A disturbing trend has emerged in the health care field: Parents are visiting their doctor’s office asking whether children as young as 2 could have a diagnosable mental illness such as depression. And now more than ever, parents are likely to leave with a prescription in hand.
According to Medco Health Solutions, one in four children now take regular medication. The number of children diagnosed with bipolar disorder and the percentage using antipsychotic medication has doubled in the past decade (Journal of the American Academy of Child & Adolescent Psychiatry), and the Centers for Disease Control and Prevention reports that nearly one in 10 children has been diagnosed with ADHD.
Have we become so accustomed to medicating problems away that we see pathology everywhere we look, or are we getting better at identifying disorders that were once dismissed as personality traits?
Identifying Children at Risk
Like adults, children may suffer from a wide range of mental health issues that are linked to both genetic and environmental risk factors. A stressful pregnancy, postpartum depression, and having a high-needs baby can lead to unstable parenting and a stressful home environment from early on.
As the child grows into a toddler, a phase when all children struggle to self-regulate because the parts of the brain that regulate emotion are still being formed, they may have sensory processing difficulties, extreme separation anxiety, impulsivity or explosive behavior. If the parents are struggling with their own mental health problems or marital conflict, or either or both parents are largely absent because of work or other demands, it is even more likely that a child will face their own mental health challenges.
A Diagnosis for Every Challenge?
In the field of mental health treatment, early intervention has been our mantra for decades. Disorders recognized and addressed in childhood can produce healthier, happier adults. But how we intervene is as important as when.
While symptoms of mental illness may be present from the earliest stages of life, those diagnosing and medicating disorders among very young children must proceed with caution. Assigning a label for every “undesirable” behavior may make it easier to get insurance coverage – and to prescribe powerful drugs with side effects that are largely unknown in children – but it does little to address the underlying causes of the explosion in childhood mental health issues.
Why shouldn’t children be able to experience the full range of emotions – not just the pleasant ones but also the more challenging ones like anger and frustration? Adults are quick to medicate those feelings away (almost half of Americans take at least one prescription drug, and more than 20 percent take medication for mental health issues), which has fueled an epidemic of prescription drug addiction. Is it wise to inflict the same intolerance of emotion on children?
The Dangers of Off-Label Prescribing
Although a growing number of children are taking psychiatric drugs, there is little research to show these drugs are safe or effective for children. Because little is known about the drugs’ long-term effects on developing brains and bodies, most have not been approved by the FDA for use in children under 6.
Yet nearly four out of five hospitalized children receive medications that have not been tested or approved for the pediatric population, according to researchers in the Pediatric Health Information Systems Research Group. Some children are prescribed multiple medications, which may put them at risk for drug interactions and carry serious side effects, including rapid weight gain, impaired growth, endocrine and metabolic abnormalities, and suicidal thoughts.
No End in Sight
Some of the proposed changes in the upcoming Diagnostic and Statistical Manual (DSM-V), which is used to define mental health disorders, raise concern. If the criteria for diagnosing childhood disorders are broadened considerably, behaviors that are currently regarded as a normal part of childhood could soon become illnesses that require treatment, often in the form of medication.
Will a broad definition of social anxiety disorder result in shy or reserved children receiving a mental health diagnosis that follows them for life? Will a child who withdraws from others at school be diagnosed with depression and treated with anti-depressants, even if there has been a death in the family or other triggering event? Will kids who talk back or show aggression, even just twice in a period of six months, be diagnosed with oppositional defiant disorder?
Alternatives to the ‘Quick Fix’
Certainly, there are children with emotional and behavioral disorders that need professional treatment, including medication if the benefits outweigh the risks and close monitoring by a physician is in place. But before jumping to the quick fix, let’s gather research to determine whether medication is safe and effective for children, and work just as diligently to educate physicians and families about non-drug alternatives, such as nutrition therapies, coping skills training, behavioral approaches and psychotherapy. Rather than making broad cuts in mental health spending, we need to make more resources available to the families that are suffering.
When considering treatment options, each child must be examined holistically by an expert in child psychology. There may be underlying issues affecting children’s behavior, such as inconsistent parenting, a death in the family or a parent’s divorce, which could be addressed in many cases with counseling, parenting skills training and lifestyle changes.
Instead of labeling children before they can utter a word, let’s offer support to the parents and families that are struggling to raise the next generation. This support must be provided long before a child appears in a therapist’s office; for example, when a woman becomes pregnant or as parents face the obstacles that go along with raising any child, but especially one who has mental and emotional issues.
David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. Dr. Sack currently serves as CEO of Elements Behavioral Health, a network of addiction treatment centers that includes Promises Treatment Centers, The Ranch, Sexual Recovery Institute, The Recovery Place, Right Step, Promises Austin, Lucida, Journey, Sundance, and Clarity Way.
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Last reviewed: 9 Jun 2014