Elizabeth Roberts MD
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Should You Medicate Your Child's Mind

Should You Medicate Your Child's Mind?
A Child Psychiatrist Makes Sense of Whether or Not to Give Kids Meds

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SUMMARY

Should You Medicate Your Child’s Mind? addresses the growing epidemic of misdiagnosing and overmedicating children with psychiatric drugs. As a lifelong advocate for children—who themselves have no power to shape public policy, and little voice in their parents’ medical decisions—Dr. Roberts felt compelled to appeal to parents on their children’s behalf. If the unrestrained frenzy to diagnose children with mental illness does not slow down, more children are going to be hurt. This book provides parents with straight-forward medical information in simple easily understood language. Dr. Roberts neither glorifies nor vilifies the use of psychiatric medications in children because sometimes they can be life saving. But, when inappropriately administered, psych drugs can make children very sick and sometimes even kill them.

Bipolar Children:
Cutting Edge Controversy, Insight, and Research

Chapters Authored by:
Elizabeth Roberts, M.D. Child & Adolescent Psychiatrist
Lawrence Diller, M.D. Developmental Pediatrician
David Healy, M.D. Psychiatrist
Philip J. Landrigan, M.D. Pediatrician
Daniel Burston, Ph.D. Psychologist
Joanna Le Noury, Ph.D. Psychologist
William J. Purcell, Ph.D. Psychologist
Toni Vaughn Heineman, MHD Psychologist
Robert Whitaker Journalist

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Edited by:

Sharna Olfman, Ph.D.
Professor of clinical and developmental psychology at Point Park University.
BOOK REVIEW
by Andrew Schultz-Ross

Well, should you medicate your child who has some problem with her behavior? I’ve been asked that question hundreds of times, and since I don’t see children in my clinical practice, I don’t get to really answer it. Instead, I usually respond with a longer winded version of “It depends.”
I don’t envy you if you have that question. The answer isn’t confusing just because of the mass of information out there about psychiatric diagnoses and treatments. I think it is especially hard because of what is mostly missing. What’s almost not there is the middle ground.

Many if not most Americans think that psychiatrists are the way that we’re depicted in the cartoons in The New Yorker or on television; that we dispense both medications and psychotherapy, that we’re agile with and keen on both, and balance them well. In fact, there’s a quiet war going on. The winner in terms of money and popularity in the profession at this time is the side that favors medications over psychotherapy, often to the point of disparaging the value of therapy. The partisans from this side of the conflict have rather successfully convinced the profession as well as the populace that almost all emotional difficulties arise from chemical imbalances.

The underdogs in the conflict are not well-organized, and are not cohesive in terms of agenda or even belief systems. Some are old-timers who practice psychiatry the way it was done in the past, with psychotherapy front and center, and medications on the side or ignored. Others have more identification with alternative medicine, and believe that psychiatric medications are harmful or at least vastly overused.

While this quiet war goes on (it would seem that it smolders more than rages), there is an information gap for parents of children with behavioral issues. While there are tons of books and other information promoting or trashing any given medication or medications in general, there is nearly nothing in the middle.

Few researchers, observers and authors have the wisdom, grace or sensibility to rise above the smoldering war to tell you what to do with your child in a way that honors your child above this conflict.

The medications are helpful, and can be harmful. They’re overused in many settings and underused in others. As Dr. Roberts discusses in the remarkable book you’re holding, they treat symptoms, not disorders, and they work better when combined with psychotherapy.

What you need is not propaganda from either side in the war. What you need is the truth, which is almost certainly in the middle. Thankfully, Dr. Elizabeth Roberts has written this book, a practical, hands-on, no nonsense guide to making one of the most difficult decisions in parentdom. She’s laid out the issues, the confusions, the problems and the solutions without getting into partisanship in the war. Her allegiance is to you and your child, to helping you to neither give your child medications he may not need nor to avoid them when they might help. In this book, your child gets to be your child rather than a poster kid for either side of the war going on in psychiatry.

It isn’t that we’ve been holding out on you. It hasn’t been easy to be in the middle as psychiatrists. There are tremendous pressures to pick a side in this conflict, and the lack of information in the middle goes all the way through to the data available to us as professionals. Thankfully, Dr. Roberts has the training, experience and wisdom to not only have crafted a path down the middle, but to have come up with the words to describe it so that you can join her, right where you belong when trying to decide if and when it makes sense for medications to be used for your child.

