A perfect storm of interacting detrimental factors has resulted in the recent massive overuse of psychotropic medication in children.
Drug companies started to focus their marketing campaigns on kids when the adult market was saturated. Children make perfect customers -- get them used to psycho-active pills when they are young and they may continue to use them for life.
Doctors have swallowed the misleading sales pitch that typical kiddie problems are really under-diagnosed and under-treated 'mental disorders' -- very easy to diagnose and very easy to treat with a pill. Just the opposite is true. Children change so much in response to environment and development that their diagnosis and treatment always requires the greatest care, patience, and time. I can't picture ever starting a child on meds after a brief evaluation, but this is often done.
Parents far too readily follow doctors' advice about medication for their kids. I recommend always becoming a fully informed consumer and getting second and third opinions before allowing your child to take any psychiatric medicine. This is an important decision that requires careful deliberation and full parental input.
Overwhelmed teachers often recommend that parents take their kids to doctors for medicine when the problem may be more in the classroom than in the kid.
Dave Traxson, a Child and Educational Psychologist in the United Kingdom, has come up with a terrific suggestion to help contain the epidemic of careless medication in kids. He has developed a checklist of questions doctors should think about before prescribing psycho-active drugs to kids. Dave writes:
There has been an unchecked, exponential growth in the use of psycho-stimulants, anti-depressants, and anti-psychotic drugs in kids- often harming more than helping them.
I have devised a checklist to help clinicians think through the necessary steps that should be part of every careful prescription of medication for children.
• Does the child have a classic presentation that closely conforms to an approved indication for this particular medication?
• Is there well documented research on efficacy and safety with children of the same age, gender, and social grouping?
• Are the child's problems pervasive, occurring in a wide range of social settings and observed by many different individuals?
• Are the child's problems severe, enduring, and impairing?
• Do the child's parents and involved professionals see the problems as significant enough to require medication?
• Are there stresses in the child's relationships, social context, and recent history which might explain this pattern of behaviours?
• Has a psychological or social intervention been tried prior to prescribing medication?
• Have there been any significant adverse side-effects from medication?
• Have you carefully weighed short and long term risks and balanced them against possible benefits?
• Have you received informed consent from the parent and (where appropriate) the child?
& perhaps the most telling question
• If your child had the same presenting problems, would you be prescribing medicine?
Thanks, Dave. Inappropriate kiddie prescribing has been fueled by billion-dollar drug company marketing -- so far, with little pushback from doctors, mental health professionals, parents, and teachers.
We simply don't know what will be the long term impact of bathing a child's immature brain with powerful chemicals. We are now conducting an uncontrolled experiment without informed consent with unknown consequences for millions of our kids.
There are childhood problems that certainly do require medication, but this should only be a last resort after careful consideration of less invasive interventions. Medication should never be, as it now too often is, a first and careless reflex. Dave Traxson's checklist is an excellent guide to more responsible practice.
And parents must be mindful of the need to protect their kids from excessive medication use. There is not a pill for every child-rearing problems. Never accept a prescription if it has been written after a quick evaluation without a full exploration of alternatives.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.
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