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.