Are Children Overprescribed Psychiatric Medication?

Debunking the myth.

Posted May 29, 2018

To those unaccustomed to psychiatric diagnostic protocols, psychiatry is a science that seems a bit like witchcraft. After all, no scan, test, or bloodwork can diagnose psychiatric conditions. It’s impossible to point to the source of the problem. And the rate at which people—particularly children—are diagnosed with psychiatric conditions has steadily increased.

It’s no wonder that skeptical parents and some advocates have expressed concern about an alleged epidemic involving the overuse of psychiatric medications. No one wants their child to take medication they don’t need, especially if there’s a risk of side effects. But no research suggests the notion that psychiatric medications are overprescribed. In fact, according to a new study published in the Journal of Child and Adolescent Psychiatry, if there is an epidemic, it’s an epidemic of untreated and unmedicated psychiatric disorders.

Study Finds Children Aren’t Overmedicated

The study, one of the most comprehensive of its kind to date, gathered data on 6.3 million children from a national prescription database. Children ranged in age from 3-24 years old. Looking at three psychiatric drug classes—antidepressants, stimulants, and antipsychotics—researchers compared prescribing rates with known prevalence rates for various psychiatric conditions.

They found that significantly fewer children took psychiatric drugs than would be expected given psychiatric disorder prevalence rates. Some highlights from the data include:

·         1 in 8 teenagers has depression, but fewer than 1 in 30 took antidepressants.

·         1 in 12 children have ADHD, yet only 1 in 20 took ADHD medications.

·         Less than one percent of the youngest children took psychiatric medications, undermining the notion that very young children take dangerous drugs they don’t need.

·         Adolescents were more likely than other groups to take psychiatric drugs. Overall, 7.7% of teens took these drugs—a prescription rate far lower than the known rate of mental health diagnoses in this age group.

·         About 1% of teens took antipsychotic drugs.

·         Stimulant use was highest in older children, who used these drugs at a rate of 4.6%.

This study conclusively undermines any claim that children are overmedicated. Indeed, it suggests that children may not be getting the psychiatric medications they need.

What Parents Need to Know About Psychiatric Medications

Parents whose children show symptoms of a psychiatric disorder should not listen to alarmist sentiments about a supposed “overmedication crisis.” The truth is that psychiatric conditions are real medical conditions. While adults sometimes find ways to manage their symptoms without medication, this is a much harder feat for children to accomplish.

Prompt treatment with psychiatric medication can confer long-lasting benefits on children. For instance, some research has found that treating ADHD with stimulant drugs may reduce a child’s lifetime risk for substance abuse. This may be because children are less likely to self-medicate with other drugs.

Psychiatric drugs alter brain chemistry, helping children’s brains work better and reducing the severity of mental health symptoms. There’s some evidence that this benefit may outlast the drugs themselves.

Children who take medication in childhood may not need it as adults. Doctors aren’t sure why this is. It could be that early treatment prevents a mental health condition from becoming more serious. Another explanation, however, seems more likely. Medication enables children to master their symptoms. In so doing, they can also focus on developing skills that offset the effects of mental health conditions. Over time, this can reduce the need for psychiatric drugs. For instance, a teen with depression may enter therapy and begin implementing healthy coping strategies over several years. With time and persistence, that adolescent may no longer need antidepressant medications and may find that symptoms are well-managed with lifestyle remedies.

What Does Evidence-Based Psychiatric Treatment for Children Look Like?

Psychiatric medication is critical to many children’s well-being. Alone, however, it’s not enough. This is why it’s important for parents to consult a mental health expert when seeking treatment for a child. A primary care provider likely can’t give a child with a mental health condition the care and follow-up they need.

The American Academy of Pediatrics advises that children with ADHD should receive both therapy and medication. Evidence suggests this rule applies not only to ADHD, but to all psychiatric conditions. Therapy offers families support, helps children learn how to live with their condition, and may offer children effective strategies for coping that medication alone cannot.

Insurance parity laws require insurers to cover mental health conditions at similar rates to physical health conditions. So therapy and medication should be covered.

Tips for Getting an Accurate Diagnosis

With more than 200 psychiatric diagnoses listed in the DSM-5, it’s important to ensure your child gets an accurate diagnosis. Because depression, ADHD, and similar conditions are common, many parents assume that they account for their child’s symptoms. But the wrong treatment for the wrong condition can make things worse. To ensure your child gets an accurate diagnosis:

·         Work with a mental health professional, not a pediatrician or a family physician.

·         Tell your provider about all symptoms your child has—not just those that fit the diagnosis you think they have.

·         Continue meeting with your provider after your child begins medication treatment. Discuss any side effects, and let the provider know if your child is not getting better.

Appropriate psychiatric treatment can make a lasting difference in your child’s life. Don’t allow yourself to be intimidated by unscientific scare tactic. Treatment works.

References

References:

Medications reduce incidence of substance abuse among ADHD patients. (1999, November 01). Retrieved from https://archives.drugabuse.gov/news-events/nida-notes/medications-reduce-incidence-substance-abuse-among-adhd-patients

Sultan, R. S., Correll, C. U., Schoenbaum, M., King, M., Walkup, J. T., & Olfson, M. (2018). National patterns of commonly prescribed psychotropic medications to young people. Journal of Child and Adolescent Psychopharmacology. doi:10.1089/cap.2017.0077