In April, Ryan D’Agostino wrote a story in Esquire called “The Drugging of the American Boy” that began this way:
If you have a son, you have a one-in-seven chance that he has been diagnosed with ADHD. If you have a son who has been diagnosed, it’s more than likely that he has been prescribed a stimulant…
And so forth.
It’s one recent example of a recurring theme in medical reporting–that we are wrongly diagnosing children with mental illness when they are merely rambunctious, and that we are pumping them up with drugs when what they really need is a guiding hand. The New York Times has written a series of stories along these lines.
Most of these stories presume that children are being wildly overmedicated–and then they go on to “investigate” the causes and what can be done about it. Few stories question the presumption. And fewer still report on those children who do indeed suffer from mental illness but who remain untreated and unmedicated–possibly because so much journalism talks about the horrors of overmedication, rather than the horrors of undermedication.
Occasionally, a writer pops up with a contrary story, noting that some kids desperately need medication and can be helped enormously by it, as the blogger melody , a college student, did in this piece at Scientific American.
But now, I’m happy to report, a blogger has finally addressed this question head on. In a post entitled, “Are Children Overmedicated?“, he writes this:
7.5 percent of U.S. children between ages 6 and 17 were taking medication for “emotional or behavioral difficulties” in 2011-2012.2 The CDC reports a five-fold increase in the number of children under 18 on psychostimulants from 1988-1994 to 2007–2010, with the most recent rate of 4.2 percent.3 The same report estimates that 1.3 percent of children are on antidepressants. The rate of antipsychotic prescriptions for children has increased six-fold over this same period…
But before decrying the wild overuse of medication, he writes this:
Is it possible that the increased use of medication is not the problem but a symptom? What if more children were struggling with severe psychiatric problems and actually the problem was not over-treatment but increased need? Surely, if we discovered more children were being treated for diabetes or immune problems, we wouldn’t blame the providers or the parents. We’d be asking what drives the increase in incidence.
That’s precisely what I’ve been trying to say, although this blogger says it better, and the analogy is on target.
I suppose I’ve kept you in suspense long enough. The blogger who wrote this is Tom Insel, a psychiatrist and the director of the National Institute of Mental Health.
Insel acknowledges that overmedication could be a problem. “No question, in a field without biomarkers, [meaning there are no blood tests for psychiatric ailments] there is a risk of over-diagnosis,” he writes. “But what if the increased use of medication reflected more children with severe developmental problems and more families in crisis?” Most parents resist giving their children drugs, he writes. Pharmaceutical companies have reduced their marketing budgets.
As to whether we are experiencing a flood of overmedication, or a crisis on undermedication, Insel, who is in a position to know, writes this:
What I hear from families in crisis is lack of access, poor quality care, and a desperate need for answers. In the media reports on over-medicating children, this perspective is missing. The possibility that there is a real increase in the number of children suffering with severe emotional problems, just as there is a real increase in the number of children with diabetes and food allergies, is not even considered. Shouldn’t we be asking why so many children, at younger ages, are being seen for emotional and behavioral problems?
Indeed. Science reporters should follow Insel’s lead and stop bemoaning the increasing use of psychiatric drugs in kids. Instead, as Insel suggests, they should take a serious look at the problem of mental illness in children, and why it seems to be on the rise.
A reorientation of journalists’ priorities is long overdue.
Jason Gillikin says
I work in the QI department of a Midwest-based health insurer. Last summer, we evaluated the rate of ADHD stimulant drug spending, based mostly on concerns from some employer groups that ADHD stimulants are quickly approaching their Top 5 drug expenses — in some cases, outpacing drugs for diabetes and even chemotherapy. Our core finding was that rates were fairly constant for children and adolescents (although we saw more for very young, like toddlers) over a 10-year period, but the real growth as a ratio of plan members really shot up in the over-30 crowd. ADHD simulant usage is a hot topic, but it’s difficult to tease out a single idea or single explanation for the increase in prescriptions over time. A lot goes into why prescriptions are written, and who’s doing the diagnosing (and based on what criteria). I am skeptical that looking at just children, without looking at all age cohorts, really tells the full story. At a minimum, talking to the providers engaged with the patients matters — you’ll get different results from a primary-care doc relatively inexperienced with behavioral-health matters, than from a formal diagnosis from a psychiatrist or other mental-health professional. As with so much with health reporting, stories about the alleged over-medication of America’s boys removes so much nuance that the breathless findings trumpeted on so many headline-news banners obscures more than it illuminates.
Sorry to be the cynic, but somebody has to…
It is probable, at this point, that more than 50% of the medical problems that Americans have are CAUSED by over-medication (as well as misguided ‘advice’ like avoiding fats), ranging from diabetes and gall bladder problems caused by inappropriately prescribed meds for hypertension; to mysterious ‘epidemics’ of autism and breast cancer that might be explained by answering questions nobody is willing to ask, such as: is the modern epidemic of breast cancer related to the fact that the last fifty years has introduced a new hormonally disrupting factor into women’s health, viz: the birth control pill?
That doesn’t mean we shouldn’t treat some kids with developmental disorders, especially if the patients are dangerous to themselves or others, but we have to be very careful with that treatment and its potential long term side effects.
One example: that guy who killed all those people in southern California a few weeks ago had long been diagnosed with one or another psychiatric disorder.
Was he or had he been on medication of some sort?
We HAVE to ask these questions if we are going to claim to be ‘scientists’.
I always wonder about kids who get 3 hours of hard exercise a day, and 10 hours of sleep. How often do they get diagnosed as needing medicine?