Frontline Investigates Psychiatric Medications for Children
> 2/4/2008 2:35:03 PM

PBS's news magazine Frontline has a long history of tackling dense and difficult subject matter. In 2001, the program turned its lens on the rising number of children who were being prescribed powerful medications for mental and behavioral health concerns. More than six years removed from that initial report, the issue has really only become more confused, more perilous, and ultimately, more important. So this week, Frontline again revisited the subject of "The Medicated Child" in an episode that can now be viewed in its entirety on the show's website.

PBS is by no means the only group to take an interest in this issue. If anything, psychiatric medications for young children became a national cause celebre when the parents of 4-year-old Rebecca Riley were arrested for murder after the girl died from intoxication caused by several psychopharmacological compounds. Rebecca had been prescribed several medications for ADHD at two and half years of age, including clonidine, which startled many. As Frontline makes clear, the case of Rebecca Riley is an extreme outlier, but it serves as a prism through which national dialogue has been shaped. For their part, the producers of Frontline present arguments from all sides of the debate, and they provide viewers with an excellent jumping-off point for further exploration.

The Medicated Child differers from the 2001 episode by focusing almost exclusively on the issue of childhood bipolar disorder diagnoses, which have increased by 4000% in the last decade. Experts offer many explanations for this enormous growth in diagnoses, but most come back to a single study, published in 1996 by Dr. Joseph Bierderman, that found that many children who were being diagnosed with ADHD may have actually suffered from bipolar disorder. Bipolar diagnoses began to rise almost immediately after this study's publication even in the absence of a clear consensus regarding pediatric bipolar and its symptoms.

Accompanying this increase in diagnoses was a rise in prescriptions for a variety of drugs including SSRIs and atypical antipsychotics. These are medications that, while deemed effective for adults, had virtually no history of testing in the pediatric sphere. Doctors, often pediatricians with little psychiatric experience, were suddenly thrust into the role of trying to treat a children who were taking several adult psychiatric medications. As Frontline illustrates, the results were not always good.

One of the over-arching themes of this PBS report is uncertainty. Parents, and very often young parents, can be uncertain if their child's behavior falls within "normal" bounds, and often find no professional agreement on what this "normal" behavior even looks like. Number and severity of tantrums were compared, moods were measured, and aggression was taken into account. But these are still children who are growing and developing in ways that are not entirely understood. Despite this uncertainty, many respected doctors and researchers feel comfortable writing pediatric prescriptions. Some of the best exercise extreme caution and monitor all aspects of the child and family's response. Unfortunately, while Frontline never asserts this opinion outright, just as many treatment scenarios probably trend toward Rebecca Riley territory.

These circumstances makes for an incredibly difficult question - one that PBS does an excellent job in portraying equitably. The research has been improving (largely because pharmaceutical companies are eager to have their drugs approved for pediatric use), and each new study brings us vital information updates. Sometimes, as with recent SSRI blackbox warnings, that information may not be used properly. Frontline speaks to several physicians who tell of the corresponding rise of antipsychotic prescriptions during the dropoff in SSRI prescriptions, and the abject fear that they feel when they hear that one class of relatively benign medications (SSRIs) has been replaced in children's medicine cabinets by far riskier prescriptions (atypical antipsychotics). Private companies like Brain Matters have also recently cropped up to fill a niche market for parents desperate for answers about what to do with a seemingly uncontrollable child.

These pieces are all part of a larger puzzle, that will hopefully begin to come into focus soon. For the time being, the best thing a parent can do is be educated and exercise caution. The drugs that are often prescribed to children are strong, and to avoid tragedy or future trouble discretion very well could be the better part of valor.

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