The next time that someone at my child’s school or at a social event asks me whether their child should be on medications, I won’t start down the path of my “It depends” speech. I’ll send them straight to this book. When you read it, you will be far better able to access the help that you need to make a difficult decision about a very important issue. The one thing that Dr. Roberts hasn’t told you in this book is how remarkable it is that it exists, and how necessary it is for parents to have a guide that doesn’t have an agenda besides the children.


Drew Ross, M.D.
 
BOOK DESCRIPTION
 
Over the past decade and a half, there has been a dramatic increase in the number of children being diagnosed with Bipolar Disorder, an illness that was once considered rare prior to adolescence. This book examines
  • Why the incidence of pediatric Bipolar Disorder has risen so dramatically
  • New treatment guidelines published by the American Academy of Child and Adolescent Psychiatry for early onset Bipolar Disorder which advocate the use of mood stabilizers in combination with atypical antipsychotics
  • The impact on children's health of a 'polypharmacy' treatment approach
  • Cultural trends at home and school that contribute to children's emotional immaturity
  • The greater likelihood in the current cultural climate that 'difficult' children will be labeled as psychiatrically disturbed
  • Marketing pediatric Bipolar Disorder by pharmaceutical companies
  • The value and limitations of the medical model as a framework for understanding early onset bipolar disorder
Excerpt

Bipolar Disorder has become the diagnosis de jour for children who display any symptoms of irritation, anger, frustration, insomnia, sadness, or aggression. Regardless of the child’s circumstances, home environment, academic problems or social struggles, child psychiatrists and pediatricians are quick to diagnose Bipolar Disorder. Frightened children, bullied kids, abused children, grieving children, even kids making adjustments to new situations such as divorce, may share these symptoms of irritation, insomnia or sadness. Yet, clinicians from all disciplines of mental health are jumping to the conclusion that these kids must have Bipolar Disorder.

Of course, some children actually do have Bipolar Disorder. Other children, misdiagnosed with this disorder, also have a legitimate mental illness—just not Bipolar Disorder. Unfortunately, children whose symptoms more closely meet the criteria for other disorders such as Adjustment Disorder, Major Depressive Disorder, Anxiety Disorder, Post Traumatic Stress Disorder, Intermittent Explosive Disorder or Oppositional Defiant Disorder, nonetheless get tagged as Bipolar anyway. Due to the understanding that Bipolar Disorder is purely the result of a chemical imbalance, many clinicians believe that Bipolar children require nothing more than medications. Consequently, medicine is often the only treatment provided. Tragically, once the label of Bipolar Disorder has been incorrectly applied, the appropriate interventions and therapies for the actual diagnosis, may never be delivered.

Perhaps the most reprehensible misuse of this popular psychiatric diagnosis is its application to ordinary, belligerent children. Parents, teachers and clinicians now characterize the typical defiance, misbehavior and temper tantrums, of bratty children as Bipolar Disorder. Using the diagnosis of Bipolar Disorder, doctors are now justifying the sedation of these difficult children with powerful psychiatric drugs—drugs which have serious, permanent and sometimes even lethal side effects.

    Unfortunately, when a normal but bratty child is misdiagnosed with Bipolar Disorder, almost everyone benefits. The schools get more federal funding for the education of their mentally or emotionally handicapped student. Once the child is medicated, the teacher has a more subdued student in their already busy classroom. Parents may benefit financially too, by getting an SSDI check for their child. Finally, the parents of bratty kids are not forced to examine their poor parenting practices. A diagnosis of Bipolar Disorder provides a parent the perfect excuse for their child's misbehavior: he has a chemical imbalance. Parents believe that a psychiatric condition absolves them of any responsibility for the child's problem behaviors. After all, parents understand that they have no control over chemical imbalances. Neurotransmitters, as parents understand them, are the responsibility of the doctors, they fall under the scope of a psychiatrist's influence.
 
