[darkeyes]

A Rush to Medicate Young Minds

By Elizabeth J. Roberts
Sunday, October 8, 2006; Page B07

I have been treating, educating and caring for children for more than 30 years, half of that time as a child psychiatrist, and the changes I have seen in the practice of child psychiatry are shocking. Psychiatrists are now misdiagnosing and overmedicating children for ordinary defiance and misbehavior. The temper tantrums of belligerent children are increasingly being characterized as psychiatric illnesses.

Using such diagnoses as bipolar disorder, attention-deficit hyperactivity disorder (ADHD) and Asperger's, doctors are justifying the sedation of difficult kids with powerful psychiatric drugs that may have serious, permanent or even lethal side effects.
There has been a staggering jump in the percentage of children diagnosed with a mental illness and treated with psychiatric medications. The Centers for Disease Control and Prevention reported that in 2002 almost 20 percent of office visits to pediatricians were for psychosocial problems -- eclipsing both asthma and heart disease. That same year the Food and Drug Administration reported that some 10.8 million prescriptions were dispensed for children -- they are beginning to outpace the elderly in the consumption of pharmaceuticals. And this year the FDA reported that between 1999 and 2003, 19 children died after taking prescription amphetamines -- the medications used to treat ADHD. These are the same drugs for which the number of prescriptions written rose 500 percent from 1991 to 2000.

Some psychiatrists speculate that this stunning increase in childhood psychiatric disease is entirely due to improved diagnostic techniques. But setting aside the children with legitimate mental illnesses who must have psychiatric medications to function normally, much of the increase in prescribing such medications to kids is due to the widespread use of psychiatric diagnoses to explain away the results of poor parenting practices. According to psychiatrist Jennifer Harris, quoted in the January/February issue of Psychotherapy Networker, "Many clinicians find it easier to tell parents their child has a brain-based disorder than to suggest parenting changes."

Parents and teachers today seem to believe that any boy who wriggles in his seat and willfully defies his teacher's rules has ADHD. Likewise, any child who has a temper tantrum is diagnosed with bipolar disorder. After all, an anger outburst is how most parents define a "mood swing." Contributing to this widespread problem of misdiagnosis is the doctor's willingness to accept, without question, the assessment offered by a parent or teacher.

What was once a somber, heart-wrenching decision for a parent and something children often resisted -- medicating a child's mind -- has now become a widely used technique in parenting a belligerent child. As if they were debating parental locks on the home computer or whether to allow a co-ed sleepover, parents now share notes with each other about whose child is taking what pill for which diagnosis.

These days parents cruise the Internet, take self-administered surveys, diagnose their children and choose a medication before they ever set foot in the psychiatrist's office. If the first doctor doesn't prescribe what you want, the next one will.

There was a time in the profession of child psychiatry when doctors insisted on hours of evaluation of a child before making a diagnosis or prescribing a medication. Today some of my colleagues in psychiatry brag that they can make an initial assessment of a child and write a prescription in less than 20 minutes. Some parents tell me it took their pediatrician only five minutes. Who's the winner in this race?

Unfortunately, when a child is diagnosed with a mental illness, almost everyone benefits. The schools get more state funding for the education of a mentally handicapped student. Teachers have more subdued students in their already overcrowded classrooms. Finally, parents are not forced to examine their poor parenting practices, because they have the perfect excuse: Their child has a chemical imbalance.

The only loser in this equation is the child. It is the child who must endure the side effects of these powerful drugs and be burdened unnecessarily with the label of a mental illness. Medicating a child, based on a misdiagnosis, is a tragic injustice for the child: His or her only advocate is the parent who lacked the courage to apply appropriate discipline.

Well-intentioned but misinformed teachers, parents using the Internet to diagnose their children, and hurried doctors are all a part of the complex system that drives the current practice of misdiagnosing and overmedicating children. The solution lies in the practice of good, conscientious medicine that is careful, thorough and patient-centered.

Parents need to be more careful with whom they entrust their child's mental health care. Doctors need to take the time to understand their pediatric patients better and have the courage to deliver the bad news that sometimes a child's disruptive, aggressive and defiant behavior is due to poor parenting, not to a chemical imbalance such as bipolar disorder or ADHD.

The writer is a child and adolescent psychiatrist in California and the author of "Should You Medicate Your Child's Mind?"




