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No Child Left Undrugged

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According to autopsy reports, 4-year-old Rebecca Riley died from an overdose of psychiatric drugs. At age 2, Rebecca was diagnosed with attention deficit hyperactivity disorder (ADHD). At 3, she was diagnosed with bipolar disorder, also known as manic depression. By the time she died on Dec. 13, 2006, little Rebecca was taking Clonidine, as well as the anti-convulsant Depakote and the anti-psychotic Seroquel.

What were some of the symptoms that prompted such treatment plans? As her mother described it, Rebecca was "constantly getting into things, running around, not being able to settle down."

Rebecca's diagnosis was not a medical aberration. Her 10-year-old brother and 4-year-old sister were already being treated for manic depression. Indeed, nearly one million children are reportedly diagnosed as bipolar, making it more common than autism and diabetes combined. From 1994 to 2003, the number of children treated for bipolar disorder increased 40 percent, a jump that many experts attribute to more doctors aggressively applying the diagnosis.

An increasing number of medical officials are voicing the concern that children are being misdiagnosed. Dr. John McClellan, who runs a children's psychiatric hospital in the state of Washington, suggested that the bipolar diagnosis has become a catch-all for aggressive and troubled children.

Likewise, child psychiatrist John Holttum believes that the definition of bipolar disorder is expanding. Whereas children who were seen as troubled or irritable 10 or 15 years ago might have been treated with counseling, parental training for their caregivers or other social interventions, children with similar symptoms today are being diagnosed as bipolar and treated with medication. Unfortunately, for many families, therapy is not even an option. According to Dr. Michael Brody, a child psychiatrist at the University of Maryland, since insurance companies often do not support therapy, most parents opt for medication.

Not surprisingly, the pharmaceutical companies are reaping the rewards, aided by the medical community and the media. Bipolar disorder medication is typically three to five times more expensive than medications prescribed for other disorders, such as depression or anxiety. As the News Tribune of Tacoma, Wash., points out, "Furthering the trend is extensive marketing of atypical anti-psychotics by the companies that make them, and media coverage of bipolar disorder as a childhood disease."

Yet many of the anti-psychotic drugs being prescribed for children have not been approved by the Food and Drug Administration for use on them. Of the two that have been approved for children, Risperdahl and Abilify, they've only been approved for short-term use. Nevertheless, as the News Tribune points out, because these drugs have been approved for adults, "doctors are free to prescribe drugs to anyone and in any way they see fit once they have been approved for some purpose."

What this means is that in addition to being misdiagnosed, there is an increased likelihood that children are also being overdrugged. Concern about this scenario has prompted Dr. Jeffrey Thompson, chief medical officer for the Washington state Medicaid program, to provide more stringent guidelines to ensure that anti-psychotic drugs are prescribed to Medicaid children only when truly needed and at proper dosages.

While Thompson's actions signal a move in the right direction, at least for minor-aged Medicaid recipients in his state, it will do little to help children in private care and in other states.

When confronted with the numbers of children being diagnosed with bipolar disorder -- about 800,000 in 2003, and likely much higher now -- it is hard to know how to respond. Could that many young people truly be suffering from this disorder? It is tempting to lay the blame on an over-zealous medical community or a greedy pharmaceutical industry. There is no doubt that they have benefited financially from the sharp rise in bipolar cases among young people.

Is it more a case of kids just being kids -- noisy, rambunctious, hyperactive, disorderly? Or is there something else going on here? Curiously, one study released in 2007 indicated that among children diagnosed with bipolar disorder, two-thirds of them were boys.

While there are undeniably cases where children are actually suffering and are helped by diagnosis and medication, I have to wonder about the majority. Little is said in the studies I have read about the impact that family life and the environment may have on the behavior of children diagnosed as bipolar, or even ADHD, yet they can't be ruled out.

Society as a whole has become irresponsible in its duty to young people. Obsessed with materialism, we have handed over our young people to marketing mavens and corporations eager to make a quick buck. Distracted by entertainment, we have relinquished our children to television babysitters, allowing them to become turned on by and tuned into mindless television programs, video games and advertising that promote violence and premarital sex, among other unhealthy behaviors. Children need human touch and love. All too often, parents give them over to others for care. They also leave them floating in the non-real world of virtual reality.

Thus, it is little wonder that so many children are out of control, disorderly and unable to settle down. But they shouldn't be victimized and punished for our neglect. Nor should they be drugged into compliance. Our children are screaming for help, but we're not listening to what they're saying. Instead, many parents are just hoping to shut them up -- whether with drugs or entertainment -- and get a little peace and quiet. But that's not the answer.

A solution will not be found by passing another law. Rather, it must start at home and in the community. When the family breaks down, everything breaks down. We need to start by re-building families. Parents need to be parents and stop over-scheduling their children. They need to start spending time with them.

Finally, parents need to say no to drugs for their children. They need to control what their children watch and listen to. And they need to take off the headphones, turn off the cell phones and try communicating with their children.