The Drawbacks to Medicating Children

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An interview with Marilyn Wedge, Ph.D.

This is part 2 of a 2-part series on Kids and Medication. 

Check out the other side of the issue in part 1:  “When Medicating Children Makes Sense.”

In general, medicating children can be a pretty touchy topic. Whether or not to turn to pharmaceuticals to cope with out-of-the-ordinary emotions and behaviors is debated by parents on playgrounds, in school communities, in the media and beyond, yet no single answer fits all. Dr. Marilyn Wedge wrote the book Pills Are Not for Preschoolers: A Drug-Free Approach for Troubled Kids. She shares her insights on the drawbacks to medicating children. — Gabrielle Pascoe, TMC Contributor

Can you share any statistics with us about the number of children currently on medications that treat behavioral disorders?  What are those medications?

There are five categories of psychiatric diagnoses for which children age 4 – 17 are commonly prescribed medications: ADHD, disruptive behavior (oppositional defiant disorder or ODD), depression, autism and anxiety.

According to the Center for Disease Control, as of 2007 approximately 9.5 percent, or 5.4 million American children 4 – 17 years of age, have been diagnosed with ADHD. In 2007, parents of 2.7 million children reported that their child was receiving medication for the disorder. The number of children taking medications for ADHD is now well over three million.  The medications most commonly prescribed for ADHD are called stimulants. These include methylphenidate (Ritalin, Metadate, Concerta), amphetamine (Adderall), and dextroamphetamine (Dexedrine, Dextrostat).

Children diagnosed with aggressive or disruptive behavior are often prescribed antipsychotic medications. According to The Journal of the American Medical Association, 1.83 children in 100 are prescribed powerful antipsychotics such as Risperdal, Abilify, Seroquel and Zyprexa.

According to the National Center for Health Statistics, about 5 percent of U.S. children ages 12 – 19 are taking antidepressants. According to the Center for Disease Control, antidepressant use increased by nearly 400 percent between 2005 and 2008. Younger children are taking antidepressants as well.

A class of antidepressants called elective serotonin reuptake inhibitors (SSRIs) is prescribed for children with anxiety, depression, and/or obsessive-compulsive disorder. Of these only Prozac has been approved by the FDA for both OCD and depression in children age 7 and older.

Autism is another disorder for which children are typically medicated. One in 88 children, or 1.1 percent of U. S. children, has been diagnosed with autism, up 78 percent in the last decade. Fifty-five percent of children with autism are taking psychotropic drugs that target their symptoms. Children with autism frequently take medications like the antipsychotic risperidone. According to a recent study on children with autism, 60 percent of youths ages 11-17 took at least one medication compared to 44 percent of children ages 6-10 years, 11 percent of those ages 3-5 and 4 percent of children younger than 3.

The New York Times reports that somewhere between 10 and 20 percent of children and adolescents will have transient anxiety at some time during their development. Medications that are commonly prescribed for anxiety are selective serotonin reuptake inhibitors (SSRIs), other antidepressants, some anti seizure drugs, and benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan).

How early are they prescribed? How is it determined that a young child needs medication?

Last year, the American Academy of Pediatrics overrode the U. S. Food and Drug Administration (FDA) guidelines and advised that children as young as 4 years old could be diagnosed with ADHD and treated with stimulant medications. This will undoubtedly increase the numbers of younger children diagnosed with other psychiatric disorders and medicated with other drugs. Many antidepressants and antipsychotics are currently prescribed “off label” for children as young as 3. These drugs have not been approved or tested by the FDA for use in children.

There are no objective medical criteria or clinical tests for childhood psychiatric diagnoses like ADHD, ODD, childhood depression, autism, etc. To make a diagnosis, a doctor interviews the child, the parents, and sometimes the child’s teacher, takes a history, and then makes a judgment call as to what kind of psychotropic medication might relieve the child’s symptoms. The doctor’s judgment is subjective: one psychiatrist might diagnose a child with ADHD, another might diagnose the same child with ODD (oppositional defiant disorder), and a third doctor might diagnose the child with bipolar disorder. Each doctor would prescribe a different medication.

A report by the respected Hastings Center for Bioethics indicates that diagnosing children with psychiatric disorders is less scientific than most people think: “Contrary to popular belief, there are no bright lines between normal and pathological behavior, nor between disorders that share symptoms such as attention deficit-hyperactivity disorder (ADHD), mood disorder, conduct disorder, and oppositional defiant disorder.”

Do you feel children are being over or under medicated?  What is the alternative?

American children are diagnosed with psychiatric disorders and medicated with psychotropic medications far more than in any other developed country. For example, 5-9 percent of U. S. school-aged children are diagnosed with ADHD. In France, by contrast, the number of children diagnosed with ADHD is less than 1 percent.

Children in the United States are being sadly over-medicated, with medications that can potentially harm their brains and their development. Adderall XR, a stimulant medication that has been banned in Canada because of the risk of sudden death in children who take it, is still commonly prescribed for children with ADHD by doctors in the United States.