© 2006 The Washington Post Company

[jennie]

I'm tired of physicians being drug pushers. These drug pushers need to stop practicing medicine.

Docs should treat all patients as if they were his/her family member. I guess that's too much to ask for. Most hospitals call their patients "customers."

I was taught the brain of a child wasn't developed until around the age 12. I'd guess that any psychotrophic drug administered before the age of 12 would cause brain damage.

Who knows what the long-term effects are of these synthetic drugs?

Wouldn't less harm be done giving your child a shot of whiskey every day then giving your child an ADHD drug?

[wisewoman]

I really don't know. I know that my very young daughter had OCD at 7 and her suffering was tremendous and still can be. I know that when she was first diagnosed that 12 years ago I was considering euthanasia and suicide as her pain was too much for me to see and I didn't know how to help her. I know that the meds did help her. Did they damage her mind? Who will know, maybe in several years we will have the diagnostic tools to find that out. I can tell you she is a gifted, intelligent, compassionate lovely young lady. I wrestled with the whole drug thing.

I also know kids who are just active and do agree that SCHOOLS, not parents push the ADHD thing. Where as I expect children to be active and question and have a natural curiosity, it is being disciplined and drugged out of them. We are expecting so much from these young people and when I see peer pressure in Kindergarten I think the battle is lost. Shoot the TV and read.

[jennie]

wisewoman (((((huggs))))) I'm sure you did the right thing for your child. You wrote that you "wrestled with the whole drug thing." That's what parents are supposed to do!

I have a huge problem with docs who prescribe drugs so easily without just cause.

I think the majority of children diagnosed with ADHD are misdiagnosed. Kids are bored with school. There's no TV, ipod, video game, radio, cellphone, and internet going simultaneously. If schools allowed all of those devices to be used in the learning environment, then those kids wouldn't be diagnosed ADHD.

Kids are getting too smart for the "old" school leaning environment.

[SeptemberMorn]

for posting this!! Thanks, DE! Sosmetimes it's also an easy out for parents that don't want to administer discipline!

[wisewoman]

I want to add to Jennie's post in a different light. Kids should not be exposed to gameboy, video games, a lot of un-supervised tv etc. I have been doing reading that discusses the fact that children who are raised without these contrations in their early lives and who are taught to observe the world around them are more intelligent and can self-regulate more. Translation. For us it means taking our new one out on the fort in the early morning and watching the birds and the meadows below us for deer and turkey. It means stopping when she mentions the stars and watching them with her. it means discussing all of the colors in sunsets. Listening to the coyotes kiyi in the distance and the owls talking back and forth. She is learning a wonder of the universe that is real and not make believe.

In other words, SLOW DOWN

[JustAPixie]

Thanks

[Peanuts]

I think parents reach for the pill bottle because they are hoping for an easy solution to a difficult problem. Lots of kids have learning difficulties that have nothing to do with how they are parented. Often, these LD issues are overlooked by both the school system and pediatricians. Not being able to read adequately, not being able to process information at an acceptible rate, etc can cause a child to be upset, angry, and uncooperative. Because they are frustrated.

Parents of such children do need to learn to parent differently and do need to advocate for their child both within the school system and when accessing professionals such as pediatricians, behavioral specialists.

When I say "learn to parent differently" it is not to imply that such parents are not competent or are somehow shirking their parental responsibilities. I mean that an LD kid requires a different approach. My child is LD and had lots of behavior issues at school and in the home - as a direct result of being LD. As parents of an LD child that struggled with behavior I can assure you that it is not easy. You have one group of people - and some from your own family - who are very sure that you are not being strict enough, or allowing too much TV, or allowing too much sugar, are not doing the "tough love" thing. And then the other group who think you are overly strict, not spending enough "quality" time, etc.

I've gone through all that - and there were many times that I just wish a magic pill administered once a day would "fix" my child. An offer to "try this med and see what happens" was the first words out of the pediatrician's mouth. And so it can be so easy for weary beaten down and desperate parents to accept that promise from a pill bottle to fix their child who is just not enjoyable to be around any more.

I'm sorry to be so touchy about the subject, it is just that I often feel very bitter and angry at the grief that we as a family had to endure before my son was finally tested and it was discovered that he had learning disabilities that were overlooked by the school.

