April 6, 2013

Are We Over-Prescribing Psychiatric Medications For Children and Teens?

A recent editorial in the New York Times, “Diagnosis: Human” by Ted Gup attracted much attention and controversy. Gup writes about a concern that is discussed frequently; a fear that psychiatry is over-diagnosing and pathologizing normal human experience. His recent article criticizes the use of medications for ADHD arguing that we “rush to medicate” that we encourage “permissive drug use”.

DRUG ADDICTION AND ADHD

Gup reports that his own son David, died at age 21 of an overdose of drugs and alcohol in 2011. Gup is a grieving parent who connects his son’s diagnosis of ADHD at age 6 and later treatment with Adderal to his problems with drug abuse and addiction and ultimately, his death. This is an undeniable tragedy but by criticizing psychiatry and the use of psychiatric medications I believe Gup adds to the misinformation and stigma that interferes with those who need help for mental illness from getting proper help. Gup reports that 11% of school age children receive a diagnosis of ADHD and implies that this is unreasonable.  Is it? How do we make that determination? What is the correct amount? What percent have diabetes, heart disease or asthma? Improved diagnosis has led to increases in rates in many areas.

Is someone with ADHD at higher risk of drug abuse? Absolutely. Research has been consistently clear on this. The rates are higher for those who are untreated. People with ADHD are stimulation seekers, restless, and high energy. They are impulsive which can lead to higher risk taking. All of these factors increase the risk for drug abuse. Drug abuse is very much on the rise among American teenagers so are there are many factors that contribute to the risks of drug abuse for kids with ADHD. Are drugs improperly prescribed and monitored in some patients? Absolutely. Do the high costs of health care and lack of access to mental health services mean that families often receive prescriptions for medication to treat ADHD without receiving adequate counseling follow up and support? Undeniably. Does this mean children should not be treated for conditions which can impair them academically and socially. I do not believe that is the right message.

PSYCHIATRIC TREATMENT OF CHILDREN AND ADOLESCENTS

Investigative reporter Judith Waller’s 2010 book, We’ve Got Issues: Children and Parents In the Age of Medication explored the controversy about children and medication in depth. She set out to write a book exposing the over use of psychiatric drugs in children  and adolescents and discovered the enormity of the real problem-the many children suffering from mental health problems who are NOT being treated. There is in fact, a vast amount of suffering that does not receive adequate care and the continuing demonization and stigmatizing of psychiatric and other mental health care discourages parents from getting help.

There are so many natural barriers to mental health care it is truly unfortunate when our fears make reluctance to seek evaluation and treatment even more difficult. Drug abuse existed long before psychiatric care. Many primitive cultures have discovered plants or fermented liquids that cause mood altering effects. Wherever these possibilities existed there are people that abused substances and were harmed by them.Substance abuse is undeniably on the increase in our society but there are a broad range of causes. Improper prescribing by psychiatrists as well as other medical specialties is a part of that but certainly not a primary cause. Better education and support can help reduce the risk of poor prescribing but doctors are not perfect and risk is a part of any health care choice. Urging parents to accept their children’s behavior when children are suffering and failing at life is not the right solution. Appropriate psychiatric medication and mental health treatment has the potential to greatly enhance the lives of so many children. Early diagnosis and treatment has the potential to prevent a failed life. Presenting treatment as the pathologization of normal is harmful.

Heart attacks, strokes, pain-these are all a “normal” part of the human condition. Do we ever think that means we should not use all the tools of modern science and research to help these problems?

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5 Responses

  1. concerned mom says:

    I worry about all of the kids being prescribed medication. I worry about anyone being prescribed a mood altering medication. There are so many kids in my son’s elementary school on one form of prescription drug or another. And many of these kids parents also take prescription drugs. But then I see and hear what happens to these people. They’re all screwed up, and the addiction gets worse, and they suffer from withdrawal and they keep having to switch their medication around or up the dosage. And when they try to quit, they go through serious withdrawal that is worse than the original symptoms. Instead of masking the original problem and symptoms, why not try to fix the problem or tackle the symptoms in a positive way? I’m frankly a little terrified that prescription drugs have gone mainstream.

    • Thank you so much for your comments. Your concern reflects the fears of many parents. Prescription drugs have “gone mainstream” because they are effective. We have treatments for so many conditions that before led to unrelieved suffering such as obsessive compulsive disorder, anxiety disorder and depression. You would have to talk to parents to learn of the suffering their kids experienced that led to the decision to seek help for their mental health.It is estimated that only a small percent of those needing help actually seek, receive or can afford effective treatment.

      Most psychiatric medications are not addictive and do not pose a risk of withdrawal. Medications for ADHD can be addictive and therefore can be abused but many drugs are prescribed that relieve conditions for which there is a risk of abuse-that is not a reason to withhold treatment, it is a reason for caution and good supervision and seeking out ethical doctors.

      Treatment is not aimed at “masking the problem” but rather at relieving or curing it! For most of human history there was no treatment for many mental illnesses just as there were not effective treatments for heart disease and cancer. Modern technology has yielded many successful results to relieve suffering and mental illnesses, thankfully, are among them.

  2. Bernard Jackson says:

    This is a subject that I’m clearly not qualified to comment on. However, I found your article bold and thought provoking. Without tilting my hand on how I personally feel about ADHD diagnosis and treatment, I do wonder what alternative treatment scenario Mr. Gup would have preferred for his son, and with what expected prognosis?

  3. Love your thoughtful comments Robin…that’s why I refer to you! Dr. Wendy

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