    When children, who are spoiled, are diagnosed with Bipolar Disorder, a great injustice is done to the child. Though other people may benefit when a child is diagnosed with Bipolar, the one individual who really loses is the child. Merely for the want of decent parenting, it is the child who must be burdened unnecessarily with the label of a mental illness. Simply because weak parents want to avoid guilty feelings, it is the child who
WHY DR. ROBERTS WROTE THIS BOOK

I have been guiding and caring for children over the past thirty years, half of those years as a physician. It started when I was fifteen years old: I began my work with mentally ill children by volunteering my time caring for an institutionalized autistic girl. In the fourteen years that followed, I sheltered and counseled runaways, coached sports in poor neighborhoods, ran the local soup kitchen for the homeless, provided direct care for profoundly mentally retarded teenagers, and completed my teaching degree from the University of Michigan. My experience as a teacher ran the gamut from some of the most prestigious private schools to public schools in the more impoverished neighborhoods of Chicago.

In 1988, I went to medical school as a single mother when my children were eight, seven, and four years old. I completed my medical education with a Fellowship in Child and Adolescent Psychiatry from the Medical School at Northwestern University in Chicago. Since then, I have worked as a child and adolescent psychiatrist in private psychiatric hospitals, public state hospitals, psychiatric emergency rooms, public county clinics, private group practices; served as a consultant to pediatricians and psychologists; and had my own private practice. I have held positions as the medical director of Hazelden, a drug and alcohol rehab clinic for teens, and as the medical director of a psychiatric emergency room for children. I have lectured to parents and professionals on the subject of children’s mental health at hospitals, schools, professional symposia, and at ChADD (Children and Adults with Attention Deficit Disorder) meetings. I have been quoted in newspapers and television news, and once appeared on The Oprah Winfrey Show as an expert on addictions in teens.

Throughout my above career, I have treated children with frighteningly severe psychiatric disorders, such as schizophrenia or methamphetamine-induced psychotic disorder. At the other end of the spectrum, I have treated children from intact, loving homes where the child was simply overindulged or was experiencing a difficult adjustment to a common life change, such as starting at a new school.

In every instance where I treat children, I am asked two questions:

1. What is wrong with my child?
2. What will help?

I believe that, if you desire to help children succeed and be happy, whether they are struggling with mental health problems or not, the proof of your methods lies in your outcomes. So, when the famous pediatrician and author, Dr. Spock, gave advice on raising children, it was difficult for me to take him seriously after learning how unhappy and dysfunctional his own children turned out to be. I have many successful outcomes in treating children professionally as well as in rearing my own children, who are now all adults. Their happiness and ability to lead fulfilling lives are the finest evidence of my understanding and treatment of children and adolescents. My methodology works.

However, the parents of the children I am called in to treat often complain that they have received conflicting advice from teachers, family, friends, media, and doctors—and they don’t know who to believe. The other, even more common complaint is how little time and attention they and their child receive from their child’s psychiatrist. Parents are appalled that they are shooed out the door with a prescription in twenty minutes, after a minimum of discussion about—or with—the child. Even more shocking, it has been reported to me that, pediatricians can, and do, assess and medicate in even less time. A five-minute appointment with a pediatrician culminating in a prescription for powerful psychotropic medications is fairly standard, according to my patients. Not surprisingly, parents tell me they often leave a doctor’s office feeling completely clueless about a medication’s potential side effects, and frustrated by never having had a chance to fully discuss the aspects of their child’s condition that meds may not even treat! Ultimately, this poor line of communication between parent and doctor leads to problems for the child. The most serious and dangerous consequence of this lack of in-depth diagnosis and parent education is that children are being inappropriately medicated or overmedicated, without nonmedical therapy options being adequately discussed or utilized.

