Psychiatric drugging of American children is cause for alarm

A new study by a group of investigators (CERT) from Rutgers University and Columbia University show that antipsychotic prescriptions written for privately insured children aged 2 to 5 years doubled between 1999-2001 and 2007. [1]

Notwithstanding the investigators’ effort to soft-peddle the significance of their findings—which supplement their previous study [2] documenting that children enrolled in Medicaid are roughly four times more likely to be prescribed an antipsychotic drug than are children covered by private insurance–the alarming prescribing trend is unabated.

"The growing use of antipsychotic drugs in children from infancy to 17 years of age has caused some concern among mental health experts, because data about the effectiveness and safety of antipsychotic drugs in children are limited for both on-label and off-label uses." 

Physicians who prescribe antipsychotics for children appear to be unperturbed by the lack of evidence to support such prescribing: there is no evidence demonstrating that these drugs are either safe or clinically beneficial for children. 

Indeed, Dr. Mark Olfson, the first named author of the new study (published by the Journal of the American Academy of Child and Adolescent Psychiatry) acknowledged: "there is little evidence regarding antipsychotic efficacy in children under age 6 years."
 
The Pediatric Advisory Committee of the FDA which has been reviewing safety data on the use of pediatric antipsychotic drugs and is considering whether to recommend new label warnings has yet to issue recommendations.

Below, the author of an investigative series about mental health issues for children of color, calls the psychiatric drugging of American children, a cause for alarm:
 
"The psychological propaganda of Big Pharma steers parents away from proactive parenting toward drug-related answers. What is most important for patients and parents to take away from these troubling issues is that we should not blindly accept whatever medication that is being promoted as the new wonder drug."

References:

1. Olfson M, Crystal S, Huang C, Gerhard T. Trends in antipsychotic use by very young, privately insured children. J Am Acad Child Psy 2010;49:13-23.

2. Crystal S, Olfson M, Huang C, Pincus H, Gerhard T. Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Aff (Millwood) 2009;28:w770-781.

Vera Hassner Sharav

The Portland Press Herald
May 3
Psychiatric drugging of American children is cause for alarm
By Leigh Donaldson
May 3, 2010

The age of children being medicated with prescription psychiatric drugs is getting younger and more widespread every year.

According to a 2010 study of data on more than a million children reported by American Academy of Child and Adolescent Psychiatry’s journal, the use of powerful anti-psychotics with privately insured U.S. children, ages 2 through 5, doubled between 1999 and 2007.

In the 2007 study, the most common diagnoses of anti-psychotic treated children were pervasive developmental disorder or mental retardation (28.2 percent), attention deficit hyperactivity disorder (23.7 percent) and disruptive behavior disorder (12.9 percent).

Fewer than half of drug-treated children received a mental health assessment, a psychotherapy visit, or a visit with a psychiatrist, during the year of anti-psychotic drug use.

"Anti-psychotics, which are being widely and irresponsibly prescribed for American children — mostly as chemical restraints — are shown to be causing irreparable harm." Vera Hassner Sharav, president of the Alliance for Human Research Protection, warns. She further asserts that long-term use of these drugs can have hazardous effects on cardiovascular and metabolic systems.

Dr. Peter Breggin, founder of the International Center for the Study of Psychiatry and Psychology and author of "Medication Madness," characterizes anti-depressants, stimulants, mood stabilizers and anti-psychotic substances as bathing the brains of growing children with agents that threaten the normal development of the brain.

Highlighting the controversial nature of medicating American children is the recent death of Rebecca Riley, a 4-year-old Boston girl diagnosed with ADHD and pediatric bipolar disorder at 28 months of age.

According to a medical examiner, she died from the effects of a combination of Clonidine, a blood pressure medication prescribed for ADHD, Depakote, an anti-seizure and a mood stabilizer for her bipolar disorder, as well as a cough suppressant and an antihistamine.

Just as tragic is the 2009 revelation in federally funded research that children covered by Medicaid were prescribed anti-psychotics at a rate four times higher than children with private insurance.

The data indicated that more than 4 percent of children in Medicaid fee-for-service programs received anti-psychotics, compared to less than 1 percent of privately insured youth. Poorer kids are receiving more of these drugs than richer ones.

The over-drugging of children in this country is complicated by many circumstances. For one thing, alternatives to medication, such as counseling, especially for attention deficit disorder (ADD) and ADHD, is not often covered under many insurance plans.

There have been countless reports from psychologists claiming that insurance companies encouraged them to get patients on medication for any diagnosis, so that they could stop paying for counseling. Further, many people have no mental health insurance to start with.

Another consideration is that our culture is an attention deficit breeding ground. Mind-numbing electronics are all over the place and our society is abnormally fast-paced, both encouraging limited attention spans. Studies have indicated that continual exposure to video games actually makes ADD worse in some patients.

Furthermore, in this country, the public is inundated with direct pharmaceutical advertising that according to Dr. Peter Parry, a child and adolescent psychiatrist in Australia, "can feed the natural desire parents of distressed and aggressive children have for a quick solution by suggesting a simple medication fix."

The psychological propaganda of Big Pharma steers parents away from proactive parenting toward drug-related answers. What is most important for patients and parents to take away from these troubling issues is that we should not blindly accept whatever medication that is being promoted as the new wonder drug.

