A Rush to Medicate Young Minds

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A Rush to Medicate Young Minds

By J.

Sunday, October 8, 2006; Page B07

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 , 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? "