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Reversing
the Trend
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Reversing
the Trend
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For more information The American Academy of Child and Adolescent Psychiatry in Washington, D.C., has long been concerned about the practice of off-label prescribing. Two years ago, it submitted a list of psychotropic drugs to the Food and Drug Administration, recommending them for further study for pediatric indications; www.aacap.org. The National Institute of Mental Health in Bethesda, Md., publishes numerous studies on psychiatric disorders in children on its Web site. A recent study looked at 600 children who had been diagnosed with attention-deficit hyperactivity disorder and concluded that a combination of medication and behavioral treatments were most effective in reducing symptoms. The National Association of School Nurses represents 10,000 school nurses. Center for the study of Psychiatry and Psychology
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Sara Solovitch National headlines last month announced a finding many health professionals are calling disturbing: a sharp increase in the number of preschoolers, some as young as 2, being treated with stimulants, antidepressants, and other powerful psychiatric drugs. Sally Hunter, RN, has observed the trend firsthand as a school nurse in Albuquerque, N.M. Every day at lunch hour, Hunter dispenses 45 pills to students at Eisenhower Middle School. "It’s a lot easier to take a pill than to see a therapist," she said. "I’ve talked with lots of parents who’ve had kids in therapy. They get four weeks paid for and then they’re given meds. A lot of times they just go to the doctor and get something prescribed. They never see psychiatrists or psychologists. And I wonder how much of this is due to HMOs." No surprise The study, published in the Feb. 23 issue of The Journal of the American Medical Association (JAMA), evoked widespread concern but little surprise. "I wish I were surprised," responded Glen R. Elliott, PhD, MD, director of child and adolescent psychiatry at the University of California, San Francisco. "Certainly, there’s a sense of people turning more to medications. You see evidence of it everywhere. It’s pervasive." Researchers led by Julie Magno Zito, PhD, an associate professor of pharmacy and medicine at the University of Maryland, analyzed prescription records from 1991 to 1995 of 200,000 preschoolers enrolled in two state Medicaid programs and one HMO in the Pacific Northwest. Though the total number of children receiving these drugs was quite small—1 percent to 1.5 percent—the report set off a wave of intense scrutiny. The White House responded to the news March 20 with the announcement that it would initiate a major effort to reverse the trend. The Food and Drug Administration (FDA) said it would develop new drug labels, and the National Institutes of Health announced plans for a nationwide study of Ritalin use in children under age 6. The use of Ritalin increased threefold from 1991 to 1995 for children between the ages of 2 and 4. Among the stimulants, it is typically used to treat attention deficit disorder (ADD) in children of all ages. In the past 10 years, the production of Ritalin in the United States has jumped 700 percent, and the number of children and adults diagnosed with ADD rose from about 900,000 to almost 5 million. Quick fix "It appears that behaviorally disturbed children are now increasingly subjected to quick and inexpensive pharmacologic fixes," wrote Joseph T. Coyle, MD, professor of psychiatry at Harvard Medical School, in JAMA’s accompanying editorial. "These disturbing prescription practices suggest a growing crisis in mental health services to children and demand more investigation." Experts say the practice is especially disturbing because there is virtually no research on the appropriate dosage, safety, or efficacy of any of these brain-altering drugs on children. Little is known about the long-term consequences of exposing young, developing brains to powerful psychiatric medications. The impact, according to child psychiatrists, may be enormous. Few psychiatric drugs are approved by the FDA for treating preschool children. Ritalin, for instance, carries a warning against its use in children under 6. Nevertheless, off-label prescribing by physicians is both legal and common. A growing reliance on medication coincides with increased acceptance of biological explanations for behaviorial and emotional problems, including ADD, bipolar illness, and depression. Even the harshest critics caution that drug therapy has a role in controlling some children with serious problems of aggression and self-mutilation. "These psychiatric diagnoses just don’t begin at a later age, even though a lot of them first show their faces in the adolescent and teen-age years," said Lisa Sharp, RN, FNP, who works in private practice in Bountiful, Utah. "For many, they begin in childhood. Under stress Others point to a changing social fabric, one that is increasingly less tolerant of childish mistakes and behaviors. "The system has much less flexibility than it used to," Elliot said. "As soon as a child begins to show difficulty, someone’s screaming, ‘We have to fix this.’ The number of options feels very small." Which is why, experts say, it comes as no surprise that societal and family stresses appear to be trickling down and affecting younger children. "We’re very concerned," said Sandra Landry, PNP, RN, health and wellness administrator for the Orange County Department of Education. "It’s not a matter of memorizing your phone number anymore. It’s a matter of memorizing your phone number, your mom’s cell phone number, your dad’s cell phone number, your address, your e-mail, your fax. It’s 10 things now where one used to do it. All that is having a major impact. And one of the things we’re going to have to look at is how children need to find ways of dealing with stress." |
