He's suspended from school for defying his teacher and clashing with classmates. She's a sullen, sometimes belligerent foster child. He's a toddler who cries frequently and doesn't sleep through the night. Their common denominator? All these children have been prescribed psychiatric medications.
The likely over-prescribing of psychotropic drugs for children is a serious issue. In the face of disturbing data and a lack of scientific evidence about safety and efficacy, some parents and professionals are speaking out.
According to a report in The New York Times, about one in 54 children aged six through 17 covered by private insurance were taking at least two psychotropic medications in 2012 - a 44 percent increase in four years. Rates among children covered by Medicaid have also increased. Together about a million kids are currently on various combinations of psychotropics, despite a lack of empirical evidence about their safety, efficacy, and side effects.
Some risks of taking these drugs include weight gain and diabetes, insomnia, hallucinations and heart rhythm disturbances. Most research carried out on these drugs, and their interactions with each other, have been conducted in adults because of safety and ethical issues. Another concern is that FDA monitoring of patients' adverse reactions to prescription drugs leaves something to be desired, partly because reporting of problems is limited. There are also worries about off-label use, especially in children.
Several studies undertaken over the past decade are alarming. One revealed that there is "little evidence available to warrant the widespread use of psychotropic drugs for children, and little data regarding its long term impact on development."
Another study carried out by the Government Accountability Office (GAO) found that children in foster care are particularly vulnerable to the use of psychotropic drugs. In its two-year investigation in five states the GAO found that thousands of foster children were being prescribed these drugs at rates up to five times higher than non-foster children. Foster kids were also more than nine times more likely to be prescribed drugs for which there is no FDA-recommended dose for their age. Children under the age of one were nearly twice a likely to be prescribed a psychiatric drug compared to non-foster children. The GAO findings are consistent with other studies that show foster children receive psychiatric medications up to 13 times more often than kids in the general population.
As one child psychiatrist put it in an ABC News story, "There is an incredible push to use medications to solve problems as if [they are] a magic wand."
One organization, Ohio Minds Matter, launched a program to promote the proper use of psychiatric medications for children in that state, and to reduce overuse, particularly for kids who receive Medicaid. According to The Akron Beacon Journal, "the statewide program is developing online tools to help parents, caregivers and physicians better understand mental health conditions and the best uses among children of 'psychotropic' medications, or those prescribed to manage a psychiatric symptom or challenging behavior." Although it carries its own concerns, the program is a start for young boys diagnosed with ADHD and "disruptive behavior disorder" and then prescribed antipsychotic medication. (One analysis found that these kinds of prescriptions for children between the ages of two and five doubled between 2001 and 2007. Most of the children were four and five year old boys.)
Of course, the drug companies love the increasing use of psychotropic meds, among all populations; they're in the business of selling magic bullets. But health professionals are increasingly concerned, especially in light of the fact that psychiatric drugs are being used in many situations as "chemical restraints," and that less than half of the children using these drugs receive any kind of evaluation or therapy-based treatment from a qualified psychiatrist.
"There is a startling trend in the United States to medicate away children's bad behavior," Wendy Innes wrote in a post to symptomfind.com. Citing the American Academy of Child and Adolescent Psychiatry, she noted that "more children than ever before are being given powerful psychiatric drugs that can have serious, long term affects on their developing bodies." She continues: "What used to be called the 'terrible twos' is now being labeled as "bipolar disorder" or some other serious form of mental illness. " The fact is that most mental illnesses are extremely difficult to diagnose in very young children. Many of the behaviors that are hallmarks of mental illness in adults are also common in normal small children"especially when they are trying to develop a great sense of independence."
I think what Innes is saying, and what sensible practitioners are asking is, why are some parents, physicians and educators so quick to pathologize childhood? That's not to deny that some children may have problems that legitimately call for appropriate intervention or relief. But for many kids, the question is simply, why can't kids just be kids anymore without the "help" of strong, mind-altering, often dangerous drugs? As adults we need to ask ourselves what price we, and our children, are paying for our culture's rush to label behavior as aberrant while Big Pharma watches its profits rise? Not to ask these questions relinquishes our responsibility in an ever-increasing pill-popping society. We must all remember to "do no harm."