Keep Out of Reach of Children

News of the arrest of a Massachusetts couple accused of overdosing their 4-year-old daughter with psychiatric medication reignited a long-standing debate about whether young children with suspected mental illnesses should be treated with drugs.
Rebecca Riley had been taking a cocktail of psychiatric medications since age 2 1/2, when she was first diagnosed with attention deficit hyperactivity disorder and bipolar disorder. Many aspects of Rebecca’s case are unusual; her bipolar diagnosis is considered outside the norms of psychiatric care and her over-medication points to parental child abuse and neglect. But the tragedy raises serious questions about if and when kids with relatively common conditions like ADHD should be medicated, and highlights the public’s unease with the practice—especially when it comes to more seemingly grown-up mental disorders of bipolar and schizophrenia.
Parents face an anguished decision when a doctor recommends drug therapy for their troubled child. Many psychiatric drugs haven’t been adequately tested in children, the appropriate dosage is often unknown, and side effects can be serious. The decision of whether to medicate often comes down to a leap of faith. Parents must assess their own parenting beliefs, deal with societal pressure and come to terms with treating their child for conditions that can’t be diagnosed unequivocally—say, via a blood test.
But before this, a diagnosis must be made—and this is an equally controversial area. Some experts question the wisdom of labeling young children when behaviors almost by definition are erratic and young minds are still developing. Young kids, and especially toddlers, have mood swings. They can throw tantrums, be wildly happy and be withdrawn and downcast all within the span of an hour. It’s hard to know where usual child or adolescent behavior ends and illness begins, and some experts believe diagnoses like bipolar disorder in children are simply inappropriate.
“The younger the child is, the more humble the clinician should be about diagnoses,” says Dr. Ken Duckworth, medical director of the National Alliance on Mental Illness. “We just don’t know enough about the brain to know what¹s really going on.”
Moreover, parents and doctors need to consider these diagnoses in light of treatment options, which, for certain disorders like schizophrenia and bipolar disorder, can have serious side effects and unknown long-term effects in children.
According to Dr. Jess Shatkin, Director of Training and Education at the NYU Child Study Center, only about 20 percent of psychiatric medicines have been tested in kids. And that’s unlikely to change for one obvious reason: People don’t want their children in scientific experiments.
Yet ADHD and bipolar diagnoses in children are on the rise. A recent study estimates that bipolar disorder diagnoses increased almost sevenfold between 1990 and 2000. A Centers for Disease Control and Prevention report estimated that 7 percent of elementary school children have been diagnosed with ADHD.
Myriad financial and social pressures on schools, parents, doctors and teachers converge to create situations in which the first line of treatment for disorders like ADHD is drug therapy rather than more conservative options, such as behavior modification.