Most parents want to do right by their kids - and all kids who have behavior issues don't have idiot parents who don't know how to set boundaries. Nor do all behavior challenged kids need to be medicated into submission. LD is a brain wiring issue... one that cannot be "fixed" by medication. Such a child CAN be taught compensation skills and such a child can get specialized education that can make a positive difference.

Badly behaved kids have more than just two reasons (valid mental health issues that require meds or stupid parents) for their behavior. Maybe the intervention is years of special ed and tutoring. But that costs money and takes a lot of effort over a years of time. Pills are cheaper and the "calming" effect rather immediate. The seduction is so easy.

And I don't go along with the excuse from the professionals that parents demand it and if they don't write the prescription some other MD will. Then you the professional take a stand and don't write that prescription. Be the one to do the right thing. How can you live with yourself to just throw up your hands and "go with the flow". Parents depend upon professionals to give their opinion. This isn't candy we are talking about. And so this is a longer response then I intended. I just wanted to comment about the stupid parent angle regarding poorly behaved children.

[wisewoman]

YOUR POST RESONATED WITH ME AS WELL. We each learn and process differently and one mold does not fit all. I am not suggesting that tvs and computer gadgets are the root of all evils, I know better. I do think we all need to work together for the benefit of the child and learn what her/his strengths are and how we can capitalize on them.

As I look back now at my son's behavior he was crying for help in elementary school. He didn't know how to tell anyone the mixed upness inside of him. I wish I could go back and do it again knowing then what I know now.

They are our precious babies.

And as I say this I will share a little story. My little one has been crying in her sleep at night. We turn to her and rub her and whisper that she is safe and loved and today I asked her if she remembers that and she said yes!!! Cool! Then she had to tantrum at a flea market to prove I still loved her.

[froggie2]

With family lives getting busier and busier and more complicated with technology are our children becoming the "symptom" of whats wrong?The warning for us all to heed? Those of us here struggling to heal have at times needed to back off from the outside world to get the quiet we need and the rest. Like sponges kids pick up our stresses, then go to school where there is more stress and competition to learn at all costs, dress like everybody else to conform, they watch violence on t.v. and games, have pressure to belong to too many other activities don't have regular bedtimes (its shocking how many are up past 9:00 p.m. in elementary school)and don't get the nutrition to grow. The "kid" cereals and candy. are loaded with chemicals and aspartame. I agree that if more kids could be kids and enjoy the beauties life gives us free they might be a lot better. They are bombarded everywhere and parents BUY into it. Is it no wonder that they now have adult diseases, and adult problems? They aren't out running off energy around playing and using their imaginations. Is it any wonder they act up in school? They are out of sorts and don't know how to relax. When the regular family time is now to go to the mall instead of the countryside.Then what about the quilt trips laid on parents to buy, buy, buy?

[wisewoman]

Thus kill the T.V. which on children's channels has commercials about every 40 seconds for the latest and greast toy. We've all seen them, nija turtles, Star war charaters, batman, dora the explorer, Barbie, baby dools that respond to what you say. Endless hand held teaching games for preeschoolers. I guess I am off on a roll here. My kiddo is getting a paper mache cave with stars and planets, and a wooden barn set complete with machinery, bales of hay and the critters. And, if mom can recover from her injured shoulder, a family of dolls for the doll house made of wool.

[Peanuts]

yup - I agree that the TV should go. Too much time is wasted watching when kids can be doing. I think the commercials are awful, not only do they entice our kids with every plastic toy around, they also introduce junk foods. Imagination teaches a child a great deal. I think it is a mistake to put TVs in bedrooms, especially a child's room. If they are going to watch a program, it should be out in the open so that parents can monitor and step in and make comments regarding your own family's beliefs about whatever the show is about. But I think it is better for young kids not to watch - they certainly won't miss anything by skipping the commercialism and they will have gained much more by actual "play".

[darkeyes]

Peanuts, that is so true, when my son was little he loved drawing, once he got into Nintendo,Gameboy and the computer, he seemed to lose interest in drawing, he's 20yo now but I often wonder if that did it or just getting older.
He did play classical piano for 9 yrs. so his free time wasn't always spent "plugged into a screen", and I made sure he got fresh air, being an older parent, and family stuff going on, it became easier to let him play games, I feel guilty sometimes.
Good points in all of the posts/replies.

