The Double-Edged Sword of Pediatric/Adolescent Mental Health

The October 2014 issue of Psychology Today magazine features two fascinating articles representing different perspectives related to pediatric and adolescent mental health. I’m always drawn to this sort of thing, so I immediately read both articles upon getting the mail that day before I even looked at the rest of the bills that were now gracing my counter top.

The first article is a memoir, written by the mother of an adolescent boy who has struggled with mental health issues for years, titled “A ‘Normal’ Day.” The second is an opinion piece, written by Allen Frances, M.D., professor emeritus and previous chair of the Diagnostic and Statistical Manual of Mental Disorders-IV task force and the department of psychiatry at Duke University School of Medicine. 1 out of 5 (4)

This article, titled, “No Child Left Undiagnosed,” delves into the diagnostic statistics for childhood disorders such as ADHD; namely, the fact that there has been a dramatic increase in the number of children diagnosed with these disorders, as well as the number of children and adolescents who are being treated with pharmaceuticals that are making drug companies billions of dollars.

Alarming statistics on the incidence of ADHD in children and adolescents

Are we in too much of a rush to diagnose children at an early age? The evidence is clear that early intervention is beneficial for children with mental health disorders, and failing to diagnose a true mental health condition in a timely manner can have disastrous consequences for an adolescent’s life.

Yet, in our efforts to ensure that diagnoses are being made early, are we introducing inaccuracy? Are we being too lax with diagnoses? Or have we educated the public too much about the possibility that their children may have these disorders, leading parents to seek easy solutions for difficult children: a simple pill can take care of the extra energy your son seems to have?

A few eye-opening statistics from “No Child Left Undiagnosed”:

  • 81% of American kids could be labeled with a mental disorder by age 21.
  • 11% of children in the U.S. have a diagnosis of ADHD.
  • 6% of children in the U.S. are on daily medication for ADHD.
  • The rate of ADHD diagnoses in the U.S. has doubled in the past 20 years.
  • Among teenage boys, 1 in 5 is diagnosed with ADHD; 1 in 10 medicated.
  • Diagnoses of developmental and childhood bipolar disorders have increased 40-fold in the past two decades.

Have we conditioned parents to seek the “easy fix”? 

I’ve known people who have pushed and pushed for a diagnosis for children as young as age two or three. Children who, at that time, I was rather certain were exhibiting perfectly normal, energetic, and full-of-life behaviors typical for that stage of development.

But push some of these parents did until they finally received the validation they had been seeking from a psychologist. There are so many diagnoses now with symptoms that overlap with normal childhood behavior, but can truly represent an underlying diagnosis when those behaviors are extreme. Parents without a background in mental health can easily read an article or two and walk away convinced that their child has ADD or ADHD. And when the solution to those tantrums and that short attention span is only as far away as the local pharmacy, we’ve created a pretty slippery slope. 

Fast-forward about a decade, and those children, who have, for the past 10 years, been shuffled in and out of numerous doctors’ offices, psychiatrists’ offices, and mental health clinics, along with dozens of meetings with school officials and counselors, have some significant difficulties in their daily lives. These kids have taken more pharmaceuticals in their short lives than many adults have by middle age. Constantly adjusting dosages, switching brands due to health insurance or side effects, and adding and removing medications from the “cocktail” has become the norm in their lives.

Wake up: these pills alter children’s brain chemistry! 

Was this failed early intervention? Or was it actually that this “early intervention” created some of the problems these children are experiencing today? Those drugs, such as Adderall and Ritalin, Xanax, and a slew of other anti-psychotics, anti-depressants, and anti-anxiety medications can wreak havoc on a patient’s brain chemistry. Neuropsychiatric roborating pills

That’s the intended effect — but how is your brain ever supposed to function ‘normally’ when it has been artificially manipulated throughout the key stages of its development? It’s as if being prescribed medication before the age of five automatically signs you up for a lifetime of stocking your own pharmacy at home.

The bottom line is that placing any child on medication should never be a decision made lightly. It’s not a matter of finding an easy solution for parenting frustrations. The first time a child is handed a pill to swallow, it can never be taken back. And it’s a pivotal moment that will shape the rest of that child’s life.

