The Washington Post
A Rush to Medicate Young Minds
By Elizabeth J. Roberts
Sunday, October 8, 2006
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
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?"
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