Many parents need to be more resourceful by looking more deeply into their child’s condition, and doctors need to be less interested in pushing drugs and focus more on the individual needs of their patients.

Medicating without thorough, professional diagnosis and research into alternative treatments is not only wrong, but abusive to the patient. Medications are necessary for many patients, but their irresponsible overuse is a serious problem that needs to be addressed.

For starters, we might regulate when and how some of these drugs are used, take ads for prescription drugs off television and expand health coverage for viable options to parents such as counseling. Also, doctors and pharmacists should be empowered to better inform parents of the possible harms many drugs can cause their children.

Doctors need to shift more of their concentration on the underlying causes of mental illness in young children.

The reality is that life today is very difficult for many people. Stressed-out parents cannot provide adequate love, patience and attention, never mind good nutrition and a calm environment for their offspring to grow up in.

Nature and nurture should play a more prominent role in how children with psychological problems are diagnosed and treated.

Drugging a child, even as a last resort, should never be equated with good parenting, counseling and professional guidance.

Leigh Donaldson is a Portland writer who is completing a series of investigative feature articles exploring mental health issues among people of color for national publication. He can be contacted at: leighd@lycos.com

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Rutgers CERT Investigators Report Troublesome Trends in Pediatric Antipsychotic Prescribing Practices
By Kim L Farina, PhD

Olfson M, Crystal S, Huang C, Gerhard T. Trends in antipsychotic use by very young, privately insured children. J Am Acad Child Psy 2010;49:13-23.

Crystal S, Olfson M, Huang C, Pincus H, Gerhard T. Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Aff (Millwood) 2009;28:w770-781.

According to newly published research by mental health experts at the Rutgers Center for Education and Research on Therapeutics (CERTs) and at Columbia University, antipsychotic prescriptions written for privately insured children aged 2 to 5 years doubled between 1999-2001 and 2007.1 Antipsychotic drugs are often prescribed to children by general practitioners and family medicine doctors.2

While the increase in prescriptions observed in this study was accompanied by overall increases in diagnoses for a variety of disorders, fewer than half of the young children prescribed antipsychotic drugs received formal mental health services in the form of mental health assessments, a psychiatric visit, or psychotherapy. According to the authors, this represents a deviation from published pediatric mental health recommendations.1

The growing use of antipsychotic drugs in children from infancy to 17 years of age has caused some concern among mental health experts, because data about the effectiveness and safety of antipsychotic drugs in children are limited for both on-label and off-label uses.2 In fact, the Pediatric Advisory Committee of the United States Food and Drug Administration has been reviewing safety data on the use of pediatric antipsychotic drugs and is considering whether or not to recommend new label warnings.2

According to first author Mark Olfson, MD, although "there is little evidence regarding anitpsychotic efficacy in children under age 6 years," there is a place for the use of antipsychotic drugs in the treatment of children. There have been recognized benefits to some uses of these drugs, prompting the American Academy of Child and Adolescent Psychiatry to release a policy statement that includes the following, "To provide optimal treatment, the child and adolescent psychiatrists must have access to a full range of psychotropic medications."3

There is also concern about recognized variations and disparities in the care delivered to children with mental health disorders. Earlier data from this group, reported in the journal Health Affairs, revealed children with Medicaid benefits are roughly four times more likely to be prescribed an antipsychotic drug than are children covered by private insurance.4 This disparity was the focus of a December 12, 2009, article in the New York Times.5

Stephen Crystal, Ph.D., first author of the Health Affairs article noted, these differences reflect, at least in part, clinical differences in the populations served by these payers [Medicaid vs. private insurance] and do not necessarily reflect programmatic differences. As he commented in the Times article, "Medicaid kids are subject to a lot of stresses that lead to behavior issues which can be hard to distinguish from more serious psychiatric conditions," he said. "It’s very hard to pin down."

However, according to Dr. Crystal, "the results do suggest the importance of further research on patterns of use and management of antipsychotic therapy among publicly insured populations, and of initiatives to encourage use of evidence-based practices in managing maladaptive aggression in children, including appropriate access to appropriate psychosocial as well as medication-based interventions."
References

   1. Olfson M, Crystal S, Huang C, Gerhard T. Trends in antipsychotic drug use by very young, privately insured children. J Am Acad Child Psy 2010;49:13-23.
   2. Pediatric Advisory Committee to the Food and Drug Administration. 2009 Meeting Materials: December 8, 2009. US Food and Drug Administration Web site. Available at: http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/ucm116530.htm. Accessed March 4, 2010.
   3. American Academy of Child and Adolescent Psychiatry. Pharmaceutical benefit management and the use of psychotropic medication for children and adolescents. Available at: http://www.aacap.org/cs/root/policy_statements/pharmaceutical_benefit_management_and_the_use_of_psychotropic_medication_for_children_and_adolescents. Accessed March 4, 2010
   4. Crystal S, Olfson M, Huang C, Pincus H, Gerhard T. Broadened use of atypical antipsychotics: safety, effectiveness, and policy challenges. Health Aff (Millwood) 2009;28:w770-781.
   5. Wilson D. Poor children likelier to get antipsychotics. New York Times 2009 Dec 11. Available at: http://www.nytimes.com/2009/12/12/health/12medicaid.html?pagewanted=all. Accessed March 4, 2010.