The New York Times has published part 3 in its series on child mental health with a look at how psychiatric drugs are being prescribed to children, and the evidence on their benefits and side-effects.
We featured the publication of the first two parts in the series on Mind Hacks. These looked at the impact of emotional and behavioural disturbance in children and the difficulties of adequately diagnosing child mental illness.
In contrast, the final part looks at the thorny issue of medicating disturbed children.
The article notes that some children are being prescribed a number of psychiatric drugs – a practice known as polypharmacy – despite limited or non-existent evidence for how effective this might be.
In fact, even the long-term effects of single drugs in children are poorly researched, with most ‘long-term’ studies lasted no more than two years.
The dilemma is that genuine long-term studies that would test for differences in adulthood after drug-treatment as a child could take 10-15 years.
This is a very long-time to wait if you’ve got a seriously mentally ill child on your hands and access to a drug which is known to help in the short-term.
Perhaps the more difficult ethical situations (as with most of mental health) do not involve the most severely distressed or impaired people.
These might be children whose behaviour is considered disruptive, who might be consistently unhappy, or who are considered not to be fulfilling their potential, but are not completely impaired in their day-to-day life.
For example, a medication such as the amphetamine-like drug methylphenidate (Ritalin) might genuinely improve school performance in these cases.
If the drug helps, is this a mental disorder? Either way, if the drug helps, should it be prescribed?
Teachers might have an interest in having medicated (and therefore better behaved) children in their classroom to maximise learning for everyone in the class.
Parents might want their child to make full use of their educational opportunities, even if that means taking a drug.
Child psychiatry is necessarily family and school-oriented, so it would take a brave doctor to refuse to prescribe when both school and parents are united in their opinion, even if they might only be focused on the desired change in the child’s behaviour, and not considering any other impact these drugs might have.
Furthermore, considering that childhood mental disorders can be triggered or made worse by inadequate social and emotional care, some worry that these drugs are being used to pacify children without addressing what might be the root cause of the problem in the family.
As the other articles in the series have done, this article combines both the experiences of families living with these difficulties and dilemmas, and includes comments from researchers and clinicians dealing with the problems from a professional standpoint.
Link to article ‘Proof Is Scant on Psychiatric Drug Mix for Young’.