An effective and safe alternative to medicating children can be family therapy, which also involves parent education. I explain this approach in my book, Pills Are Not for Preschoolers. The family therapist looks for sources of stress in the child’s social environment–family, school and friends. The therapist asks, what could be making this child jumpy or anxious, sad or aggressive? Then the therapist guides the parents in making targeted changes in the environment to reduce stress on the child.

The intervention may be as simple as limiting media stimulation at home, enrolling the child in an active sport or moving the child to a new classroom. The family therapist may help parents become more consistent with discipline, change patterns of communication that may be stressful to their child, or find ways to become happier in their marriage.

In Pills Are Not for Preschoolers, I tell the story of Olympic swimmer Michael Phelps, who was diagnosed with ADHD at the age of 9 and prescribed stimulant medication. Phelps took himself off the medication at age 13 because he felt it was an unnecessary crutch that prevented him from learning to control his behavior by himself. When Phelps went off stimulants, his teacher said that Michael “would never succeed at anything” because he couldn’t focus on anything long enough.

Despite his teacher’s prediction, Phelps went on to win more medals than any athlete in the history of the Olympics. He first took up swimming as a way to work off his extra energy and learn self-discipline. For Phelps, vigorous exercise turned out to be an excellent alternative to psychotropic medication. For many so-called antsy or high-energy children, team sports, time spent in nature and less time watching television or playing video games are often effective alternatives to medication.

What are the benefits of medicating children?  What are the drawbacks?

Stimulant drugs increase anyone’s ability to focus, and therefore provide a quick fix for a child who has difficulty paying attention at school. Antidepressants and antipsychotics can mute a child’s jumpiness and correct his behavior.

As for drawbacks to medication, there are a number of serious health risks.  Children’s bodies do not absorb and eliminate drugs in the same way adult bodies do, and their developing brains may be affected differently by drugs than the adults on whom the drugs were tested. A child’s psycho-sexual and social development may well be interrupted by psychotropic drugs. At this time there have been no long-term studies on how psychotropic drugs affect the developing brain of a young child.

Stimulants like Ritalin have a formidable list of possible side effects, including difficulty sleeping, dizziness, vomiting, loss of appetite, diarrhea, headache, numbness, irregular heartbeat, difficulty breathing, fever, hives, seizures, agitation, motor or verbal tics and depression. These drugs can slow a child’s growth or weight gain. Most disturbingly, they can cause sudden death, especially in children with serious heart problems. Moreover, stimulants–which are also known as speed–are highly addictive. Research shows that children who take stimulants are at higher risk for addiction to drugs like cocaine in late adolescence or early adulthood. A child who takes antipsychotics has a significant risk of weight gain and metabolic problems. These put the child at risk for Type 2 Diabetes.

When a child truly benefits from medication, what can a parent do to prevent social stigma?

If parents think of behavioral problems as an illness, and explain to a child that he is taking pills just as he would for any other illness, the child will not feel stigmatized. In the past thirty years, we have moved from a culture that viewed emotional problems as psychological in origin to one that views these problems in terms of a biological illness–a chemical imbalance in the child’s brain.

I think, however, that parents should make a distinction between the short-term and long-term benefits of medication for their child. There is no doubt that stimulant medications will, in most cases, help a child focus better on his school work. This benefit, however, is short term. Often a child will need higher and higher doses of the medication as time passes, and new research indicates that the long-term benefits of stimulants are questionable.

What can parents to do support a child who is growing-up on medication?

Parents can help their child become emotionally literate. That is, they can guide their children in gaining awareness of the situations that make them feel uncomfortable or anxious, and the situations in which they are comfortable or happy. Because psychotropic medications tend to mute feelings, medicated children may grow up unaware of who and what make them feel good and what makes them feel bad.

In a recent Wall Street Journal article, the reporter writes poignantly on her experience growing up on antidepressants. “Looking back, it seems remarkable that I had to work so hard to absorb an elementary lesson: Some things make me feel happy, other things make me feel sad. But for a long time antidepressants were giving me the opposite lesson. If I was suffering because of a glitch in my brain, it didn’t make much difference what I did. For me, antidepressants had promoted a kind of emotional illiteracy. They had prevented me from noticing the reasons that I felt bad when I did and from appreciating the effects of my own choices.”

In addition to helping their child become aware of feelings, parents should do everything they can to build their child’s self-confidence and self-esteem, so that when their child eventually decides to go off medication, she will feel confident that she can overcome life’s challenges without reaching for a bottle of pills.

Marilyn Wedge, Ph.D., lic. MFT, is a family therapist and author of two books and numerous professional articles in the  field of family therapy. Dr. Wedge has blogs on the Huffington Post and Psychology Today and writes for numerous websites and magazines on issues of child development and how to parent happy, healthy children. She has three grown children and two grandchildren.

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Posted in: Behavioral Issues, Expert Advice, Special Needs