Medicating Kids with Behavioral
Problems: Solution or Problem?

By Mary R. Anderlik
Health Law & Policy Institute

Recent studies document dramatic increases in the use of psychotropic medications (drugs that work on the brain) to treat children, including children younger than 5 years old. On March 20, the White House hosted a summit on the issue and announced a plan to rein in this potentially risky practice.

A study published in the Journal of the American Medical Association (JAMA) in February found a 3-fold increase in the use of methylphenidate (Ritalin) for 2- to 4-year-olds between 1991 and 1995. While that amounts to only 11.1 children per 1000 taking the drug in 1995, the rate of growth is striking as the drug carries a warning against use in children under 6. Another study found a 10-fold increase in the prescription of selective serotinin reuptake inhibitors (a category of anti-depressants that includes such drugs as Prozac and Zoloft) for children 5 and younger between 1993 and 1997.

Even those unfazed by the prospect of a Prozac Nation—and medication as the normal response to disease—have expressed concern over the findings of these studies. Reasons include:

One study found that, in a sample of young children diagnosed with attention-deficit/hyperactivity disorder, nearly 60% received psychotropic medications (frequently two or more psychotropic medications) while only a quarter received psychological services. Pressed to hurry up and treat, clinicians may fail to undertake the evaluations necessary for sound prescribing and neglect to supplement drug treatment with time-intensive, but effective, and less risky, cognitive and behavioral therapies.

Others are concerned about the whole drug treatment enterprise, especially in children. They believe the label "mental disorder" is often attached to age-appropriate behavior (or misbehavior), or to a response to disorder in the child’s (home or school) environment. In the 1970s, a neurologist found that hyperactive children had lower levels of serotonin than a control group. When she arranged for the two most hyperactive children to spend additional weeks in the hospital, their serotonin levels rose and their hyperactivity diminished. Returned to their ordinary environment, their serotonin and their hyperactivity returned to their previous, problematic, levels.

Managed care organizations, doctors, teachers and parents may all have reasons for seeking a "quick fix." And drugs do appear to work wonders in some children, transforming them from disruptive forces in the classroom to engaged learners. Finally, certain kinds of behavior clearly fall outside the "normal" range, e.g., repeated head-banging or compulsive hand-washing.

Experts consulted by JAMA rarely prescribed psychotropic medications for young children. Those who did limited their use to severe, intractable cases, such as cases of serious self-injurious behavior. For the White House summit, the National Institute of Mental Health prepared a fact sheet, "Treatment of Young Children with Mental Conditions," which lists age ranges for many brand name and generic medications. Until further studies contemplated under the White House plan are carried out, caution is warranted. Among other things, parents should be informed of the risks associated with medications and equipped to monitor their children for side effects.

03/31/00