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Published On July 23, 2010

CLINICAL RESEARCH

Medicating Young Minds

One writer planned to write a book about the willful overmedication of children, but what she found was the opposite.

As a follow-up to her bestseller Perfect Madness: Motherhood in the Age of AnxietyJudith Warner set out to write about what she considered the willful overmedication of children with mental health disorders. Producing a provocative exposé of prescription-happy psychiatrists and parents seeking chemical solutions to family problems would just be a matter of dogged legwork to connect the appropriate dots, she supposed.

Yet as Warner conducted her research, a very different tale emerged. We’ve Got Issues: Children and Parents in the Age of Medication, published earlier this year, actually comes to the defense of parents driven by concern for their children. The rise in diagnosis and treatment for children’ s mental health disorders, she argues, is a sign that society is finally waking up to a serious problem.

 

Q: What changed your initial thesis?

A: I tried very hard to make it work. I had been reading news reports about overmedicated children. I had just finished a book about hypercompetitive, perfectionist parents. But when I started looking for reliable numbers to confirm overdiagnosis and overmedication, I couldn’t find them.

 

Q: What did your talks with parents reveal?

A: The stereotype that they are irresponsibly taking the easy way out by giving pills to their kids is false. None of the parents I interviewed wanted to medicate their children. Even when the medication works, they’re always looking for ways to take their kids off it or to keep the dosage from increasing.

 

Q: So what’s the source of the stereotype?

A: The media have perpetuated the idea that Americans take mental health medications for trivial concerns and that the medication of American children is a symptom of everything that’s wrong with our era and with parents. The demands on kids are so excessive these days that it’s not much of a leap. It feels like the truth.

 

Q: Do that many American children really suffer from mental health disorders?

A: The best government estimates range from 5% to 20%. The 5% refers only to those conditions involving serious impairment. The 20% includes children with milder conditions.

 

Q: Does one disorder stand out as being particularly misunderstood?

A: Attention deficit/hyperactivity disorder has been consistently trivialized as a disorder of perfectly normal kids who happen to be high-strung or nonconformist or, on the flip side, kids who just need discipline. That image does a terrible injustice to children who, in fact, are suffering and are impaired.

 

Q: Critics claiming overmedication point to the ADHD drug Ritalin as Exhibit A.

A: During the 1990s, Ritalin use jumped 250%—not 600%, as is often incorrectly reported, but still a big increase. Yet during the same decade, there were huge leaps forward in the understanding of ADHD. It was really just a matter of recognizing a problem that already existed.

 

Q: Is the same thing happening with other disorders?

A: Yes. A generation ago, it was believed that depression did not exist in children; that thinking has changed. And though experts still debate how early children can develop bipolar disorder, it’s widely accepted now that teens and even preteens can suffer from the condition. More parents are willing to find out if their kids have problems.

 

Q: What prompted the stereotype of psychiatrists medicating children at the drop of a hat?

A: Some psychiatrists take money from drug companies for giving lectures about medication, or even allow drug companies to ghostwrite medical journal papers for them. This creates the impression of a conflict of interest. It also adds to impressions that medicines are sometimes prescribed for the wrong reasons and that kids are getting too much care. In fact, there’s a dearth of children’s mental health providers.

 

Q: Does the new health care bill address children and mental health?

A: Private plans don’t always offer mental health coverage. But any plan offered as part of the exchanges described in the legislation will be required to offer mental health benefits on par with other medical benefits.

 

Q: What other changes must happen?

A: I’d like to see institutions take greater control of research so that drug companies are not able to subordinate research findings to commercial interests. More important, there should be an end to direct-to-consumer advertising, which trivializes these conditions. We not only allow such advertising, we subsidize it by giving drug companies tax deductions for advertising costs. A few years ago, I saw an ad in a parenting magazine for an ADHD drug. On one page, a mom was tearing her hair out over her son. On the next, all was calm, and he’d finished a big homework project. Solutions rarely come that easily.

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