My broad knowledge and experience as a child psychiatrist, a teacher, a counselor, a coach, a child-care worker, and a parent has given me a unique perspective on behavior problems that encompasses every aspect of mental health in children. I have cared for the most disadvantaged and abused children of our society, and the most privileged and gifted, who yet had problems requiring my care. Regardless of their socio-economic group or the nature of their psychiatric condition, the heavy-handed approach taken by some physicians who attempt to solve all behavioral problems with a pill can cause more problems for children instead of less.
Recently, I evaluated a seven-year-old who had been given five different psychiatric medications by the child’s prior doctors: two antipsychotic drugs, a mood stabilizer, an amphetamine, and an antidepressant. He had been previously diagnosed with both Bipolar Disorder and AD/HD. It might help to understand that this child had experienced extreme chaos, neglect, and unspeakable physical and sexual abuse at the hands of his drug-addicted parents. His home life alone would have been enough to explain why this child was angry and agitated! He was living in foster care at the time I met him. Unfortunately, I was only able to see the boy once in the psychiatric emergency room where I work part of each week. I eliminated one of his many prescriptions and encouraged his new caregivers to seek competent outpatient treatment for the correct diagnosis of Post-Traumatic Stress Disorder. I explained the diagnosis and the different treatments which could help him recover, and assured the foster parents that, with time, in a stable environment, and lots of reassurance from them plus psychotherapy and close monitoring of the proper medications, their new foster child had hope of recovery. In doing so, I dealt a commonsense blow to two troubling roots of the boy’s prior, ineffective treatment: a too-hasty and downright wrong diagnosis by his previous physicians, and their overloading his system with unnecessary chemicals that did not properly address his real psychiatric needs.

In another case, I evaluated a three-year old girl who had been previously diagnosed with both Bipolar Disorder and AD/HD as well. She had been raised by a drug-addicted mother who had provided little if any supervision. Instead of receiving guidance, nurturing, and discipline, this child had been pacified and indulged whenever she became belligerent or demanding, by a mother who wanted not to be bothered. There was no routine or structure in this three-year-old’s life. Every day was another day of unpredictable chaos at the hands of her drug-using mother. The girl had developed a behavior pattern of being defiant and even physically aggressive whenever she didn’t get her way. This was another situation that involved the child’s eventual removal to a more caring and attentive foster home. By educating the girl’s new parents about the legitimate and proper diagnosis of Oppositional Defiant Disorder, and its effective treatment by introduction of consistency and discipline to the child’s daily life, I was able to convince them that medications were entirely unnecessary. In this instance, no medication was prescribed; the girl’s “cure” required only good parenting.
How had this seven-year old boy been diagnosed incorrectly and given so many strong medications with serious potential for permanent physical side effects? Why is a child as young as three, who is simply defiant, being brought to a psychiatrist? A multitude of societal influences and modern medical practices has converged to create problems in the treatment of childhood mental illness. Foremost among these problems is a rush to medicate children with psychiatric drugs, a tendency by parents and doctors alike that is growing at an alarming rate.

This growing epidemic of misdiagnosing and overmedicating children needs to be urgently addressed. As a lifelong advocate for children—who themselves have no power to shape public policy, and little voice in their parents’ medical decisions—I feel compelled to appeal to parents on their children’s behalf. Should You Medicate Your Child’s Mind? is my attempt to address this unrestrained frenzy to place children on medications that may not improve their children’s well-being and might just make matters worse. Before you join the rest of the parents flocking to their doctor’s office demanding psychiatric medications for their children, read this book and decide for yourself whether a drug will truly resolve or merely mask your child’s behavioral problems.
I wrote this book not to replace appropriate psychiatric care but to help you prepare for, and then proceed from, what may be a very brief encounter with your child’s psychiatrist. With the accurate information on diagnoses and appropriate treatments in hand, the time you do get to spend with your child’s doctor will be more efficient and productive. You will be able to determine quickly if the doctor’s advice seems poorly suited to your child’s condition, as well as whether the doctor is answering your questions adequately.
When I see a patient for the first time, I start with a thorough evaluation that takes at least one and a half hours, sometimes longer. I spend a lot of time in the first few sessions answering questions about the diagnosis, explaining how I arrived at my conclusion, what the child’s prognosis is, and what treatment options exist. Unfortunately, due to the time constraints of managed care, doctors cannot usually take the time required to provide this kind of care and instruction to their patients. If you are unable to find a doctor who can spend the time necessary to bring you up to speed on your child’s condition and his treatment options, you will simply have to push for this information from the doctor that you do have. Knowing what questions to ask is half the battle. That is how Should You Medicate Your Child’s Mind? will prove invaluable to you as you seek help for your troubled youngster.
Your child may, in the end, require some form of medication, but it is my fervent hope that my advice within these pages will guide you toward making an informed choice, one that may affect your child for many years to come.
has to endure the side effects of the powerful psychotropics that treat Bipolar Disorder. Medicating an ordinary, bratty kid, based on a misdiagnosis of Bipolar Disorder is a tragedy. Sadly, a child's only advocate is the parent who lacked the courage to apply appropriate discipline.

