Healthy Skepticism Library item: 6207

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Publication type: news

Roberts EJ.
A Rush to Medicate Young Minds
Washington Post 2006 Oct 8

Full text:

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?”