[complic8d]

My 10 year old daughter is on medications. I struggle with this every day. I even checked with her doc as to whether or not we should stop them and see how she is. Her doc didn't want to make any changes right now at the beginning of a school year. I agreed, but we will look at it again in the spring.
The meds have helped her a lot with social anxiety disorder, and impulsiveness. It seems like there is a difference when she forgets to take them.
I don't really know what to do, so I have to trust the experts. I was severely depressed and suicidal by age 12, and could have used help, then maybe I wouldn't be having such a hard time with life right now.
I have a problem knowing how to parent because I know the way my parents did it was wrong, but that leaves me guessing. I have taken my daughter to a therapist who gives us advice on parenting. Parenting has got to be the hardest job, and how do you know if you are doing it "right" or not.
I don't know the "right" answers.

[darkeyes]

I want to add, the article I pasted here, does not come from me, but the author, so no one, please feel it necessary to direct any disagreements (hard feelings) towards me.
I just thought it was a good article,may be controversial,but many good points made.
I do agree with much of what was written, but also feel the author may have been too general, for there are legit cases, and I do believe if one reads this pdoc's article will see she does not discount cases, but wants to make the point that many of this is due to mis DXes, provoked from the school systems and desparate parents that haven't devoted time needed to see and confirm DXes that often can be falsely made.
Through my experience, being a teacher's aide, I witnessed school counselors in cohort with the teachers, labeling kids with ADD/ADHD and with professional evaluations, many were Bipolar and not ADD/ADHD, which led them to be wrongly medicated which triggered worse behaviours.
Many parents,wheter people like to hear this, would push for their GP's to prescribe meds., making their homelife tolerable,due to the fact the working mom's just did not have the energy to cope or work with their kids, the pills made it all easier for them and the faculty who lacked patience and knowldege of how to work with these kids.
Kids with FAS and/or LD's were clumped into this category, and sadly mis DXed and mis medicated which so often created havoc. My heart believes kids with various disorders,learning disabilities, and yes, parental weakness, need to be treated as individual cases, not some "one size fits all".
In depth evaluations by pdocs, and not consisting of 20 minutes, as the author of this article stated, is most important.
My sister in law and other RN's I've been around, that have been in the field over the years have literally heard and seen executive parents beg for ritilin,etc. to chemically control the kids they were too much worn out from work to spend time and give attention to their kids, very sad, when parents resort to this, when a child may not require meds, being chemically controlled to suit parents and the faculty.
Again there are true,legit,cases where intervention is needed,which is a great thing,preventing a child from future struggles,disappointment,poor self-esteem, and society looking down on these kids,crucifying them,etc.
Maybe I am now regretting pasting this article,but some of it is very true.
On the other hand, I hate to see any of today's kids suffer like I did in the early 60's,being labeled as "she doesn't pay attention","can be disruptive" and is not living up to her potential.
I'm glad things have progressed over the past decades, but hurts me to see overkill with meds/labels on kids that just need extra attention and re-routing of educating the minds that require different approaches where they can learn and progress.
It is an extremely difficult job in knowing what to do or how to do things to help our kids, especially those needing a little extra attention.
Just do not base things on a school's counselars opinion, instead take things up with a reputable child psychologist and/or psychiatrist, to achive a real DX, not what some website,book,films,etc. may give a survey/answer type thing causing a person to establish their own DX.
Our children are important, and we need to give them us ALL, not some part time attention.
It warms my heart to see the members here with children, are wise to this stuff.
Give them all the love,structure, and discipline they will need from time to time.
They are individuals, so individual approaches may work best, but be there for them, be parents not friends, set boundaries, and good examples. With that I'm sure we can all do good jobs, to begin with.
Lots of love and luck to all,
DE

[SeptemberMorn]

Here!! Here!!

[Peanuts]

I totally agree with you about advising parents to seek out qualified child psychologist rather than take the sole recommendation of a school counselor and/or teacher. Good advice.

[hillbunnyb]

* watch a few episodes of The Nanny tv show: shows what a little discipline/boundaries/involvement/consistancy can do to calm hyper kids.......
* also, Trading Spouses is a great way to compare parenting styles. Everybody is enriched by expanding their comfort zones....