    Parents must put the needs of their children before their own when they seek a psychiatric diagnosis for their misbehaving child. A parent's efforts to avoid an uncomfortable confrontation with their belligerent child may spare themselves a headache but they hurt their child. When it comes to providing guidance and discipline to a child, the sooner, the better. The longer a parent waits to address their misbehaving youngster, the harder the job becomes. Rushing to a psychiatrist for absolution from their parental guilt, will not always correct a child's behavior problems and puts a child at medical risk. Unfortunately, families have no idea what risks they take when stepping into a child psychiatrist's office seeking medications for their misbehaving kid.
 
    There was a time in the profession of child psychiatry when doctors insisted on hours of evaluation of a child before making a diagnosis or prescribing a medication. Today many of my colleagues in psychiatry make an initial assessment of a child and write a prescription in less than 20 minutes. Parents have reported to me that their pediatrician took only five minutes to assess and medicate. Who's the winner in this race? Parents eager to fix their child's problems, pressure doctors to provide fast relief. Unfortunately, most doctors usually reach for the one and only tool they are familiar with: medication. Medicine is what they know best, and often what the parent comes to expect from a child psychiatrist.
 
    Doctors under the pressure of practicing in the managed care environment, will spend less and less time with each patient, and rush to a quick diagnosis, with little if any explanation to the family regarding the risks of the psychiatric drugs they prescribe. Well-intentioned but hurried doctors play the biggest role and carry the greatest responsibility in this complex system that drives the current practice of overmedicating children based on a misdiagnosis of Bipolar Disorder.

  Doctors need to take the time to understand their pediatric patients better, and have the courage to deliver the bad news that sometimes a child's disruptive, aggressive and defiant behavior is due to poor parenting, not to a chemical imbalance such as Bipolar Disorder.

 
    What I hope to impart to you is the importance of a careful, honest, and thorough evaluation prior to medicating a child. Don't be overly hasty to find the solution for a troubled child in the convenience of a pill. Psychiatrists need to have the courage to withstand the pressures placed on them by guilty parents or frazzled teachers. Doctors need to put the welfare and safety of their pediatric patients ahead of the push by their managed-care contract to get the assessments done quickly. Every psychotherapeutic intervention needs to be explored and implemented before a doctor reaches for his prescription pad. If a child must be prescribed medications, proceed with caution. Correctly prescribed, for a legitimate mental illness, a psychiatric medication can enable a child to function more normally. Properly prescribed, medications have the potential to save a child's life. Casually prescribed, they can destroy it.
 
INTRODUCTION to Should You Medicate Your Child’s Mind?

Does Your Child Need Help?
Your child has a behavioral problem, one you have finally admitted to yourself may need outside help. Perhaps you have been aware of his or her difficulties for some time, or maybe they has been brought to your attention by a teacher, a similar situation affecting a child you know, or a story in the media. One thing is certain: you want the problem resolved. So the question becomes “How?” That simple word unlocks the door to many other questions:

• How can you distinguish good advice from bad?
• What environmental/social triggers may produce symptoms that mimic those of psychiatric problems?
• Does your child have a condition that may respond positively to medication?
• Should you medicate your child?
• Which medication is the right one for your child’s problem?
• What are the side effects associated with such a drug?
• Do you even want your kid to be on a medication?
• When is it more appropriate to use behavioral techniques instead of psychiatric drugs?
• How can you tell which behaviors are simply the result of willfulness or bad habits?

Complicating this already controversial subject are reports in the media about the harmful effects psychiatric medications may have upon children. In 2004, Congress held hearings to investigate the connection between antidepressants and child/adolescent suicide. In the spring of 2005, the Canadian government outlawed the sale of the very popular AD/HD drug, Adderall XR, due to the sudden cardiac deaths of twelve boys in the United States. Adderall was reinstated in Canada in the fall of 2005. Psychiatric medications are powerful tools, not to be taken casually even by adults, and yet they are increasingly prescribed by physicians and psychiatrists to children. Why is this happening, and how may this trend affect your child?