My own son had signs of ADHD around age four to five. We discussed the possibility with his pediatrician and ruled out some other possibilities like Type I Diabetes. Instead of trying medication, we switched to a gluten-free diet and still follow it today — not 100%, but most of the time when it’s feasible. It turns out he actually has a vision disorder called Convergence Insufficiency (CI), which has many overlapping symptoms with ADHD.

That’s an interesting story that I’ll share in detail in an upcoming post, but the point is we investigated all options and were willing to try other solutions before trying medications. Had I pushed for it, I could have gotten him on meds back then. Easily. Had we done so, we would have masked symptoms that were actually pointing to a different underlying disorder and ended up overlooking the CI, which would have had negative consequences for him for the rest of his life. In the end, he never had ADHD and certainly never needed medication.

I’m not anti-medication. I’m anti- medicating children as an easy fix-all when it’s truly not warranted.

Parents feel hopeless; teachers have their hands tied

On the other hand, there are children and adolescents with truly accurate diagnoses, or as in the case of the child in “A ‘Normal’ Day,” a catch-all diagnosis after years of trying to pinpoint the specific underlying cause. Many of these parents feel isolated and helpless, unsure where to turn for help or resigned to the fact that there is no “fix” to this situation.

This is an issue that resonates with many teachers who regularly encounter children in their classrooms who could benefit from mental health and social support interventions, yet their hands are tied to do anything about it. In many cases, teachers can refer students to school counselors or administration, but their involvement may end there. Originality

Some may get to participate in meetings with parents and administrators or counselors, but they have no control over whether any particular child actually receives social services. Parents can outright refuse it, and there’s little anyone can do to change that until the child ends up in the criminal justice system, which is too often the ultimate outcome. For the children who clearly need help but don’t go on to receive it, teachers are left to continue observing and coping with behavior that might be easily managed with appropriate intervention.

Then there are children like the young man in “A ‘Normal’ Day,” whose mother is desperate to get him the help that he needs, yet she’s simply exhausted all of her available options. Perhaps most disheartening is the fact that in some cases, his only chance of continued support is if he is arrested, which places him in the justice system in which some services are available for free — services most parents simply can’t afford to pay for otherwise. 

Research proves challenging

Part of the problem stems from the fact that the science behind all of this is so complex. It’s challenging to adequately control for the many variables that come into play when seeking to prove causal relationships. For instance, those children who were started on medications at age three: how do we know what the outcomes would have been had that not been the case?

Those children were subjected to many situations that wouldn’t have otherwise taken place. They’ve possibly been surrounded by other troubled children in emotional or learning support classrooms. And most importantly, they’ve been raised by a set of parents who could be influencing these behaviors in a multitude of ways, such as choosing different disciplinary actions based on their perceptions that their children have “problems.”

Some existing research points to clues that our diagnostic methodology is resulting in diagnoses that are too broad. For instance, Frances mentions a study of one million Canadian children, in which the biggest predictor of whether a child would eventually be diagnosed with ADHD was the child’s birthday.

“The youngest boy in the class was almost twice as likely as the oldest to be diagnosed. There can only be one way to interpret this result: Perfectly appropriate developmental immaturity is being mislabeled as a mental disorder and treated with unnecessary, expensive, and potentially harmful pills,” says Frances.

No clear and obvious solution 

If we are over-diagnosing our children, that’s a big problem. The other problem is that there are not enough services to support the number of children being diagnosed, not to mention the fact that both teachers and parents who try to advocate for children in need of help often hit roadblocks that leave them helpless. 

We need change, but there’s no easy answer. We can develop more pharmaceuticals. We can — and should — give parents and teachers more power to get children help and support. But we’re too worried about politics and administering more tests to equip teachers with tools they can use to actually help their students in meaningful ways that will have positive impacts throughout their lives.

Read a related article from Allen Frances, M.D. at Psychology Today online.

What’s your take on the current state of mental health diagnostics in children and adolescents? Are we over-diagnosing, or is there a true rise in the incidence of ADHD due to extraneous forces? What can be done to provide adequate support systems in our communities for children and adolescents with mental health disorders? Share your thoughts with us in the comments.

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