stimulants and two antidepressants (Zoloft and Luvox) have met the FDA's tough approval standards for pediatric use. Another handful of drugs have been evaluated less rigorously in children for either effectiveness or safety. Most have only been studied and approved for use in adults--often for non-psychiatric conditions.Yet child psychiatrists and behavioral pediatricians these days are commonly prescribing these medications. Both the professionals and public have come to believe most serious childhood emotional problems have a biological basis and therefore should be addressed with a medication.Parents are generally feeling desperate by the time they are willing to consider a psychoactive drug for their child. They expect the doctor to provide an answer. Managed care adds to the pressure to do something quickly (usually after one 50-minute visit) about the kid's problem.Many of these children have extremely tense or chaotic family lives. The kids often have learning problems that are inadequately addressed by overcrowded and underfunded classrooms. The absence of any definitive research on the value and safety of these psychiatric drugs for children is compounded by the minimal efforts made to address the environment these children are placed in.No one says these children are easy to raise. They are often at risk physically for abuse or self-injury. Something must be done for them, yet that something too often is only a medication or two or three.I sometimes wonder whether I'm still competent when it comes to children' s behavior and psychiatric drugs. I wonder whether I've missed something in my persistence at working with children's parents and schools. I feel very old-fashioned by my relatively conservative stance on the newer psychiatric medications for children.I'm not against using medication in children. I just believe in the rule: First do no harm. It's important to keep asking questions.The writer practices behavioral pediatrics in Walnut Creek, Calif. Wednesday, February 2, 2000; Page A21  Copyright 2000 The Washington Post CompanyRelated Web Site:PBS: Close To Home
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Comment #1 posted by Russ Whitesel on August 07, 2000 at 10:56:15 PT:
FDA Conference on Drugs/Ritalin/ADD-HD
In March 2000 at a White House Conference reference was made about a "Fall Conference" on Drug Use by Children that would be held by the FDA. Do you know whether such a conference has been scheduled or any details about such a conference? Thank you for your prompt reply.
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