Medication-Based Solutions Are on the Rise
Are more children becoming disturbed, are diagnostic techniques improving, or is it simply a quick-fix convenience for educators, doctors, therapists, and parents alike to turn to the pharmacy to treat behaviors now deemed a “chemical imbalance” in our nation’s youth? Does this last suggestion seem exaggerated? Just consider the following:

• The Surgeon General’s 1999 report estimated that 21 percent of children ages nine through seventeen experience the signs and symptoms of a psychiatric disorder in the course of any given year.

• The Center for Disease Control reported in 2002 that almost 20 percent of the office visits (to pediatricians surveyed) were for psycho-social problems, eclipsing both asthma and heart disease.

• According to the DEA, the number of prescriptions for medications like Ritalin (an amphetamine-class drug) has risen by 500 percent since 1991.

• In 2002, an estimated 10.8 million prescriptions were dispensed for patients younger than eighteen—minors are beginning to outpace the elderly in the consumption of pharmaceuticals, according to FDA, as reported by the Wall Street Journal.

These startling figures demonstrate how many children’s problems are diagnosed as chemically based and treated with psychiatric medication. Can it be possible that so many misbehaving children are really physically ill?
Many doctors who prescribe such medications are all too aware that our society is increasingly turning to the use of medication to “fix” a child’s behavior…and yet they also understand that, thanks to the media, Internet, and other sources of advice, parents who believe that the only answer is medication, will simply go to another physician for a prescription if none is forthcoming from a doctor who refuses to write one.

Who Are the “Experts”?
Complicating your desire for the best care for your child, the medical community is split on the use of drugs to “cure” behavioral problems in children. On the one hand, numerous psychiatrists and pediatricians explain away all behavioral problems in children as psychiatric disease; in consequence, they recommend psychiatric medications for most behavior problems. On the other, many experts condemn the use of psychiatric medications in children and adolescents, instead recommending an exclusively behavioral solution. These two approaches are in complete contradiction to each other. Is there a gray area—are there doctors who take a more balanced approach, where a drug may indeed be a safe and effective partial solution, while behavior-altering methods are also applied? Complicating the issue still further, self-proclaimed nonmedical child-care authorities in the media are endlessly touting their own wonder cure for various behavioral or learning difficulties. Where can you turn, to sort through so many sources of conflicting information?
You could hold the key toward finding a solution in the book, Should You Medicate Your Child’s Mind? This book will answer your questions on how to decide whether or when psychiatric medications are right for your child, providing facts currently available to the medical community concerning the diagnosis and treatment of behavioral conditions in children and adolescents, to enable you make an informed decision about the health and happiness of your child.
Should You Medicate Your Child’s Mind? will guide you through the sea of confusing medical advice with hard facts and tough love, not an automatic reach for the prescription pad. Remember at all times that, as a parent, your goal is to have a healthy, happy child functioning to the best of his or her abilities…the goal of every parent of every child. And that this may be achievable with minimal use of medications or no drugs at all.

What You Will Not Find in This Book
Should You Medicate Your Child’s Mind? is not intended to be used as a diagnostic tool. I am not attempting to deputize you as pseudo-psychiatrists. Nothing can replace the trained eye of a competent, licensed child psychiatrist, if you want your child evaluated for treatment for a behavioral problem. If your child needs the help of a psychiatric professional, you want the best doctor you can find, not a self-proclaimed expert lacking a medical degree. Remember, too, that it is impossible for you to be objective about your own child. The best assessment and treatment plan will be obtained, with the help of your input, from an unbiased and highly trained clinician.

What You Will Find in This Book
Because of the current trend in psychiatry to overdiagnose and overmedicate children, to use the strongest and most dangerous medications available even in the youngest children, parents need a guide that explains the risks associated with seeking mental health treatment for their children. This book is intended to provide guidance through the difficult process of finding help for your child’s behavioral problems.

I hope that what readers learn here will translate to a nation of healthier, happier children. Let’s proceed!