In a decade of practice as a clinical social worker in an outpatient community mental health setting, working predominately with children and families, I have borne witness to the increasing propensity of the psychiatric establishment to treat children like guinea pigs raised in sterile laboratories. The bias toward adjudging chronic and severe emotional and behavioral difficulties as largely the product of nature (i.e., brain chemistry, genetics) while ignoring or minimizing the significant impact of nurtureâ€”or, as is often the case, the lack thereof (e.g., neglect, abuse, trauma)â€”in producing such symptoms has led to a state of affairs that verges on malpractice. With the avaricious complicity of the pharmaceutical industry, emotionally and behaviorally disturbed children are being subjected to multitudes of psychotropic medications with little apparent consideration of the long-term effects on their developing brains and bodies or concern for the experimental nature of such treatment. Benedict Carey, writing in yesterdayâ€™s New York Times, confirms what I have known to be true for some time: children are being heavily medicated.
The use of potent antipsychotic drugs to treat children and adolescents for problems like aggression and mood swings increased more than fivefold from 1993 to 2002, researchers reported yesterday. The researchers, who analyzed data from a national survey of doctorsâ€™ office visits, found that antipsychotic medications were prescribed to 1,438 per 100,000 children and adolescents in 2002, up from 275 per 100,000 in the two-year period from 1993 to 1995.
The findings augment earlier studies that have documented a sharp rise over the last decade in the prescription of psychiatric drugs for children, including antipsychotics, stimulants like Ritalin and antidepressants, whose sales have slipped only recently. But the new study is the most comprehensive to examine the increase in prescriptions for antipsychotics.
The explosion in the use of drugs, some experts said, can be traced in part to the growing number of children and adolescents whose problems are given psychiatric labels once reserved for adults and to doctorsâ€™ increasing comfort with a newer generation of drugs for psychosis. Shrinking access to long-term psychotherapy and hospital care may also play a role, the experts said.
The findings, published yesterday in Archives of General Psychiatry, are likely to inflame a continuing debate about the risks of using psychiatric medication in children. In recent years, antidepressants have been linked to an increase in suicidal thinking or behavior in some minors, and reports have suggested that stimulant drugs like Ritalin may exacerbate underlying heart problems.
Antipsychotic drugs also carry risks: Researchers have found that many of the drugs can cause rapid weight gain and blood lipid changes that increase the risk of diabetes. None of the most commonly prescribed antipsychotics is approved for use in children, although doctors can prescribe any medication that has been approved for use.
Experts said that little was known about the use of antipsychotics in minors: only a handful of small studies have been done in children and adolescents. â€œWe are using these medications and donâ€™t know how they work, if they work, or at what cost,â€? said Dr. John March, a professor of child and adolescent psychiatry at Duke University. â€œIt amounts to a huge experiment with the lives of American kids, and what it tells us is that weâ€™ve got to do something other than weâ€™re doing nowâ€? to assess the drugsâ€™ overall impact. more…
The article goes on to identify â€œan increase in the diagnosis of bipolar disorder in children as a contributing factor.â€? For a number of years now, this diagnosis has been in vogue among psychiatrists to describe children who present with extreme emotional and behavioral dysregulation, e.g., moodiness, irritability, explosiveness, aggression towards self and others, difficulty self-soothing, relational problems, etc. However, these same symptoms can alsoâ€”and, in many cases, more accuratelyâ€”be accounted for by complex trauma experienced early in life. Bessel van der Kolk, a world-renowned psychiatrist who is the founder and Medical Director of the Trauma Center in Brookline, MA, describes complex trauma as â€œthe experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within the childâ€™s caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood.â€? Children who have experienced such complex trauma can be among the most challenging to parent (or foster parent, as is often the case) and to treat. Mislabeling them as bipolar and foisting an experimental cocktail of medications upon them adds insult to injury. And, as suggested by Jennifer Harris, a clinical instructor at Harvard Medical School, â€œgiving a child this diagnosis may diminish stigma by not making the childâ€™s condition anyoneâ€™s â€˜faultâ€™….[and] is far easier than examining family interactions that contribute to behavior.â€? She goes on to say, in an opinion piece in the May 2005 issue of Psychiatric Services:
[T]reatment planning is simplified if the problem is conceptualized as being largely biological, which results in medications and alliance building to ensure compliance. These interventions are difficult, but they are simpler than trying to stop a parent from drinking or from getting involved with violent partners; the biological approach is an attractive route when a child seems untreatable because of conduct difficulties and a hopelessly entangled set of social problems. Clinicians who care deeply about children often find it enormously painful to witness the lack of nurturance and the instability and cruelty that many children live with. A clinician may succumb to unconscious temptations to stop asking or to stop listening. The enormity of the problems many children face makes the simplicity of a biological explanation tremendously appealing. It allows us to feel we are doing something so that we can avoid feeling helpless with our most difficult patients.
When a psychiatrist accepts juvenile bipolar disorder as a diagnosis before it has been shown conclusively to be valid, he or she is forced into a host of shaky assumptions about treatment, particularly medication treatment: â€œMedication is needed.â€? â€œAntidepressants are likely harmful.â€? â€œMood stabilizers are necessary.â€? â€œMedication treatment should be aggressive.â€? Medications are not benign agents. They have both short- and long-term effects that have not yet been thoroughly studied. Thus we should be cautious about initiating psychopharmacologic approaches. It is important not to deny treatment that might benefit children who are truly suffering. However, we must not allow personal, financial, societal, and professional pressures to impede our ability to be thoughtful and cautious with our patients. [full text]
Sadly, such thoughtfulness and caution seems to be the exception rather than the rule, of late. It is my contention, based on anecdotal experience, that the rise in use of antipsychotic medications in children as reported in the New York Times has not lessened but grown dramatically in the intervening years, as has the use of bipolar disorder as a diagnosis. The explosion of such has taken on bizarre proportions, as evidenced by a recent Australian Broadcasting Company science report entitled â€œToddlers diagnosed with bipolar.â€? It is maddening. And it is misguided. The most vulnerable and dependent among us are being treated as guinea pigs by a pharmaceutically-influenced psychiatric establishment that, by and large, cannot see the forest for the trees or the child for the cluster of symptoms. What untold harm are we doing to future generations?