Treatment Online

Childhood Prescriptions, Mental Health Awareness on the Rise
> 12/5/2007 11:46:25 AM

New reports repeating the claim that millions of American kids currently suffer from a "silent epidemic" of undiagnosed psychiatric illness raise questions about how to more effectively recognize and treat these conditions and the concerns broached by prescribing powerful medications to young children. In an attempt to increase the public's awareness of mental illness among children and adolescents, the New York University Child Study Center fashioned a pro bono public service campaign in the form of a series of "ransom notes" sent by the personalized disorders currently holding our children hostage; their particular focus rests on ADHD, depression, bulimia, autism/Asperger's and obsessive compulsive disorder.

The presence of these conditions among the adolescent population has been well established, and there's no question that their influence begins early in life, most often before the onset of young adulthood. While the NYU campaign's efficiency has yet to be measured, any questions regarding its specifics should not downplay these general assertions: millions of children and adolescents certainly do suffer through major emotional and psychological problems, most of them treatable, and due to a combination of societal stigma, lack of communication and an underlying unease with the concept of medicating children, only 1/3 receive the treatment they need. Repeated studies also confirm the oft-repeated claim that these conditions exponentially increase the likelihood of a number of subsequent behavioral problems including academic failure, substance abuse, delinquency, unemployment and suicide. Current increases in overall treatment practices are commendable but insufficient; the children affected by these disorders need the most astute medical attention and treatments offered by our health care system, and this ad campaign may very well create some more expressive kids and/or receptive parents. Further steps must obviously be taken, but in the meantime, diagnosis and treatment trends are very clearly on the rise for increasingly young children, and a newly published set of regulations looks to advise doctors on the prescription of psychiatric medication to preschoolers.

This ad campaign does not specify the age groups targeted, but one can assume that they are not, at least for the most part, under the age of 6. While the idea that mental illness remains "stigmatized, under-diagnosed and under-treated" is a valid one, one wonders about the practice of medicating those whose ability to understand and regulate their own behavior is, to say the least, underdeveloped. Diagnosis inevitably proves more difficult among young children than adults, and the impact of these medications on 3-6 year-old brains has not been explored deeply enough to warrant rampant prescription. Certain drugs may well contribute to the recovery of the youngest victims of mental illness, and we can't argue against making every effort to provide them with this treatment if and when it proves safe and effective. But in the meantime, the noted paucity of research specifically related to young kids should dissuade pediatricians who lack the necessary expertise from acting on some overeager inclination to distribute drugs that may have dramatic effects on a child's neurological development.

Ritalin and related ADHD stimulants have represented perhaps the most public face of this controversy, but the concept of a 6 year-old taking antidepressants or antipsychotics raises many eyebrows. If a child with a severe condition does not respond to non-pharmaceutical treatments, what options do parents and doctors have? Behavioral and personality disorders can seriously compromise a child's education and social development in the crucial early learning stages, and medication may be the best response. To assuage the fears of the critical public and its (inevitably unsatisfied) anti-psychiatry fringe elements, researchers state that their goal in developing these guidelines is not to encourage the use of pharmaceuticals but to ensure that the prescription process is handled in a more responsible way, inevitably leading to an environment with fewer medicated preschoolers. They also encourage some form of psychotherapy in all cases in which medication is considered. If a child can be effectively treated without medicine, he or she certainly should be. But, as the "ransom notes" seek to remind us, increased awareness and sensitivity to the psychiatric needs of our underaged citizens does not equal overprotective paranoia - it's compassion and common sense.

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