Healthy Skepticism Library item: 4521

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Publication type: news

Korn P.
Preschoolers put on ‘adult’ medication
Portland Tribune 2006 Apr 14
http://www.portlandtribune.com/archview.cgi?id=34841

Notes:

Ralph Faggotter’s Comments:

“ A new study directed by an Oregon Health & Science University professor has found that 246 preschool children covered by the state-sponsored Oregon Health Plan are receiving antipsychotic or antidepressant medications that have never been studied for use in children.”

It’s not the children who are sick here, but the society which allows young children to be treated in this manner, and the psychiatrists who act as apologists for the practice.

Full text: Preschoolers put on ‘adult’ medication Study: 246 kids in Oregon Health Plan use drugs not tested for childen By PETER KORN Issue date: Fri, Apr 14, 2006 The Tribune A new study directed by an Oregon Health & Science University professor has found that 246 preschool children covered by the state-sponsored Oregon Health Plan are receiving antipsychotic or antidepressant medications that have never been studied for use in children. And while the study’s lead researcher admits the figure might seem alarming, mental health experts caution that the prescriptions might have been justified and may be a result of Oregon’s insufficient mental health resources. The study, a collaboration between the state’s department of human services, its Medicaid program and the Oregon State University College of Pharmacy, was headed by OHSU psychiatry professor David Pollack. Pollack said he understands that at first glance, the prospect of children age 5 and under receiving psychiatric medication intended for adults can be startling. “There’s an element of alarm,” he said. “But it leads us to say we need to answer more questions. It doesn’t mean it’s inappropriate.” Pollack noted that the 246 children represent less than one-half of 1 percent of the 86,828 Oregon Health Plan children whose records were reviewed. The Oregon Health Plan is an insurance program for low-income Oregonians funded through Medicaid. “The problem is there’s very little data to direct the use of pharmacological agents in preschool children,” said Joan Luby, associate professor of child psychiatry at Washington University School of Medicine in St. Louis. “There’s just not much known. That doesn’t mean these drugs aren’t effective. We just don’t have the studies to show whether they are safe and effective.” Still, Luby, who has spent a decade studying children under 6 years of age, said that mental illnesses such as depression occur in the very young more frequently than most people realize. “I wouldn’t say I’m surprised, but the public is surprised,” she said. “Depression is a disorder that’s a good example of a combination of biological and psychological risk factors. It’s a complicated equation.” A third of kids were abused The Oregon study, first reported in a monthly publication called Oregon Health News, looked at Medicaid pharmacy prescription records from Oregon Health Plan claims. Among its findings: 41 percent of the children given psychiatric medication had an attention deficit disorder (though the prescribed medications were not those usually recommended for children with the disorder), and 33 percent were diagnosed victims of child abuse. But the study, Pollack said, poses as many questions as answers. Among them: Whether the children were adequately assessed before being medicated, and whether the prescriptions were accompanied by appropriate therapy. Pollack said he thinks data showing 82 of the 246 children given the drugs had suffered some form of abuse might be particularly revealing. “I know enough about clinical practice to know that it’s really hard to make diagnoses in children, and there’s a lot of pressure,” Pollack said. “You have some very complex cases where children might have some combination of illnesses, developmental disabilities and autism.” ‘You’re out on the front line’ One of the questions Pollack would like answered, but which pharmacy records don’t address, is: “How much pressure was the prescriber experiencing from whomever?” “A lot of cases are where they’re trying to keep the child from being placed outside the home,” he said. “This was a study of Medicaid children. A lot of these kids may have had some involvement with child protective services or some other protective services agency.” Sometimes, Pollack said, medication may be seen as the only way to keep a child with behavioral problems in the home. Luby agreed that the Medicaid status of the children in Pollack’s study could play a role in the prescriptions: “You’re out on the front line and you have kids coming into your office with serious psychiatric symptoms, even that young, and you often have restrictions of care to the extent that it’s not feasible or affordable for nonmedication therapy to be done.” Ideally, Luby said, therapy takes place for children before medication is considered. “Psychotherapy is the first option,” she said. “With Medicaid kids, there’s no resources. There aren’t providers who will take Medicaid. If there are providers who will take Medicaid, they often have very overburdened caseloads. It’s not possible to get psychotherapy on Medicaid, or it’s extremely difficult. And you need clinicians with expertise treating young children. “For people who have limited resources, sometimes medication might be offered first for kids with disruptive problems, even if psychotherapy might be the more appropriate treatment,” she said. Incentives go missing Christopher Thomas, director of child and adolescent psychiatry at the University of Texas medical branch at Galveston, said that economic status might play two roles in the lives of children receiving psychiatric medication. “The way our mental health policy and reimbursement is organized right now, there just are not incentives to work with children in impoverished conditions,” Thomas said. “And we know that poverty increases the risk for mental illness in children.” Lynn DeBar, a Portland psychologist with Kaiser Permanente’s Center for Health Research, who studied preschoolers as part of a study three years ago, said most of the preschool children she found who had received psychiatric medication truly needed the help. “Kids who were medicated – they were kids that were highly aggressive, that were engaged in behavior that was dangerous to themselves and to other people,” DeBar said. “The concerns really were that not having some kind of treatment would put them in more jeopardy.” Email peter korn